Choosing a LASIK Surgeon

So you’re ready to free yourself from your dependence on glasses or contacts. What’s the next step? Call a few LASIK center franchises and see who offers the lowest price? Think again.

This is your eyes we’re talking about! Why would you want to shortchange yourself? A center that performs LASIK-only may not offer the procedure that is right for you. For some patients, implantable contacts, CK or refractive lens exchange may be the best option. A LASIK-only center can’t offer these options. Worse yet, they may be tempted to offer LASIK when it is ill suited for you. And even if LASIK is the best procedure a low price can often mean corners are being cut.

Choosing your surgeon is the most important aspect of making the decision to undergo LASIK.

Patients should seek out surgeons who are experienced, qualified, use quality equipment and can perform procedures other than LASIK. Don’t just go to a LASIK “franchise” as though you were getting an oil change for your car. LASIK is a surgical procedure and surgeons have variable skills. Talented golfers use the best and varied tools to achieve results; the same holds true for surgeons. However, having state-of-the-art equipment does not necessarily make for a good surgeon. It is best to have confidence in your surgeon based on a face-to-face meeting.

Make Sure You Have Met With the Surgeon Before the Day of Your Procedure

Part of being comfortable with elective surgery is to have confidence in your surgeon. Consider meeting and interviewing at least two different surgeons. Ask for referrals from friends or family you know who have had LASIK. Don’t accept meeting with a surrogate or technician ahead of time. How can you be comfortable with your surgeon if you have never met him or her? Patients should be given the opportunity to meet with the surgeon to discuss their individual condition before the day of surgery. If a patient does meets the surgeon on the day of surgery, the meeting should happen before going into the surgery room. A patient should not meet the surgeon for the first time while laying under the laser.

In elective surgery such as LASIK, there should be ample time to carefully read the informed consent document prior to surgery. All potential complications should have been addressed by the surgeon before you are asked to sign it. The consent form should never be signed under duress. Ask about anything you don’t understand or want clarified.

Make Sure Your Surgeon is Qualified.

Some surgeons may have learned LASIK by taking a weekend course. The most qualified have completed a Fellowship in Refractive Surgery. A Fellowship in Refractive and Corneal Surgery entails an advanced training that occurs follows the completion of a 3-year ophthalmology training program. This training involves rigorous didactic and hands on work under the tutelage of an experienced surgeon. Fellows learn how to identify who are good candidates for LASIK, alternative vision correction procedures and how to handle postoperative complications.

Excellent surgeons are often recognized through awards and special honors. Does the surgeon’s literature list any such distinctions? Ask if they are involved in research, teaching or contributing scientific articles.

Ask how many LASIK procedures the surgeon has performed. Having adequate experience is important but having the most procedures is not. How many of the LASIK procedures had complications and how were they managed? What is the satisfaction level of patients?

Check your surgeon’s medical license to see if there were any reports of disciplinary action or suspension by looking up your surgeon on his/her state’s medical board web site (which can be found on an Internet search engine).

Select A Surgeon With Quality Equipment

Your surgeon should be able to offer IntraLase which is blade-free LASIK procedure with a proven safety profile. Custom LASIK making use of a wavefront analyzer is another important option. This technology gives more precise results and is much less likely to result in night-time driving difficulties. Make sure your surgeon wears scrubs and gloves when he performs his procedures. Ask what measures are in place to prevent infection.

When Going Through Your Preoperative Evaluation, Make Sure Specific Testing is Done.

In order to determine your suitability for LASIK. Certain tests need to be performed. Your evaluation of your surgeon should include your surgeon’s thoroughness in judging your suitability for LASIK. A LASIK evaluation includes the following:

I. Tear film evaluation

It is normal for patients to experience temporary dryness after LASIK. Patients who have inadequate tears before surgery are at higher risk of prolonged dry-eye symptoms after LASIK and should have increased lubrication before surgery. Some patients have the feeling of dryness while wearing contact lenses since lenses absorb tear moisture. This does not mean that the eyes are dry when contact lenses are not being worn. There are different methods to evaluate tear function: including special dyes, tear collection or visual inspection.

II. Pupil size evaluation

Following LASIK, some patients experience glare and halos. Often this is due to a combination of larger pupil sizes and higher amounts of nearsightedness or farsightedness that was not recognized as a risk factor prior to surgery. With large pupils, light rays from the peripheral cornea are more likely to cause symptoms of glare and halos after LASIK. Measuring your pupil size may be important in determining the procedure that is best for you. The risk of night time visual symptoms can be minimized by insuring the LASIK flap is of adequate size and making use of wavefront technology.

III. Corneal Topography

Corneal topography shows the surgeon whether or not the cornea has normal astigmatism or abnormal astigmatism. Some patients with abnormal astigmatism have a condition called keratoconus.These corneas often are weaker than normal corneas and thus should not be treated by LASIK.

IV. Pachymetry

Pachymetry is the medical term for the measurement of “corneal thickness.” As you already know, the LASIK procedure involves creating a flap on the surface of the cornea and using the laser to reshape the cornea by removing tissue. It is possible that too much tissue can be removed by the laser. This can destabilize the cornea and lead to corneal bulging. This condition is called ectasia and results in distorted vision.

Before surgery, the surgeon should calculate how deep the laser will penetrate and be sure it does not penetrate beyond the safe level, which is why measuring corneal thickness is imperative.

V. Epithelium evaluation

Attached to the surface of the cornea there is a thin clear layer of “skin” or epithelium. In some patients, this layer of skin may not be firmly attached. If so, while making the flap in the LASIK procedure, this skin layer may be brushed off by the microkeratome, leading to a higher risk of complications. It is important to identify beforehand with a microscopic examination of the cornea if the “loose skin” condition exists.

By now it should be apparent that not all LASIK procedures and surgeons are equal and your selection of surgeon should not be based on price alone. LASIK is a medical procedure. In providing a service in the form of a surgical procedure, there are a host of factors that play a role in the fee for the procedure.

As a general rule, the lower the fee, the less surgeon-patient interaction there is. The reason is that lower fees mean that more patients need to be treated in order to generate the same level of income as fewer patients at a higher fee.

There are other factors that can account for differences in fees even if you meet the surgeon at every visit before and after surgery. The more experience of the surgeon, typically the higher the fee. In other words, the greater the expertise, the higher the fee. As with any profession, some surgeons are more skilled than others which includes not only surgical expertise, but also diagnostic expertise as well since LASIK is not always the best procedure for everyone. Some patients may be better suited for other procedures and some patients should not have surgery at all.

The equipment and physical plant are another cost factor. There are several studies that confirm that an environmentally controlled room is essential to good LASIK outcomes. The surgical suite should have a separate heating and cooling unit from the rest of the clinic. Humidity must be strictly controlled. An air filtration system may have some impact on outcomes. There are several different manufacturers of flap making devices and lasers to perform the procedure all with varied prices and associated costs just as there are different makes and models of automobiles. Which would you want: a Ferrari or a Hyundai? In general, an all-laser or blade-free LASIK procedure is safer and more precise than a standard LASIK but costs more. A wave-front guided procedure costs more than a wavefront-optimized procedure which costs more than a conventional LASIK. The more expensive techniques tend to give better results and fewer side-effects such as night-time driving difficulties.

If nothing else, I hope this article gets you thinking that not all LASIK procedures are equal and that there are varying degrees of surgeon skills and levels of care. Patients should not shortchange themselves by shopping for the lowest price. LASIK vision correction surgery is an investment which pays for itself many times over compared to the costs of years of glasses and contact lenses. Take the time to do your research. The dividends can mean a lifetime of clear comfortable vision.


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