Surprising qualitative research out of Flinders University, suggesting patients prefer refractive laser surgery over spectacles for vision correction and want “eye care practitioners to have a broader perspective and present more options” has not been embraced by optometrists.
The researchers found that many patients were unhappy being prescribed spectacles and claimed it affected their quality of life.
The study authors, Flinders research associate Dr. Jyoti Khadka and PhD candidate Himal Kandel, said the passionate responses of patients raising significant quality of life issues came as a surprise.
“Patients want eye care practitioners to have a broader perspective and present more options that will offer better quality of life outcomes,” said Dr. Khadka, pointing to a raft of patient issues with wearing glasses and contact lenses, and to patients who voiced a clear preference for refractive laser surgery.
I question who the researchers were asking
The researchers found that patients believe laser surgery is more crucial than a cosmetic surgical option, with some calling it a “life changing solution”, especially for people needing glasses during activities from work requirements to sporting endeavours. Mr. Kandel suggested the finding could be a first step towards optical laser surgery being reclassified and recognised for Medicare rebate.
The optometrists mivision spoke to had reservations about more widely recommending laser corrective surgery.
“The Flinders University study may state that patients prefer laser corrective surgery compared to wearing glasses, but it does not account for complications or risks associated with the surgery,” said Josh Clark from EyeQ Optometrists in Berowra, NSW. “Many patients experience dry eyes, halos and glare for years following laser-corrective surgery.
“It is also a dangerous idea to put in patients’ heads that laser-corrective surgery will replace glasses as it’s not an effective treatment for myopia progression. I would think again before routinely offering laser corrective surgery over glasses to my (progressing) myopes! Why not offer orthokeratology or soft contact lenses to these patients?”
Margaret Lam from George and Matilda acknowledged that optometrists in Australia default to prescribing glasses in preference to other prescribing options more than other countries, however she said the idea of prescribing laser correction for all patients over-simplifies things. “The study findings are certainly relevant for us in understanding the impact on vision correction on our patients’ quality of life. To suggest prescribing refractive surgery for all patients without due consideration of their individual circumstances is a step too far, and one that over-simplifies things. There are other less invasive options, such as contact lenses, which can minimise the detrimental quality of life this study highlights.”
Thao Hannaford from Bowral, NSW said offering patients advice to meet their specific needs was most important. “There are many ways we can correct refractive error and they will have their pros and cons: spectacles; contact lenses; orthokeratology; laser surgery and its various types; and clear lens extraction.
“I question who the researchers were asking and where those participants went for their eye care needs… depending on the model of optometry practice, some are geared towards pumping out spectacles and others provide the complete service.
“I like to think I offer the latter and personally I offer my patient the best solution/s to meet their life needs. More often than not, it can be a few solutions.”
Optometrist Jessica Chi said laser is not for everyone. “The idea of being spectacle free is very appealing people who are dependent on refractive correction. I am a myope, and for the most part I manage well with my contact lenses (and sometimes spectacles). However, there are times when they bother me. I am fully aware of how debilitated I would be without them… If I could wave a magic wand and be an emmetrope I would. But would I go and slice and dice every cornea to make this happen? Refractive surgery has been shown to very safe in the appropriate candidate. However let’s not forget that refractive surgery is surgery, and should be proceeded to with caution,” said Ms. Chi.
Medicare Rebate Not Warranted
Ms. Lam did not support the suggestion that optical laser surgery could be reclassified and recognised for Medicare rebate. “A Medicare rebate that encourages all patients to undertake an elective surgery with potential risks and adverse effects is a step too far.”
Ms. Hannaford supported her, “If the aim of this paper is to allow laser to fall under Medicare benefits, then why shouldn’t other methods of refractive error correction be included as well?,” she said.
The results of the qualitative study – “Impact of refractive error on quality of life” – were published as the lead feature in the September/October issue of Clinical and Experimental Ophthalmology, the official journal of the Royal Australian and New Zealand College of Ophthalmologists. The journal also published an editorial on the findings, underlining its significance to eye care professionals.
Dr. Khadka and Mr. Kandel’s research has been selected for Continued Professional Development, with their quantitative studies expected to be completed in six months.
