We understand that most people have a choice
in refractive surgeons in their area and make an effort to
determine which doctor they should choose. We provide a list
of questions for you to ask your doctor and information that
will help you gauge your doctor's responses. The decision
regarding a surgeon is a very personal one, and ultimately,
patients need to decide for themselves how comfortable they
are with any answers they receive from their surgeons.
 |
How many LASIK procedures have you performed? |
 |
Several studies have shown that there is a learning
curve associated with this procedure.1-4
The rate at which an individual surgeon progresses
through the learning curve differs as there are many
variables which must be taken into account. The number
of procedures performed and length of time practicing
the procedure are only two. It is important for you
to gain an overall sense of the surgeon's experience
with the procedure, the equipment to be used and treatment
of corrections similar to your own. Your doctor's answer
to this question is just one piece of information to
evaluate.
Top
|
|
I understand benchmarking is important.
What pre-operative and post-operative factors are you
currently tracking or have tracked in the past as you
went through the learning curve? |
|
While there is no right or wrong answer to this question,
the depth of the surgeon's answer will give you an idea
about the relative seriousness that the surgeon places
on the matter.
Top
|
|
What are the outcomes you are achieving? |
|
According to figures submitted to the US FDA, at six
months post-operatively, approximately 93% of patients
achieve 20/40, and 56% achieve 20/20. Answers close
to these demonstrate the surgeon is close to achieving
or exceeding benchmark outcomes. Remember that these
figures are from old studies and many surgeons are experiencing
much higher success rates today. It may be more beneficial
for patients to focus more on finding a doctor who benchmarks
than worrying about tenths of percentage points.
In the event that a surgeon says they do not have the
resources to formally track their benchmarks, consider
asking the following:
Top
|
|
Has anyone on your staff had the surgery,
and are they available to answer questions? Do you provide
a list of patients I can contact? |
|
Given circumstances related to staffing or volume at
some practices, providing formal statistics on outcomes
may be difficult. An alternative to the formal results
would be to discuss the individual experience with staff
members or previous patients. While you will probably
not speak with unhappy patients, you may get some insight
into happy patients' decision-making process and their
choice to be treated by the doctor.
Top
|
|
What is your complication rate? |
|
According to several large studies, there is approximately
a 2% intra-operative and 3-5% post-operative complication
rate. Most of these complications do not result in loss
of 2 or more lines of best corrected visual acuity or
interfere with vision long term. The rate of severe
complications should be substantially less than 1%.
It is important for patients to understand that LASIK
is surgery, and a small incidence of complications is
to be expected.
Top
|
|
How many eyes that you have treated
have lost 2 or more line of best corrected visual acuity,
and were there any unusual circumstances? |
|
Most complications related to LASIK do not result in
significant loss of BCVA. However, surgery on eyes with
other complicating factors may be more likely to result
in significant loss of BCVA
Top
|
|
How many LASIK procedures do you perform
each month? |
|
Patients need to feel comfortable with the volume a
practice does. Some patients may prefer a practice with
a great deal of access to the surgeon. Others may prefer
a high volume practice where LASIK is the only procedure
performed. Still others may choose an option somewhere
between these. A patient's comfort level with volume
is very personal, and patients must determine for themselves
what is important for them.
Top
|
|
What percentage of patients do you reject?
|
|
Doctors should turn away patients if they are not good
candidates. Some patients will have medical or anatomical
conditions that contraindicate surgery. Other patients
have unrealistic expectations, and a physician would
decline to perform surgery if a patient would not be
satisfied with the outcomes. This is a somewhat unusual
question and therefore you should not be surprised or
upset if your doctor does not have the answer immediately
available.
Top
|
|
In the event I have a question regarding
my outcomes, who do I go to for answers? |
|
Some patients prefer a great deal of contact with their
surgeons. Others feel more comfortable dealing with
nurses or refractive surgery coordinators. Patients
must gauge their own needs with respect to access to
the surgeon.
Top
|
|
In the event I have a question regarding
my healing, who do I go to for answers? |
|
Some patients prefer a great deal of contact with their
surgeons. Others feel more comfortable dealing with
nurses or refractive surgery coordinators. Patients
must gauge their own needs with respect to access to
the surgeon.
Top
|
|
What laser do you use? |
|
In the United States, it is illegal to use a laser
other than one that is FDA approved outside of clinical
trials. Many fine instruments are permitted for use
in other countries that are not permitted in the US.
You should check with your country's government agency
responsible for approval of surgical devices to see
if there are any similar restrictions in your country.
You should also ask about the age of the laser, updated
features, and its track record.
Top
|
|
How are you going to measure my pupils? |
|
Given that there appears to be a correlation between
wide pupils and the frequency of night vision symptoms,
and that newer lasers offer a range of treatment zone
sizes, it is important that patients obtain accurate
measurements of their pupils. Although the symptoms
of this condition do not necessarily interfere with
visual acuity as it is measured by an eye chart, for
some patients, the experience can interfere with daily
activities and driving at night. Therefore, you want
to be sure that your doctor measures the pupil in both
bright and dim light to simulate day-to-day lighting
situations. Some use a pupil gauge that is compared
to the eye to determine the pupil size. Others use infrared
detectors that can measure the pupil size in the dark.
Top
|
|
What diagnostic tests will you perform
to check for dry eye? |
|
Some patients who seek LASIK have underlying dry eye
syndrome that has not been diagnosed. There appears
to be a correlation between pre-operative dry eye syndrome
and developing more pronounced dry eye symptoms post-operatively.
Therefore, many doctors test for dry eye prior to making
a decision regarding eligibility.
Doctors can detect the possibility of dry eye by performing
a careful pre-operative slit lamp examination (examination
under the microscope) using rose bengal and fluorescein
staining. During this examination, a doctor can assess
the precorneal tear film, check the tear meniscus for
height and debris, and check tear break-up time. If
after this examination the doctor suspects dry eye,
a Schirmer test can be performed to assess the extent
of the condition.All patients should discuss with their
doctors how dry eyes are screened for pre-operatively.
Top
|
|
How do you test to see if my contact
lenses have changed the shape of my cornea? And, if my
cornea has changed shape, what will indicate that I am
ready for surgery? |
|
Contact lenses can temporarily change the shape of
the cornea, and patients should understand that operating
on a cornea that is not in its natural shape can affect
outcomes and create complications. Therefore, the vast
majority of patients who have worn contact lenses will
need to keep their contact lenses out of their eyes
for some period of time before surgery so that the cornea
can return to its natural shape.
The amount of time it will take for the cornea to return
to its natural shape will depend upon a number of factors.
These include the kind of contacts worn (soft, hard,
gas permeable), the number of hours a day the contacts
have been worn, and how long you have worn them over
your lifetime. It can take three days to several months
without wearing contact lenses before you are ready
for the operation. Generally speaking, patients who
have worn hard or gas permeable contacts for long periods
of time throughout the day for many years will need
to be without them for several weeks or longer.
A corneal topography examination will be used to determine
if your cornea has been affected by contact lens wear,
and if it has, when it has returned to its natural shape
and surgery is indicated.
Top
|
|
What other diagnostic tests will you
perform pre-operatively? |
|
Your corneal profile needs to be carefully evaluated
in order to determine if you are eligible for LASIK.
Therefore, patients interested in refractive surgery
should receive a complete eye examination, including
a dilated eye exam, corneal topography and pachymetry
(corneal thickness measurements) as part of their evaluation.
Top
|
|
May I observe a surgery? |
|
Viewing a surgery provides patients with a first-hand
look how the doctor operates and can be very helpful.
However, patients should understand that sometimes viewing
a surgery is not possible, given logistics and space
within a particular practice.
We would also recommend that patients look to ophthalmic
boards and societies regarding licensure and professional
records. Taking this route ensures that patients achieve
an honest and accurate profile of the surgeon's professional
history and those circumstances directly related to
their medical practice. Patients need to decide for
themselves how comfortable they are with any answers
they receive from their surgeons.
Ask for specifics about the doctor's training, practice
pattern, and career. If a claim is made about the doctor
being a "developer" of the technique, performing
important research, giving lectures, or teaching, ask
for specifics. Truthful positive answers to these items
may indicate a doctor who is truly up-to-date and skilled;
vague answers may indicate that these claims are not
very accurate.
Finally, if you are seeking surgery in a different region,
you should understand that follow-up appointments are
required at regular intervals following LASIK. Therefore,
you need to make arrangements for post-operative examinations
and care where you reside. Moreover, if a complication
were to arise post-operatively, understand that someone
other than your surgeon would be providing medical attention.
You will, therefore, need to interview ophthalmologists
or optometrists in your region about their experience
with LASIK follow-up and recognizing complications.
Top
|
