Success in refractive surgery requires equal parts clinical insight and setting and managing appropriate patient expectations. Preoperative expectations predict satisfaction following refractive surgical procedures, and managing these expectations is essential to achieving a successful refractive surgical experience for both the surgeon and the patient. In this review, we describe our approach to managing expectations for laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and phakic intraocular lenses (PIOLs). We provide an overview of patient selection, preoperative patient counseling, postoperative visual acuity and refractive results, and refractive stability. We discuss the large published reviews comparing outcomes of surgical procedures pitted against one another as well as postoperative issues, including night vision complaints, contrast sensitivity, and surgical complications. Finally, we comment on overall patient satisfaction following these life-altering surgical procedures.
' Patient and Procedure SelectionThe clear goal of any refractive surgical procedure is spectacle independence, and the first step in reaching this goal is to determine which techniques are appropriate to treat the individual patient. The decision must be based on the patient's refractive error and the findings of a full ophthalmic history and examination. Then, based on patient age, profession, and hobbies (visual needs), the surgeon and patient should collaboratively and objectively set visual goals for refractive surgery.