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    What's the difference between LASIK enhancement and refinement?


    Understanding the difference between a LASIK enhancement and a refinement in the age of customized wavefront technology will go a long way toward patient satisfaction and modifying the public perception of LASIK, according to Roy Scott Rubinfeld, MD, who spoke during the AAO's refractive surgery subspecialty day meeting.

    Although some LASIK surgery cases may fall into a "gray zone," it is important to provide some guidelines to differentiate these two terms for the patient and the physician, noted Dr. Rubinfeld.

    Essentially, an enhancement can be defined as an aspect of the original refractive procedure, and as part of the global fee structure, there should be no additional charge to the patient. For this enhancement, the physician may use conventional or new technology, he continued.

    One such example is a patient with high myopia who has been corrected to ­2 D and has a stable refraction. "To get this patient where he wants to go, conventional technology will work," Dr. Rubinfeld said. "And in a global fee structure, there should be no charge for that."

    In the case of a refinement, the patient understands that new technology is now available or the patient has now elected to use new technology for a quality "upgrade." Both the patient and the physician understand this and the patient expects an additional charge.

    Dr. Rubinfeld offered the example of a weekend golfer who wants to improve his golf game and underwent LASIK 3 years earlier. His uncorrected visual acuity is 20/30.

    Not ever patient case will be so clear cut, Dr. Rubinfeld said. To ease this burden, he suggested providing patients with informed consent in the form of patient education materials and of course, one-on-one communication.

    "It is the physicians' responsibility to listen carefully to patients and make decisions on a case-by-case basis," he said. "Incorporating custom enhancement and refinements will require us to rely on our flexibility, our sense of medical ethics, our professionalism, and fairness."