When the bottom dropped out of the LASIK market a few years ago, were you maybe just a little bit relieved? It’s OK to admit it. At first blush, refractive surgery seems antithetical to optometric practice. If optometrists derive a good portion of their practice revenue by providing corrective lenses, and along comes a surgery that obviates the need for that service, it’s easy to have mixed emotions. If your desire to give patients the best care possible is ever at odds with what’s best for your practice, someone loses out.

Tread carefully here: Should patients sense a reticence on your part to discuss refractive surgery, that will color their impressions of you and the care you provide. As Richard Mangan, O.D., points out in this month’s cover story, just about 10% of optometrists actively tout the benefits of refractive surgery to their patients. Maybe the other 90% of O.D.s genuinely believe that an expensive surgery just doesn’t stack up all that well against safe, affordable, non-permanent corrective lenses. Or maybe there are ulterior motives for keeping mum about laser vision correction.

It doesn’t have to be that way. Better to embrace refractive surgery than—excuse the pun—turn a blind eye. Making it an integral part of your practice gives you a serious measure of control over its impact. You choose the best candidates for it, based on their visual demands and psychological make-up. You choose the surgeon who’ll perform the surgery, rather than letting patients be lured in by advertising messages. You provide the follow-up care that ensures success and keeps the patient in your practice. And you get the referrals of friends and family from a happy LASIK patient’s pool of acquaintances.

In other words, as Michael Corleone says in The Godfather Part II, “Keep your friends close, but your enemies closer.”

Refractive surgery and its practitioners need not be enemies of optometrists. We aren’t heading toward a future where refractive error is permanently eliminated as a matter of routine. (Ever notice how hardly anyone in sci-fi movies wears glasses? Not gonna happen.)

LASIK will remain an attractive option for a subset of people with the means, and the chutzpah, to undergo elective surgery on their eyes to replace the eminently serviceable option of corrective lenses. But the reality is that plenty of people will continue to prefer glasses or contacts for reasons of fashion, safety, cost savings, or all three. Either way, they deserve to hear about all their corrective options from the doctor entrusted with their vision.

In fact, it’s fair to say that you hold the future of the market in your hands. 

In the late 1990s, the gee-whiz novelty of LASIK’s debut—which had the good fortune of coinciding with an era of, well, good fortunes—led to an early surge in interest and surgical volume. Ophthalmologists traded on the public’s fascination (a cynic might call it gullibility) with the cachet of high-tech laser surgery. Nowadays, with the economy on life support and refractive surgery off the cultural radar, the procedure will require a good deal of in-office education and awareness if it’s to be undertaken. And because most routine eye care is provided by optometrists, O.D.s call the shots now.

Ironically, the outcomes of LASIK have never been better, with a good many patients achieving 20/16 (some even 20/12) postop acuity. If you want to give surgical candidates the clearest vision possible, you need to be a bit of a visionary yourself.