Better Vision Takes a Team: Special Live Episode at CRSF
Wise EYES Guys Podcast — Episode 5
What does it take to help someone choose the right vision correction? For the Wise EYES Guys, it starts with listening to the patient and keeping their eye care team in the conversation.
In this special live episode of Wise EYES Guys, Dr. Andrew Holzman, Dr. Jonathan Solomon, and Dr. Sonny Goel welcome Dr. Bruce Rivers and an audience of eye care professionals at the Capitol Refractive Surgery Forum (CRSF). They discuss how optometrists and ophthalmologists work together, what shapes a recommendation for LASIK, SMILE, or refractive lens exchange, and why two people with 20/20 vision can describe very different experiences.
In This Episode
The Wise EYES Guys and Dr. Bruce Rivers discuss:
- How optometrists and ophthalmologists collaborate from the first conversation through follow-up care
- How listening and explaining risks and benefits can help patients work through fear of eye surgery
- Where LASIK, SMILE, refractive lens exchange, cataract surgery, glasses, and contacts fit into the conversation
- Why eye health, daily activities, and expectations matter when evaluating surgical options
- What 20/20 vision tells you and why glare or halos can still affect how you see
- How surgeons think about multifocal, extended-depth-of-focus, and Light Adjustable Lenses
- What a coordinated handoff looks like after surgery
- Which lens options the doctors would consider for their own eyes
How Optometrists and Ophthalmologists Work Together
An optometrist may be the first person a patient asks about reducing their reliance on glasses or contacts. That conversation gives the patient a chance to describe what is bothering them, ask about options, and decide whether they want a surgical evaluation. The refractive surgeon can build on that conversation by explaining what the exam shows and how the findings affect the choices available.
Dr. Rivers recalls working alongside optometrists during his time in the military. The panel also talks about collaboration among surgeons and the value of knowing which colleague to call when a patient asks about a particular technology or approach. Those relationships help the doctors guide patients toward the expertise they need.
Understanding Your Vision Correction Options
The doctors discuss LASIK and SMILE alongside refractive lens exchange (RLE) and cataract surgery with lens implants. LASIK and SMILE are corneal procedures. RLE and cataract surgery involve replacing the eye's natural lens, and the panel explains how the reasons for considering each procedure can differ. Someone exploring elective RLE may come in hoping to rely less on glasses, while someone with a cataract may be seeking treatment for vision affected by a cloudy lens.
The forum's discussion also makes room for glasses, contact lenses, and the decision to continue with a patient's current correction. The doctors describe how a consultation can give patients time to understand the risks, benefits, and tradeoffs before deciding how to proceed.
Why the Right Procedure Depends on the Patient
The panel describes starting with the problem the patient wants to solve. A person who spends much of the day at a computer may put a premium on intermediate vision. Someone who drives frequently at night may have more questions about glare and halos. Knowing what the patient needs to see clearly helps the team explain what each option could mean in daily life.
The exam can also bring another concern into focus. The doctors use dry eye as an example of something worth identifying and addressing during an evaluation. The patient can leave with a clearer understanding of their eye health whether they pursue surgery or continue with glasses or contacts.
What Does 20/20 Vision Really Tell You?
Reading the 20/20 line on an eye chart measures how well a person resolves detail under the conditions of that test. The panel discusses why someone who reads that line may still notice glare or halos in low light. Those experiences help explain why surgeons ask how patients see in everyday situations as well as checking their visual acuity.
The doctors also talk about higher-order aberrations, optical irregularities that can affect image quality. They describe using diagnostic measurements to help distinguish irregularities associated with the cornea from those associated with the eye's natural lens. That distinction can inform which procedures the surgeon discusses with the patient.
Comparing Lens Implant Options
The panel discusses multifocal and trifocal lenses, extended-depth-of-focus (EDOF) lenses, and the Light Adjustable Lens. Much of the discussion centers on how patients weigh near, intermediate, and distance vision alongside their concerns about glare and halos. The doctors also describe the appeal of adjusting a Light Adjustable Lens after implantation.
Several panelists share examples of pairing an EDOF lens in the dominant eye with a trifocal in the other eye. They explain what they hope to achieve with that pairing and how eye dominance and the patient's priorities inform their choices. These examples reflect the surgeons' experiences with individual patients.
Why Patient Expectations Matter Before Surgery
The doctors discuss asking patients what they hope to do more comfortably after surgery and how they would feel about possible visual tradeoffs. Reading up close, working at a screen, and seeing comfortably at night can carry different weight for different people. Talking through those priorities before choosing a lens gives the patient and surgeon a shared picture of the desired outcome.
The panel also considers when a contact lens trial can help a patient explore a proposed approach. They describe situations where a trial may be easier to use before RLE and why a cataract can make that kind of preview harder to interpret.
What Coordinated Follow-Up Looks Like
With an audience of eye care professionals in the room, the hosts ask what makes it easier for optometrists and surgeons to share postoperative care. The discussion turns to the handoff after surgery and the importance of both clinicians understanding the plan for follow-up.
The panel invites optometrists to see the full experience at a surgical practice, from the patient's arrival through the procedure and postoperative visits. Seeing that sequence firsthand gives the referring clinician more context for preparing patients and continuing their care after surgery.
What Would the Doctors Choose for Their Own Eyes?
Dr. Rivers says he would lean toward combining an EDOF lens with a trifocal. He points to his strong right-eye dominance and how much he thinks he would notice halos. Dr. Holzman says he would lean toward a Light Adjustable Lens and prioritize distance and intermediate vision.
The panel closes with a show of hands from the live audience. Some attendees would consider a multifocal or EDOF lens in at least one eye, and others would consider a Light Adjustable Lens. The answers bring the discussion back to the same question the doctors ask their patients about which aspects of vision matter most to them.
Meet the Wise EYES Guys and Their Guest
Dr. Andrew Holzman, Dr. Jonathan Solomon, and Dr. Sonny Goel are ophthalmologists and co-hosts of the Wise EYES Guys podcast.
Dr. Bruce Rivers joins the panel to share his experience working with optometrists in military practice and his perspective on referrals, patient selection, and lens implants.
Explore Your Vision Correction Options
If you're considering vision correction, bring your questions and tell us what you'd like to see more comfortably in daily life. At a Holzman Laser Vision consultation, you can discuss your eye health, your vision goals, and the options that may fit both.
