Vision Correction Surgery

SURGEON’S PRACTICE STYLE AND STATISTICS

Once you have the names of qualified refractive surgeons with good reputations and credentials, the next step is to find out more about their practice style and how you relate to the surgeon. There are aspects of the surgeon’s practice that you will learn when you visit his or her office. You should keep your eyes and ears open and ask direct questions to find out this information. You will also want to find out about costs.

HOW ARE YOUR QUESTIONS HANDLED?

When you find a doctor with a promising reputation and solid credentials, call the office and ask to speak with the surgery coordinator or a staff member who can answer your questions. Don’t be shy about asking penetrating questions. Vision correction surgeons understand that patients have many questions about them and about the procedure, and they should be prepared to answer the questions for you.

“FEEL” OF THE PRACTICE

Visit the office. It should “feel” right to you. If it is too quiet, the doctor may not be busy enough to have the experience you want in a surgeon. If it feels like a bus station, with long waits and people overflowing out the doors, they may be too busy to provide a high level of attention to examining you and planning your surgery.

CONNECTION WITH THE SURGEON

Avoid the “shopping mall” approach to surgery, where patients are shuffled through to the surgical suite without first having met with the surgeon. Most doctors have knowledgeable and compassionate staff to help perform tests and answer questions. However, it is also important to meet the surgeon and receive his or her personal evaluation before you decide to have the surgery.

Do you feel a connection with the surgeon? Do you trust the person? Is he patient or rushing to get to the next patient? Does she answer your questions in a way that you understand? I believe your connection to the surgeon is important and something that you should pay close attention to.

Some patients choose to see their regular eye doctor, an optometrist or ophthalmologist, for their preoperative and postoperative care. If you plan to do this, be sure your surgeon is comfortable working with your regular eye doctor. Although the majority of people have an uncomplicated postoperative course, you want to make sure your care provider will be able to recognize complications if they arise and can either treat you or refer you for treatment before more serious, long-term repercussions occur.

FOCUS OF PRACTICE

A “Jack of all trades” is a master of none. Look for a surgeon whose practice specialty is refractive surgery or refractive and cataract surgery. If your surgeon is a member of American Academy of Ophthalmology, that organization’s website, www.aao.org, lets you search for member eye doctors by city, state, and specialty (refractive surgery). The site lists doctors’ practice focus, current professional activity, educational history and degrees, residency, fellowships, teaching positions, board certification, contact information, and often a website address.

NUMBER OF LASIK AND OTHER VISION CORRECTION PROCEDURES PERFORMED

You want a surgeon who has performed your procedure over and over. Studies clearly show that more experienced surgeons have lower complication rates. If you are a candidate for LASIK or PRK, look for a surgeon who has done a minimum of 3,000 LASIK procedures. If the ICL is the right procedure for you, look for a surgeon who has done at least 300. If refractive lens exchange is your procedure, you want a surgeon who is a busy cataract surgeon, doing at least 300 cataracts a year and who is also an experienced LASIK surgeon because LASIK enhancement may be needed after RLE.

TRACKING STATISTICS

If the surgeon has readily available statistics of the practice’s results, he or she is most likely benchmarking, or tracking, outcomes of vision correction surgery.

Benchmarking is very important because it indicates the surgeon is concerned about achieving the best possible results over time. There is no mandatory central reporting database for tracking outcomes, unless a surgeon is participating in a sanctioned clinical trial. Therefore, a surgeon’s doing benchmarking voluntarily indicates high personal standards of professionalism and performance.

Fortunately, outcomes can be predicted by using scientific data. Each surgeon achieves somewhat different results with the same procedure. The best surgeons track their own results and adjust the laser to optimize each patient’s outcome based on the surgeon’s personal results. This adjustment factor for the laser is called a nomogram. A nomogram takes into consideration the surgeon’s own technique and the type of laser he or she uses. A well-developed nomogram allows the surgeon to more accurately program the laser for each patient, increasing the likelihood of perfect vision.

It takes about 3,000 surgeries for a surgeon who tracks outcomes to develop a nomogram. The reality is that most surgeons have not compiled personal statistics, for one of three reasons: first, they haven’t done enough procedures; second, they aren’t willing to do the labor-intensive work of entering large numbers of cases into a database; or third, they don’t have the statistical knowledge necessary to analyze their results. This is unfortunate because it reduces patients’ chances of achieving a perfect 20/20 result. Ask to see the surgeon’s nomogram.

SURGEON’S SUCCESS AND COMPLICATION RATES

The surgeon should be able to give you the percentage of patients whose procedures result in 20/20 vision or better. It’s normal for more than 80 percent of LASIK patients to achieve this level of vision. In fact, with wavefront-guided treatment, which uses newer diagnostic technology, most patients in a top practice today have a 95 percent chance of achieving 20/20 vision. With data based on 1,000 or more procedures, your surgeon should be able to tell your chances of achieving a good result with the chosen procedure and whether you will need an enhancement procedure. Ask what percentage of patients report significant complications. Less than 1 percent is acceptable. Keep in mind that most complications, if they do occur, can be managed by an experienced surgeon.

PERCENTAGE OF PATIENTS THE SURGEON TURNS AWAY

A conscientious surgeon will turn away about 10 to 15 percent of the patients he or she evaluates if the surgeon believes they are not good candidates for surgery. Be wary of a doctor who rarely advises a patient against the procedure. Many factors can make a patient a poor candidate for vision correction surgery. No doctor with high ethical standards will perform laser surgery on your eyes if you are not a good candidate.

EMPLOYEE TURNOVER

Much of the success of surgery depends on outstanding support staff. Was the support staff happy and helpful? Had they worked there for a long time or is there a lot of turnover? During your visit, ask the employees you meet how long they have worked there and whether they like their job.

TYPE OF LASER USED

Make sure your doctor uses a newest-generation excimer laser that is capable of performing wavefront-guided treatment. Laser technology has improved dramatically over the past decade. State-of-the-art lasers now have eye tracking, which further improves the safety of the procedure. If your eye moves accidentally during the treatment, the laser automatically tracks, or follows, it. Make sure your surgeon uses an eye-tracking laser. State-of-the-art lasers enable surgeons to treat larger areas, minimizing the risk of night-vision disturbances.

The FDA website, www.fda.gov, has links to laser manufacturers’ websites, where some maintain lists of doctors certified to use their machines. If your doctor is not listed, you may wish to contact the laser manufacturer directly. Verify that the doctor has been certified by the laser company to operate a particular machine, which means he or she took a required training course.

COST OF SURGERY

Cost should not be the main factor in choosing a surgeon. First and foremost, seek out a surgeon who has a good reputation in the medical community and plenty of experience. If you are swayed by low cost, this may signal trouble for you down the road. Find the best-qualified surgeon you can. He or she should have high medical standards for patient care and should also offer comprehensive postoperative care. The surgeon should be willing to perform enhancement procedures if they are needed, as well as be available for any problems that might arise after surgery. Also, the surgeon’s staff should be well trained and compassionate.

The cost of surgery varies from surgeon to surgeon. Generally, high-quality, all-laser wavefront-guided vision correction surgery runs between $2,500 and $3,500 per eye. Lens-based surgeries are more expensive. Be sure to ask whether the quoted per-eye cost includes preoperative and postoperative care, as well as enhancement procedures. Many practices can help you arrange low-interest or no interest financing, which makes high-quality surgery affordable for almost everyone.

Working With Your Regular Eye Doctor