The Surgeon is Key to Successful LASIK Eye Surgery

In the overall scheme of things, LASIK eye surgery is not as difficult as many other kinds of surgery. But a bad eye procedure outcome can affect your life dramatically. That’s why it is so important to choose a well-qualified surgeon.

LASIK is a procedure in which the eye surgeon creates a thin surface flap of the cornea using a microkeratome to expose underlying tissues (stromal bed). It is within the deeper layers of the cornea that the surgeon then applies the Excimer Laser beam to create the refractive ablation. This reshapes the cornea using the extraordinary precision of the Excimer Laser.

The laser is programmed prior to each procedure for the ablative "cut" based on the patient's pre-operative refractive error (nearsightedness, farsightedness and astigmatism). Once the laser ablation is completed, the surgeon gently replaces the corneal surface flap to restore surface integrity of the eye. It's as if the refraction is "ground in" to the middle layers of the cornea!

LASIK surgeons have at their disposal the newest and most advanced technology in the world. In order for a procedure to work to its full extent, the best doctors in the world are required.

Consider the surgeon's versatility and competency in a variety of refractive procedures. LASIK isn't the only surgery for refractive problems, 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.

As with any relationship you have with someone in the medical profession, it has to be one of trust. 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.

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.

The best way to learn if you are a candidate for LASIK and to select a LASIK surgeon is to arrange a screening or consultation. At that visit, you will have the opportunity to ask the surgeon, or their staff, a number of questions to help you decide if a particular LASIK surgeon is right for you. The following questions may be useful in helping you with the selection of your LASIK surgeon.

What experience does the surgeon have performing Laser Eye Surgery for the correction of nearsightedness, farsightedness and astigmatism? The United States Food and Drug Administration (FDA) formally approved the use of the Excimer Laser for Laser Eye Surgery on October 21, 1995. During 1996, 1997 and 1998 a large number of eye surgeons participated in the required training necessary in order to become certified. Thus there are a considerable number of LASIK surgeons who indeed have been performing Excimer Laser Eye Surgery for more than 10 years. Those physicians, who have recently completed an Ophthalmology Residency or Fellowship in Corneal and Refractive Surgery, should be expected to have at least three years experience with the Excimer Laser Eye Surgery. An important aspect to consider is not simply the length of time since their certification with the Excimer Laser, but the actual number of years that they have been performing LASIK Surgery on a regular basis. The combination of three or more years of experience and regularly performing Laser Eye Surgery is a key benchmark in determining LASIK surgeon experience.

In the past 12 months, how many Laser Eye Surgery procedures have they performed with the Excimer Laser? While one might be inclined to think that the greater the number, the better the surgeon, this may not be entirely true. There is however a minimum monthly threshold that a LASIK surgeon should perform in order to maintain the basic competence and skill level necessary to deliver good, consistent results. Twenty procedures per month, at a minimum, or approximately 250 procedures in the last 12 months is an appropriate range. It is reasonable for a single LASIK surgeon to perform as many as 150-200 LASIK surgeries per month without really compromising the care necessary to provide personal attention and ensure results. In very well run and established LASIK practices that have been performing surgery for many years, it may even be possible for a LASIK surgeon to perform as many as 300 procedures per month. However, as the number of surgeries performed by a single surgeon climbs much beyond this, it becomes necessary to delegate much of the clinical care to assistants who may or may not be as skilled and experienced as the treating surgeon. Laser Eye Surgery is still surgery and thus requires a certain level of contact with the treating surgeon in order to consistently deliver quality care. When selecting your LASIK surgeon, consider whether you are comfortable not only the number of procedures performed monthly and annually, but whether that number necessitates a "low contact" approach in order to perform an exceptionally high number of procedures.

Percentage of patients treated that are able to pass a drivers test without glasses or contacts within 1 month after their LASIK surgery. It is reasonable to expect that 95% + of those treated will be able to pass a drivers vision test without the use of glasses or contacts.

Percentage of patients treated who have some type of complaint after their LASIK surgery. This would include dryness, haloes, etc., many of which would resolve within three to six months after surgery. Since it is normal and expected to have some transient symptoms after LASIK surgery, it would not be acceptable for a LASIK surgeon to tell you that none of his or her patients experience any of these symptoms. You should be told that there are many common mild symptoms that you might experience and that they will gradually end on their own. It may not be possible for a LASIK surgeon to give you an exact percentage, but a range of possibilities is reasonable.

Has the surgeon had malpractice settlements for more than $25,000, been denied malpractice insurance or access to any insurance plan? Is he or she under professional board investigation or ever had disciplinary action taken against their license to practice medicine? The greater the number of cumulative surgeries that a LASIK surgeon has performed, the more likely that he or she will have at least had a malpractice suit filed against them. Regardless of the number of surgeries performed, there should not be repetitive settlements for amounts that indicate that minor damages were awarded or even a single suit whereby the patient received a considerable amount of money as compensation for damages.

“No” should be the answer to failure to qualify for malpractice insurance and board investigation and / or discipline. A positive answer to any of these questions requires careful review as it indicates that the surgeon may have been involved in conduct that is questionable by professional standards.

Ask your surgeon, “What is the worst LASIK result you ever had? How did you handle it? What is the patient's vision today? Are they still your patient?” Even if the LASIK surgeon has really only had excellent results, there should be one case that stands out in his or her mind as the most challenging clinical result. They should be able to clearly tell you what they did to remedy it and how the patient is currently doing. This demonstrates a willingness to discuss things honestly.

Your consultation findings. You should expect the LASIK surgeon to have carefully evaluated your overall health and eye history, the health of the cornea in particular, the health of the retina and optic nerve, the intraocular pressure, the wavefront measurement (aberrometry), your prescription with and without drops, the stability of your prescription, the size of your pupils, the shape of your cornea measured by topography, the thickness of your cornea measured by pachymetry, the quantity and quality of your tearfilm and most importantly, your personal goals for having the surgery. The LASIK surgeon should be able to check off these criteria and explain that they have been examined and why you are or why you are not a good candidate for eye surgery.

Review of risks and complications. The LASIK surgeon should be able to candidly review the risks and complications with you, and explain how they might or might not apply to your individual situation. This discussion may include a complete review of the Informed Consent document that will give you a chance to ask any additional questions that you may not have thought of during your consultation.