How to Broach the Subject of SMILE, LASIK, and PRK Options to Refractive Surgery Patients

By With Michael Cooper, OD; Mark Schaffer, OD; Justin Schweitzer, OD; and Gina Wesley, OD, MS

Justin Schweitzer, OD

Sioux Falls, S.D.
Vance Thompson Vision

Patients seeking refractive surgery have more options now than ever before. I believe strongly that a discussion should be had regarding LASIK, PRK, and SMILE for all patients who are candidates for refractive surgery. I like to discuss the advantages of each and allow the patient to ask questions so that we can mutually decide which procedure best fits his or her needs. Patients appreciate knowing all their options, and, at times, none of the three is what they are looking for.


Mark Schaeffer, OD

Birmingham, Ala.
Schaeffer Eye Center

When patients are in for their exam and ask about refractive surgery, I ask friendly questions about their motivations and postsurgical expectations. With different types of procedures and various visual demands, we can’t have a one-size-fits-all approach. By guiding the conversation, the entire team can address patients’ questions from initial interest through procedure completion. When educating the patient, we discuss all options available and the reason we ultimately chose the route we are recommending. When we can tailor our preference for one intervention over another to a specific concern, the patient understands that we all want the best outcome for vision and safety.


Gina Wesley, OD, MS

Medina, Minn.
Complete Eye Care

When patients start inquiring about refractive surgery, or when I have proactively inquired as to their interest in pursuing it, I first go through my initial assessment of their candidacy, no matter what type of surgery they may receive. The risks and benefits, as well as my own observed clinical outcomes for both the short and long term, are also overviewed. Specific surgical procedures may be discussed depending on patient questions or my assessment. Ultimately, I place trust in the surgeons to whom I refer to recommend the procedure that best fits each patient, and that is the final message I communicate.


Michael Cooper, OD

Willimantic, Conn.
Windham Eye Group

Even as our patients are becoming more informed by internet research, they still implicitly trust us with their vision and rely upon us to assist in making difficult decisions. I take this responsibility seriously by devising a chief strategy. I elicit the patient’s goals and activities, as these tend to be their motivation in ascertaining our feedback. I give a brief overview of the different options available with my interactive wallboard, always reminding the patient that the ultimate decision is a shared one between patient and surgeon. Additionally, our office sends the patient a cataract welcome kit to support what was mentioned during the exam. From my perspective, when I make my best effort to set the table prior to referral, my skilled surgical colleagues can have an efficiently guided discussion to further enhance the experience.