Patient-centered care remains the foundation of successful cataract and refractive surgery, even as rising surgical volumes and shifting practice models push toward greater delegation of preoperative and postoperative responsibilities. The real challenge is balancing efficiency gained by utilizing physician extenders—optometrists, physician assistants, and clinical staff—with the imperative for a highly personalized, comprehensive preoperative evaluation that stacks the cards in the surgeon and patient’s deck for a good outcome and a 20/happy patient.
Preoperative assessment is far from a routine step; it requires a nuanced, detective-like approach to uncover subtleties that are critical for getting across the finish line. This includes an in-depth discussion about the patient’s visual history, daily eye use, prior refractive surgeries such as LASIK or radial keratotomy, hobbies, lifestyle needs, and how they use glasses and contacts in their daily lives. Additionally, identifying subclinical epithelial basement membrane dystrophy, ocular surface disease, or early macular changes requires clinical acumen beyond what is easily delegated.
Advanced imaging—OCT, corneal topography, epithelial mapping—provides vital objective data but must be interpreted holistically. For example, recognizing subtle epithelial irregularities or guttata can influence lens choice or prompt preoperative treatment to optimize results. Equally crucial is managing expectations and assessing personality traits, particularly when weighing trade-offs such as the risk of nighttime glare or dysphotopsias against the desire for spectacle independence.
Complex cases are increasingly common, including patients who have previously undergone RK or LASIK, those with prior monovision in contacts, or individuals highly sensitive to glare with minimal cataracts present unique challenges that necessitate direct surgeon involvement in preoperative planning and counseling. By contrast, straightforward cataract patients with stable ocular comorbidities such as advanced glaucoma or macular degeneration may be appropriately managed by well-trained extenders. The key lies in efficient triage by the entire clinical team—from front desk through counselors and technicians—to ensure patients receive the appropriate level of surgeon engagement.
Patient-centered care in cataract and refractive surgery requires a multidisciplinary team approach that preserves the surgeon’s critical role as clinical detective and counselor. This balance enables surgeons to provide not only technically excellent surgery but also a carefully personalized plan and clear communication—essential elements to achieving the best outcomes and patient satisfaction. As much as we may want to spend more time in the operating room and less in clinic, there is no shortcut to surgical volume and practice growth. One patient at a time with good decision-making and surgical execution is the clearest and safest path.
