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.
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How many LASIK procedures have you performed? |
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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.
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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? |
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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.
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What are the outcomes you are achieving? |
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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:
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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? |
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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.
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What is your complication rate? |
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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.
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How many eyes that you have treated have lost 2 or more line of best corrected visual acuity, and were there any unusual circumstances? |
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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
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How many LASIK procedures do you perform each month? |
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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.
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What percentage of patients do you reject? |
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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.
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In the event I have a question regarding my outcomes, who do I go to for answers? |
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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.
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In the event I have a question regarding my healing, who do I go to for answers? |
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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.
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What laser do you use? |
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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.
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How are you going to measure my pupils? |
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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.
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What diagnostic tests will you perform to check for dry eye? |
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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.
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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? |
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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.
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What other diagnostic tests will you perform pre-operatively? |
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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.
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May I observe a surgery? |
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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.
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