When Not to Operate in Ophthalmology: The Importance of Saying No

In my daily practice as an ophthalmologist, it is very common to meet patients who come to consultation with a clear idea: they want surgery.

In refractive surgery, this is especially frequent in patients with myopia, hyperopia, or astigmatism who wish to become independent from glasses or contact lenses. That motivation is understandable and legitimate.

However, operating is not always the right decision.

Surgery as a Balance Between Benefit and Risk

I have always understood surgery as a balance between benefit and risk.

Every surgical procedure involves risk, even if minimal. This is unavoidable and part of medicine.

My personal criterion is very clear: when the benefit does not clearly outweigh the risk, I do not operate.

Even when the balance is equal — when there is a real minimal risk but the benefit is uncertain — I consider that this risk is not acceptable.

There is no valid argument that should stand above this principle.

The Role of the Patient and the Role of the Doctor

Ophthalmic surgery is ultimately a decision made by the patient.

The patient comes requesting a solution, with expectations and a clear goal. That is entirely respectable.

However, that request requires something essential: a rigorous, honest, and realistic medical evaluation.

My responsibility as a doctor is not to say yes to a request, but to assess whether a treatment can offer a good outcome without putting vision at risk. And that is not always possible.

Saying No Is Also Medicine

Telling a patient that they are not a suitable candidate for surgery is not easy.

In fact, for many doctors, it is much harder to say no than to say yes.

Saying yes is often more comfortable. Saying no requires judgment, experience, and the ability to face a difficult conversation.

But I firmly believe that true medical excellence lies precisely there: in knowing when surgery does not provide a clear benefit and in protecting the patient, even from their own desire to undergo surgery.

My Commitment

For this reason, when I recommend not operating, I do so with the same conviction as when I indicate surgery in appropriate cases.

Not because it is not technically possible, but because I do not consider it medically correct.

In ophthalmology, knowing when to say no is not a refusal. It is a profound form of respect for the patient’s vision.

Wondering whether you’re a candidate for eye surgery? A thorough, honest assessment is the safest first step.