How to choose a LASIK Surgeon

There is no easy answer to choosing a LASIK or iLASIK surgeon – competing claims of superior technology, higher numbers of procedures performed, or lowest price can lead even the most mindful patients to a state of uncertainty about the best route. Almost all Internet searches will lead you first to the dozens of Web sites that claim to be impartial but are actually just commercial listing services for doctors. Unfortunately, there’s a lot of misleading information about LASIK.

But the right questions can lead you to the right surgeon. Here are some key questions to consider.

• Where can I turn for reliable information about LASIK?
• My friend had a great experience with LASIK. Can I trust her opinion?
• Is there any kind of medical certification I should look for in a LASIK surgeon?
• I’m confused by LASIK surgeons talking about doing the procedure thousands of times. Does how many thousands of times a doctor has performed LASIK really matter?
• Do different LASIK surgeons have different approaches? Is there a type of care or surgical technique I should be looking for?
• What about the laser facility itself? Does technology really make a difference?
• Why do price levels seem to vary so much between surgical centers?

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Q. Where can I turn for reliable information about LASIK?

Dr. Goldberg: A good place to start getting detailed, honest answers about LASIK is the FDA LASIK website and independent ophthalmologic associations like the Council for Refractive Surgery Quality Assurance, the American Society of Cataract and Refractive Surgery, and the International Society of Refractive Surgery. These impartial sites have no interest in any particular doctor and can give you many of the facts you should know before undertaking LASIK surgery.

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Q. My friend had a great experience with LASIK. Can I trust her opinion?

Dr. Goldberg: Asking friends who have had LASIK about their experiences is a start, but make sure you do your own research as well. Your friend’s experience may not be the norm for a particular surgeon, and truthfully, friends aren’t always experts in these matters. It’s best to substantiate anyone’s recommendation by asking the right questions of the doctor. Another good place to turn for information about a recommended ophthalmologist is your family physician or internist.

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Q. Is there any kind of medical certification I should look for in a LASIK surgeon?

Dr. Goldberg: Minimally, your LASIK surgeon should be board-certified. It’s absolutely reasonable to expect this of a doctor, and it’s easy enough to ask – are you board certified? Some surgeons and facilities ’dabble’ in refractive surgery, performing a few cases here and there mixed in with other types of eye surgery. A surgeon who performs ONLY refractive eye surgery, a specialist in the true sense of the word, will be able to deliver the best results possible. Independent, non-profit agencies also certify refractive surgeons, and I’ve always felt these objective third-party endorsements help patients feel more comfortable with their surgeon. So my surgical skills are also accredited by the American College of Eye Surgeons and the Council for Refractive Surgery Quality Assurance.

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Q. I’m confused by LASIK surgeons talking about doing the procedure thousands of times. Does how many thousands of times a doctor has performed LASIK really matter?

Dr. Goldberg: Your refractive surgeon should have many years of experience, but the difference between 5,000 and 25,000 surgeries probably isn’t a good gauge of a surgeon’s quality. In fact, some ophthalmologists who perform LASIK are so busy adding surgeries that they don’t have the time to consult with patients before the day of surgery and do not see patients beyond the week following surgery. In extreme cases, at chain discount laser centers, the only time a patient actually sees a doctor is during surgery. This kind of "experience" – when a doctor’s surgical schedule is so busy that he can’t see the patients he already has – holds no benefit for the patient whatsoever. Your experience with your doctor should involve personal contact before and well after the day of surgery, which is why I have a free initial consultation with every patient and a year of follow-up visits.

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Q. Do different LASIK surgeons have different approaches? Is there a type of care or surgical technique I should be looking for?

Dr. Goldberg: Your vision is precious, and you must feel comfortable with your surgeon on a personal level. Among the most important tasks a LASIK surgeon does is determining whether a patient qualifies for LASIK at all. This happens after a careful analysis of your cornea during the screening stage. It’s important to know that the doctor who is operating on you has personally conducted a thorough pre-screening of your eyes and is familiar with your case. Beyond the initial recommendation, your surgeon should be involved with all aspects of your care – including the pre-operative exam and the post-operative care. Good surgical technique comes from experience and is an important element to avoiding complications.

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Q. What about the laser facility itself? Does technology really make a difference?

The technology a surgeon uses is an important consideration. On the most basic level, the laser a surgeon uses is a delicate, highly-calibrated instrument, and it should be installed in a well-ventilated room. Mobile laser systems are trucked over bumpy expressways and have much more potential to be damaged. Beyond a fixed location, the facility should be all about LASIK surgery, like our Little Silver office. Many lasers are approved by the FDA, and we chose the VISX Star 4™ after much research and thought for its superior tracking and adjustable laser size. The benefits of using IntraLase® – creating the corneal flap with a laser instead of a blade – are increased safety, more precision, more predictability, and 100 times better accuracy than microkeratomes. Ask your surgeon directly – do you have IntraLase®? Unfortunately, some surgeons are willing to misrepresent themselves to draw patients. Finally, for genuine no-blade LASIK facilities like Atlantic Laser Center, ask your surgeon if you’ll need to walk after the creation of the corneal flap to the laser. We’ve found patients are much more comfortable not moving during the surgical procedure.

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Q. Why do price levels seem to vary so much between surgical centers?

Dr. Goldberg: Price can be an important factor for patients, and prices vary widely for LASIK. A high price doesn’t promise a better result, but it’s best to be wary of high-volume facilities that advertise prices that sound too good to be true. Additional costs for retreatments, post-operative care, and differential pricing based on higher prescriptions inevitably drive the actual price up for the patient. Charging more for post-operative care is highly unethical and a quick sign to view a facility with some skepticism. High-volume facilities often pay young surgeons per eye, which rewards working quickly and generating surgical volume. A good question for any LASIK surgeon is to ask how long they’ve been at a facility, and try to avoid quick turnover "shops". Ironically, the drive for profit at these lower-cost facilities is what in fact makes them potentially more compromising for a patient. Low margins and high volume means you may not meet your surgeon before surgery and your surgeon will not examine you after surgery. Eye surgery is not a household appliance or even a car – it’s critical to your health to be an intelligent, skeptical consumer.

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