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One of the greatest challenges in telemedicine is that, while it is useful for providing guidance and addressing many questions, the final decision to proceed with surgery should never be made solely via a video call.
Modern ophthalmic surgery requires a vast amount of anatomical and functional information about the eye. In many cases, the success of a surgery depends more on thorough preoperative planning than on the surgical procedure itself.
For this reason, for both domestic and international patients—whether they are seeking a second opinion or planning to travel to Mexico City for surgery—we dedicate a significant portion of the process to a personalized preoperative assessment.
Our goal is clear:
To provide the right surgery, to the right patient, at the right time.
Patients with Corneal Diseases
Patients with corneal diseases represent arguably the most complex group in the entire field of ophthalmology.
Conditions such as keratoconus, post-LASIK ectasia, corneal dystrophies, scarring, opacities, previous transplants, recurrent pterygium, or inflammatory diseases require an extremely detailed evaluation.
For these patients, no diagnostic test should be spared; often, a minor finding can completely alter the diagnosis, the stage of the disease, or even the recommended treatment.
Depending on the specific case, the following tests may be necessary:
Corneal topography.
Corneal tomography (using systems such as Pentacam).
Anterior segment OCT.
Macular OCT.
Optic nerve (papilla) OCT.
Specular microscopy.
Pachymetry.
Aberrometry.
Clinical photography.
Tear film analysis.
Evaluation of the Meibomian glands.
Visual field testing.
Each of these provides distinct information.
While not every patient requires every test, in complex cases, it is often advisable to perform several of them to gain a comprehensive understanding of the condition.
Although this entails an additional investment prior to surgery, it typically leads to a much more precise diagnosis, better treatment selection, and far more realistic expectations.
Accurate Staging of the Disease
One of the primary objectives of these assessments is to determine the exact stage of the disease.
For instance, a case of keratoconus might require:
Observation only
Corneal cross-linking
Specialized contact lenses
Intracorneal ring segments
Customized refractive surgery
A Corneal transplant
The approach depends entirely on the stage of the disease.
Accurate staging ensures that the most appropriate treatment can be offered and allows for a more precise explanation of the expected visual prognosis.
Patients Interested in Refractive Surgery
When a patient from another country inquires about refractive surgery, certain information is essential.
Ideally, we require the following:
Age.
Current prescription.
Ophthalmological history.
Previous surgeries.
A recent corneal topography or tomography.
Ideally, the topography should be less than three months old.
If a patient has an older topography, they may still submit it, as it can provide useful information. However, the more recent the scan, the greater our confidence in beginning the planning process.
In many cases, this information allows for a fairly accurate preliminary assessment before the patient travels.
The Importance of Age and Presbyopia
For patients between the ages of 40 and 50—and especially those over 50—a significant portion of the consultation is dedicated to explaining the limitations associated with presbyopia (age-related loss of near vision).
It is crucial to understand that refractive surgery to correct myopia (nearsightedness), hyperopia (farsightedness), or astigmatism does not halt the natural aging process of the eye's crystalline lens. Over time, the ability to focus on near objects gradually declines; therefore, the surgical strategy must be adapted to this changing visual reality.
Depending on the patient’s age, prescription, lifestyle, and visual needs, it may be advisable to consider various alternatives, such as:
Monovision
Phakic intraocular lenses (ICLs)
Phakorefractive surgery
Other customized techniques, tailored to the specific characteristics of each case.
In cases where monovision is being considered, we strongly recommend conducting a preliminary in-office trial to determine whether the patient adapts well to this visual strategy. Ideally, this simulation should be performed using a phoropter, trial frames, or—most preferably—contact lenses, as these provide the most accurate representation of the expected post-surgical outcome.
This trial is particularly important because, while many individuals adapt very well to monovision and achieve significant independence from glasses, others may experience a slight reduction in depth perception (stereopsis) or simply feel uncomfortable with the difference in prescription between their two eyes.
Therefore, the optimal treatment approach depends not only on the patient’s prescription but also on their age, the condition of their crystalline lens, their daily activities, their visual expectations, and, above all, how they respond to these preoperative tests. Personalized planning is the key to achieving a satisfactory and long-lasting outcome.
Candidates for Phakorefractive Surgery
Phakorefractive surgery requires even more meticulous planning.
Before recommending an intraocular lens (IOL), we must confirm that the eye meets the necessary anatomical criteria.
This may involve assessments such as:
Biometry.
Macular OCT.
Optic nerve OCT (when indicated).
Corneal topography.
Corneal endothelial analysis.
Pachymetry.
Fundus examination.
Peripheral retinal evaluation.
Repeated intraocular lens power calculations using various formulas.
The choice between a monofocal, toric, EDOF (extended depth of focus), or multifocal lens depends on all of this information, rather than solely on the patient’s prescription.
Consequently, the final decision is always made during an in-person consultation.
In-Person Examination Remains Essential
Although telemedicine greatly facilitates the initial contact, a definitive recommendation for surgery can only be established following a comprehensive ophthalmological examination.
During an in-person consultation, we evaluate aspects that cannot be assessed via video call, such as:
Corneal transparency
Tear film quality
Refractive stability
Intraocular pressure
Slit-lamp examination
Fundus (back of the eye) examination
Lens condition
Pupillary dilation
Optic nerve health
These findings may lead to significant changes in the initial surgical plan.
Is it possible to have surgery on the same day as the consultation?
For most refractive surgery patients, we do not recommend this.
The primary reason is that a comprehensive evaluation usually requires pupil dilation to properly examine the back of the eye (the fundus).
Following dilation:
Vision remains blurred for several hours
Your prescription may be temporarily altered
Driving becomes uncomfortable
Certain diagnostic tests may need to be repeated before the surgery.
Therefore, it is generally preferable to have the consultation first and then schedule the surgery for a later date.
For international patients, we can help coordinate the schedule to minimize the length of your stay in Mexico City, while always prioritizing safety and the quality of the outcome.
A process designed to achieve the best possible result
Surgery is only one part of the overall treatment.
A thorough medical history, a meticulous examination, high-quality diagnostic testing, and personalized planning are often the factors that most influence the final outcome.
Our philosophy is simple:
We do not aim to perform surgery as quickly as possible; rather, we aim to perform it under the best possible conditions.
This approach is especially important for international patients and complex cases, where every decision must be supported by an accurate diagnosis and an individualized plan.
Because an excellent surgical outcome begins long before you enter the operating room.
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