Eyeworld

I n refractive surgery, achieving 20/20 vision has long been treated as the finish line. But experienced surgeons know that a perfect Snellen score doesn't always trans- late into a satisfied patient—and dissatisfied patients can mean longer chair time, misaligned expectations, and lost trust. Audrey Rostov, MD, believes the true measure of success is something less quantifiable, but far more mean- ingful: a 20/happy outcome. "If somebody is happy with their vision, they're pleased with their outcome. They can do what they like to do and need to do," Dr. Rostov said. "That's really what matters." The 20/20 disconnect Snellen acuity is objective, familiar, and easy to track, which is why it has become the dominant benchmark in refractive surgery. Training, peer comparison, and outcome reporting all reinforce its importance. But numbers alone can create a false sense of completeness. Patients rarely describe their vision in fractions. They describe how they feel and what they can do: "I can drive at night again." "I don't think about my contacts anymore." "I wish I'd done this sooner." These are the outcomes that define success in the patient's mind. This disconnect between clinical metrics and lived experience is where frustration begins—for both patient and surgeon. Reaching a 20/happy outcome begins with patient counseling. Surgeons and patients must share a realistic un- derstanding of that individual's best visual potential. Some patients may have pathology that does not preclude refrac- tive surgery but makes a 20/20 outcome unrealistic. "For some patients, taking them from 20/200 to 20/60 can result in a '20/unbelievably happy' outcome," Dr. Rostov said. "It all depends on the expectations you help set as the surgeon. ... The goal, as a hard number, many times is effec- tively 20/20. But I tell patients that our goal is really to get you to the best that you can see, given your eyes and your prescription—and to make you happy." From philosophy to practice impact A 20/happy mindset is not just patient-centered—it is prac- tice-centered. When expectations are aligned with real-world goals, patients are more satisfied, postoperative conversa- tions are easier, and trust is strengthened. Some patients, even when they function well in daily life, still fixate on achieving a specific visual number. These are often referred to as "20/20-unhappy" patients—not because their vision is poor, but because the outcome has been framed in a way that doesn't reflect how they actually experience the world. Patients rarely describe their vision in clinical terms. They don't tell friends, "I see 20/20." Instead, they say things like: "I don't have to think about my eyes anymore," "I can see clearly the moment I wake up," or "I finally feel comfort- able being active without glasses." These statements capture the real-world value of refractive surgery—freedom, confi- dence, and convenience. Understanding and reflecting this language back to pa- tients can make outcome discussions feel more authentic and meaningful than quoting statistics such as, "98% of patients see 20/20 or better." When practices shift the conversation toward lived benefits and personal goals, they reinforce what 20/happy truly represents—not just a number, but a positive change in daily life. For clinics, this approach does more than improve satisfaction. It helps align expectations, strengthens trust, and creates stories patients naturally want to share—fueling referrals and long-term success. By reframing success around function instead of fixation on a single number, many of these patients can be counseled —or treated—back to a 20/happy result. Redefining success Focusing solely on 20/20 is like focusing on a number on a scale. What matters more is what the patient can do and how they feel. "Our goal is helping patients on their visual wellness journey," Dr. Rostov said. "We want everyone to get to 20/happy—whatever that number is—so they can do the things they like to do and need to do without glasses as much as possible." For refractive practices, redefining success around 20/happy creates clearer alignment, stronger relationships, and more meaningful outcomes—for both surgeons and their patients. 20/HAPPY: RETHINKING WHAT SUCCESS MEANS IN REFRACTIVE SURGERY sponsored content Audrey Rostov, MD, of Bellevue Precision Vision, is a consultant for Carl Zeiss Meditec USA Inc. CAP-en-US_34_010_0069I Copyright 2026 American Society of Cataract and Refractive Surgery (ASCRS). All rights reserved. The views expressed here do not necessarily reflect those of the staff and leadership of EyeWorld and ASCRS and in no way imply endorsement by EyeWorld and ASCRS. Sponsored by

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