How to Choose a LASIK Surgeon

In the overall scheme of things, LASIK and PRK are not as difficult as many other kinds of surgery. But a bad eye procedure outcome can affect your life almost as negatively as a bad heart operation outcome. That's why it is so important to choose the best surgeon available.

Advertisements, academic medical centers and the American College of Surgeons. Many refractive surgery centers are advertising in newspapers, on the radio, and on TV. Some ads are more informative than others; and some tout extremely good pricing. But while they can be a starting point, an ad or a procedure price should not be your only criterion in choosing a doctor.

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Don't assume too much from advertising, says Penny Asbell, MD, Professor of Ophthalmology at Mount Sinai School of Medicine and Director of the Cornea Service and Refractive Surgery Center in New York. A refractive surgeon herself, Dr. Asbell recommends asking the surgeon if he or she is associated with an academic medical center, such as a teaching hospital or one that is well-known for advanced technology.

"Those who work in, or are at least associated with, academic medical centers are more likely to keep up with current information," she explains. "They are more likely to have more constant exposure to new things and to issues related to new procedures, than if they are related to an (albeit busy) isolated office setting with little contact with the academic world."

"A lot of companies make LASIK sound like it's a flap-and-zap commodity. But the truth is, it's surgery," comments Dr. Steve Updegraff, a LASIK surgeon and medical director of Updegraff Lasik Vision in Tampa Bay, Fla. He recommends choosing a doctor who is a Fellow of the American College of Surgeons. "The credentialing process there is pretty steep; also, that group is diligent about advancing the field of surgery."

Watch out for misleading advertising claims, Dr. Updegraff adds. "If someone says he's been using a laser for 15 years, don't accept that — he's probably talking about another type of laser or procedure, because LASIK hasn't been around that long."

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Referrals. Ask for a referral from your regular eyecare practitioner, whether an optometrist or an ophthalmologist. Tell him or her that you want the LASIK surgeon in your area with the best reputation in the profession.

Other resources. Visit the American Academy of Ophthalmology's website at www.aao.org, where you can use the "Find an Eye MD" feature. Be sure to specify "refractive surgery" under "specialty."

Call refractive surgery centers in your area; you'll find them in the Yellow Pages. Most have websites that explain their specialties and doctor credentialing. Some even let you search for particular surgeons on their sites.

After you find a surgeon, make an appointment for a consultation. This is an important meeting. To take full advantage of it, write down every single question you can think of, and ask every single one during your visit.

The Council for Refractive Surgery Quality Assurance has a list of 50 questions on its website. Here are a few of them:

• How long have you been performing refractive surgery procedures? (Not less than three years.)
   
• How many total procedures have you done? (Not less than 500.)
   
• How many refractive procedures of the exact type you intend to use for me, with the same equipment, and the same refractive error, have you performed? (Not less than 100.)
   
• What percent of your refractive surgery patients receive Snellen uncorrected visual acuity (UCVA) of 20/40 or better? (The CRSQA says you should be suspicious of any number that is greater than 90 percent, which is the norm.)
   
• What percentage achieved 20/20 or better? (Around 65 percent is the norm; ask for proof if a higher number is stated.)
   
• Will you provide me the names and contact information of at least ten previous patients who have had the exact same surgery with similar refractive error?
   
• Have you ever had malpractice insurance coverage denied?
   
• Have you had your license to perform refractive surgery revoked, suspended or restricted?
   
• Have you been convicted of a felony? etc.

As you can see, the CRSQA recommends asking tough questions that some may consider difficult or even rude to ask. But remember that your precious vision depends on your surgeon's competency. You need to be confident that you have chosen the right person. If you are not happy with the answers to your questions, consult another surgeon.
 

In addition to the above concerns, you also need to consider the surgeon's versatility and competency in a variety of refractive procedures. LASIK isn't the only game in town, and it isn't the best procedure for every person. Choose a surgeon who is comfortable and experienced with several procedures — such as LASIK, PRK, LASEK, CK, and clear lens replacement — and the latest technology. If your doctor knows these procedures inside and out, he or she can confidently choose the one that will be best to correct your particular vision problems. If you're considering a surgeon who doesn't perform a particular procedure you're interested in, he or she should be able to explain why not, beyond "I don't do that."

After a consultation, never feel that you are obligated to use that surgeon. You are completely free to talk to other surgeons as well. And don't feel that you are offending anyone. It has long been an accepted practice to seek a second opinion, and most doctors would urge their patients to do so.

"As with any relationship you have with someone in the medical profession, it has to be one of trust," says Dr. Asbell. "You have to feel that you trust the person and that they're personally interested in you."

She adds, "If you can't develop that rapport, I would be concerned. If everything goes well, you probably won't have to see that person too often, and that's the end of it. But if for any reason you're not happy with the quality of the result, or there's any issue with healing that's going to require more attention, you want to know that you have someone who is personally connected to you and is working hard to address your concerns — someone who isn't just running a mill where they don't even remember who you are."