Standards for laser refractive surgery

The Royal College of Ophthalmology had asked the BSRS membership to endorse a document on standards1 so a discussion session was included in the society's May conference with the aim of considering the standards and voting on whether or not to endorse them. The standards are designed to set out best practice but are not regulations, rather they are intended to advise and assist members of the RCO. Already some opponents have criticised it for being too stringent and unrealistic, whereas others feel the document does not go far enough. In general, the document was seen by the BSRS membership as a positive step that would help to improve refractive surgery standards in the UK. There were some concerns raised about the strength of statement 3d regarding the serious implications of an infection following bilateral simultaneous surgery, since the majority of UK surgeons perform bilateral Lasik in preference to two monocular procedures as it is much preferred by patients. Paragraph 4d also caused some controversy in its original form, which suggested that the patient should have a meeting with the surgeon performing the procedure prior to the day of surgery. The revised version now states that all patients should have a consultation with a refractive surgeon prior to the day of surgery, something that does not happen in all clinics. It is of course advisable for the patient to meet the operating surgeon in advance and they should be encouraged to select a particular surgeon based on his/her reputation and personal results. Occasionally, patients have been known to feel ill at ease with their surgeon having met them only half and hour or so before the procedure, but gone ahead anyway because they are too embarrassed to pull out at the last minute.