HOW DO I CHOOSE
A LASER SURGEON?
There is no easy answer to this question.
Eye surgeons and laser facilities are not subject to
universal standards and are not all equal. Would you
have a heart bypass operation without meeting your surgeon?
Would you shop around for a heart surgeon on the basis
of price alone? Obviously, the answers to these questions
are no. If what patients are telling us is true, that
their eyesight is one of their most precious possessions,
why should the answers be any different for eye surgery?
The following are suggestions, but remember, you only
have one set of eyes, so pick wisely.
Recommendations
Certification
Experience
How much is the surgeon
doing?
Laser facility
Importance of meeting
the surgeon before choosing
Price
Complication rate
Recommendations
While asking friends who have had LASIK might be a start,
friends are not always experts in these matters; the
truth be told, they may have come by their surgeon by
chance, perhaps leafing through news ads. Their surgeon
may be very good, but do your own homework and substantiate
their recommendation. Ask your family physician or internist
whom he or she would recommend. If you are already under
the care of an ophthalmologist, ask whom he or she would
go to for LASIK. If your ophthalmologist performs LASIK,
use the additional criteria below. If your ophthalmologist
is experienced in LASIK and has earned your trust, you
may already have the right person.
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Certification
You want a board-certified ophthalmologist. Though such
certification is no guarantee of a quality LASIK surgeon,
it is a reasonable standard to expect of a doctor. A
surgeon who has additional "fellowship" training
in corneal surgery is sometimes touted by laser centers.
Most ophthalmologists have performed corneal surgery
during their training. Fellowship-training is no guarantee
of a more skilled LASIK surgeon. While it is true that
LASIK surgery is performed on the cornea, one must not
lose sight of the rest of the eye. Fellowship-trained
corneal surgeons who only specialize in the cornea may
not have continuous clinical exposure to other parts
of the eye. While there exist no widely-accepted uniform
standards for LASIK training, hospital-affiliated laser
facilities may hold ophthalmologists, in general, to
more strict standards than non-hospital centers where
there is less federal and state oversight.
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Experience
Your LASIK surgeon should be experienced and have good
results. How can you get this info? Ask the doctor at
the screening exam. Ask to speak with some of the surgeon's
patients to get a sense of their satisfaction. How much
experience is enough? The learning curve of LASIK depends
on the surgeon; some are fast-learners, and others,
slow learners. While you might not want a surgeon who
has only done a few cases, going to a surgeon who has
done "thousands" is no guarantee of a better
or even average result. Such a high-volume surgeon may
not be able to give you the one-on-one care you should
seek. Your surgeon should have done at least one hundred
cases. Beware of being seduced by advertisements claiming
"thousands of refractive surgery procedures performed".
Oftentimes, these "thousands" include older
surgical procedures such as RK or radial keratotomy,
which is an entirely different type of surgery, or these
"thousands" include all the cases of several
surgeons using an open-access laser facility. Besides,
dwelling on the numbers beyond a certain point misses
the whole point: you should care about the quality,
not the quantity.
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How much is the surgeon doing?
Your surgeon should not only do the surgery, but be
involved with the screening exam, the pre-operative
exam, and the post- operative care. The surgeon is ultimately
the one best-trained to determine whether a person is
a good candidate for LASIK, not the counselor. The surgeon
should be the one examining and measuring the patient
at the preoperative exam. The measurement of the prescription
is critical, as these numbers are the basis of the numbers
that are programmed into the computer of the laser.
Certainly, there are things that can be delegated to
others in the name of efficiency, but not this. The
surgeon doing the surgery is also best-suited to examine
you after surgery. Your surgeon should feel responsible
and accountable enough to see you after surgery. At
some chain discount laser centers, the only time you
may see your surgeon is at the time of surgery!
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Laser facility
What laser facility does the surgeon use? Remember,
the laser is a very delicate instrument that must be
well-maintained by trained and experienced technicians.
The humidity, temperature, and even ventilation of the
laser room must be controlled and kept constant; otherwise,
LASIK become unpredictable. For these reasons, be wary
of mobile laser systems; these are lasers that are trucked
from office to office on pot-holed expressways. There
are justifiable concerns about possible malfunctioning
equipment, not to mention the non-transportability of
the critical operating conditions of temperature, humidity,
and proper ventilation.
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Importance of meeting the
surgeon before choosing
It is critical for you to meet with the surgeon well
before surgery, at the initial consultation. How can
a surgeon know his or her patient just on paper? Nothing
can substitute for the one-on-one meeting. It's important
for the patient to be comfortable with the surgeon.
Good rapport or bedside-manner is important. If you
can't communicate with your doctor at the time of the
screening, why would that change during surgery or afterward?
Your doctor should answer questions in a friendly, unhurried
fashion that won't make you feel like you're on an assembly-line.
There are many LASIK surgeons. You should take your
time choosing one. Given a choice between a competent
surgeon who doesn't have the time to meet with you,
and another who does, why wouldn't you want to choose
the one willing to make a commitment?
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Price
Price can be an important factor for patients. Prices
for LASIK go from cheap to very expensive. Paying the
most is no guarantee of a better result or even an average
one. On the other hand, consumers should be wary of
high-volume facilities with big advertising budgets
that advertise prices that sound too good to be true.
Oftentimes, there are add-on charges for retreatments,
postoperative care, and treatment for higher prescriptions,
so that the actual price differential is narrowed. The
notion that postoperative care is an "extra"
or option is ludicrous and unethical, and at best, misleading.
Postoperative care should always be included in the
surgical package. High-volume facilities sometimes hire
surgeons fresh out of training and are oftentimes paid
on a per-eye basis, which rewards fast surgery and volume.
Ask how long the surgeon has been at the facility; turnover
is frequent. This is assembly-line medicine. There are
always issues of compromising quality, safety, and service
for the sake of profit with large corporate entities.
It is ironic that the profit-motive may be more of a
problem on the low end of the pricing tier, where margins
are very low. These are the places where you may not
meet your surgeon at the screening, where your surgeon
may not do your preoperative exam, and where the person
who examines you after surgery is not the surgeon. While
comparison shopping on the basis of price alone makes
sense when it comes to buying a car or household appliance,
eye surgery is clearly not a commodity, and should not
be treated as such.
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Complication rate
All surgeons have complications, even the best LASIK
surgeons. The true test of an excellent LASIK surgeon
is how he or she handles a complication, and how the
patient does in the end. While a LASIK surgeon who performs
many surgeries will have more complications than someone
who does fewer cases, the percentage of complications
should be at least the same (and probably lower). Ask
your LASIK surgeon about his or her complications. A
competent surgeon should not be offended by such a question
nor should that surgeon boast about a "zero"
complication rate. If a surgeon tells you that there
are no complications, be very suspicious. He or she
is either being dishonest or not doing enough cases.
Ask your surgeon if you can talk to a patient who has
had a significant complication, but ultimately had a
good result. You may not be seriously interested in
doing so, but you can gauge your surgeon's reaction
to your request.
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