The worrying finding is that his prescription keeps changing. A refractive condition that is unstable over time is a listed contraindication to refractive surgery. Contraindication means a reason not to operate. The laser reshapes the cornea to match the measurement taken before surgery. If the eye is still changing, the correction is right today and wrong next year. A 1 diopter shift each year is a clear signal of that. A diopter is the unit used to measure the strength of a lens.
Other chart findings also rule people out, and it helps to group them. Eye disease that is not controlled comes first, including blepharitis, dry eye, cataract, and uncontrolled glaucoma. Next come corneal shape problems. Keratoconus, a thinning and bulging of the cornea, gives erratic results and is avoided. Then come whole-body problems that slow healing. Examples are being immunosuppressed, taking long-term corticosteroids, or having an autoimmune connective tissue disease such as rheumatoid arthritis or lupus. One more is easy to miss. A contact lens can warp the cornea, so warpage must clear before the measurements are taken. Wanting fewer glasses is a normal reason to ask about surgery, and understanding the risks makes a patient a better candidate, not a worse one.
Flag a moving prescription for the surgeon, because only the ophthalmologist decides who is a candidate and discusses expected results. Screening refractive surgery patients falls in the COA content area on surgical assisting.
Incorrect Answers
- B. Contact lens intolerance is an indication, not a barrier. It is one of the common reasons patients seek this surgery.
- C. Occupational and safety goals are accepted reasons to consider surgery, along with cosmetic and recreational ones.
- D. Knowing the risks, benefits, and alternatives is exactly what a good candidate should be able to do.
Testing Pearls
- An unstable refraction is a contraindication to laser vision correction.
- Uncontrolled dry eye, blepharitis, cataract, or glaucoma usually rules surgery out.
- Keratoconus and other corneal thinning give unpredictable results.
- Let contact lens warpage resolve before taking preoperative measurements.
- Only the ophthalmologist discusses expected outcomes and unrealistic hopes.
References
- American Academy of Ophthalmology. Ophthalmic Medical Assisting: An Independent Study Course. Chapter 18, Refractive Surgery Concepts and Procedures.
