title: Role of the treating surgeon in the consent process for elective refractive surgery.
abstract: OBJECTIVE
  To compare patient's perception of consent quality, clinical and quality-of-life outcomes after laser vision correction (LVC) and refractive lens exchange (RLE) between patients who met their treating surgeon prior to the day of surgery (PDOS) or on the day of surgery (DOS).
  
  
  METHODS
  Retrospective, comparative case series.
  
  
  METHODS
  Optical Express, Glasgow, UK.
  
  
  METHODS
  Patients treated between October 2015 and June 2016 (3972 LVC and 979 RLE patients) who attended 1-day and 1-month postoperative aftercare and answered a questionnaire were included in this study. All patients had a thorough preoperative discussion with an optometrist, watched a video consent, and were provided with written information. Patients then had a verbal discussion with their treating surgeon either PDOS or on the DOS, according to patient preference. Preoperative and 1-month postoperative visual acuity, refraction, preoperative, 1-day and 1-month postoperative questionnaire were compared between DOS and PDOS patients. Multivariate regression model was developed to find factors associated with patient's perception of consent quality.
  
  
  RESULTS
  Preoperatively, 8.0% of LVC and 17.1% of RLE patients elected to meet their surgeon ahead of the surgery day. In the LVC group, 97.5% of DOS and 97.2% of PDOS patients indicated they were properly consented for surgery (P=0.77). In the RLE group, 97.0% of DOS and 97.0% of PDOS patients stated their consent process for surgery was adequate (P=0.98). There was no statistically significant difference between DOS and PDOS patients in most of the postoperative clinical or questionnaire outcomes. Factors predictive of patient's satisfaction with consent quality were postoperative satisfaction with vision (46.7% of explained variance), difficulties with night driving, close-up vision or outdoor/sports activities (25.4%), visual phenomena (12.2%), dry eyes (7.5%), and patient's satisfaction with surgeon's care (8.2%).
  
  
  CONCLUSIONS
  Perception of quality of consent was comparable between patients that elected to meet the surgeon PDOS, and those who did not.
authors.affiliation: Department of Ophthalmology, University of California, San Francisco, San Francisco; Roski Eye Institute, University of Southern California, Los Angeles, CA, USA; Optical Express, Glasgow, UK.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Schallhorn
authors.affiliation: Optical Express, Glasgow, UK.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Hannan
authors.affiliation: Optical Express, Glasgow, UK.
authors.forename: David
authors.initials: D
authors.lastname: Teenan
authors.affiliation: Department of Ophthalmology, University of California, San Francisco, San Francisco.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Schallhorn
keywords: consent process; laser vision correction; quality of life outcomes; refractive lens exchange; refractive surgery