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The choice of refractive surgeon is as personal as the decision to have the surgery. Many patients have their ophthalmologist picked out before making the final decision to have the surgery. Others consider the surgery and only begin looking for a surgeon once the decision is made. In this section, we provide patients a few tips to finding area practices and some points to consider when evaluating them. We emphasize that there are no absolute right or wrong answers. Ultimately it is up to the individual to decide which practice offers the style of care that suits their needs.
Begin with Those You Know
A word of mouth network often proves a good initial source of information. You should ask friends, family and associates if they could recommend a surgeon based on personal experience. Consider expanding this circle by speaking with an optometrist with whom you have already developed a relationship.
Extend the Possibilities
By considering outside resources, you can further expand the pool of talent from which to choose.
Our parent organization, the American Society of Cataract & Refractive Surgery provides a listing of their members on line. This list includes both US domestic and international members. We are aware of several physician search directories available on the Internet. You should understand that these directories do not include a complete listing of all refractive surgeons within your area, only those who have elected to participate in this directory. Some of these directories are new and do not have the extensive lists compiled; others charge the surgeon a fee for inclusion and therefore only include those who want to advertise on that site. You might want to seek and search several different directories as you look for a physician, in order to gather a more complete picture of who is performing refractive surgery in your area. Also, please understand that the majority of these sites and referral, not recommendation, sites and do not check physician credentials. Therefore, we recommend you research their credentials thoroughly prior to making a final decision. If you are inclined to use message boards to obtain recommendations, please keep in mind that this forum affords anonymity and, as such, gives people the opportunity to relay information without the responsibility demanded by a face-to-face interaction. In other words, patients should view posted information with a healthy dose of skepticism. Ophthalmic Boards and Medical Associations offer useful information about board certifications, licensures and other pertinent criteria. Even if you have heard of good surgeons from a friend, relative or acquaintance, we would recommend that you check their professional credentials. If you reside in the United States, the following independent agencies and ophthalmic associations can assist you. While they do not list all surgeons performing refractive surgery, they will provide information about a particular surgeon if you give them a name.
You may also want to call your local library or a medical library and ask the reference librarian if the library has the latest edition of the four-volume list of medical practitioners put out by the American Board of Medical Specialties. These volumes list medical specialties by region, and refractive surgery is one of the specialties included.We would also recommend that you contact your local or national ophthalmic associations for their lists of member surgeons. We suggest you contact more than one professional organization, since not all ophthalmologists are members of each organization.
Style of Care
Once you have expanded the pool of possibilities to the extent that you feel comfortable, it is time to narrow the choices to suit your own preferences by interviewing surgeons and looking at practices. Each surgical practice is different, and you should understand how those on your list approach patient care, from the pre-operative protocol through the post-operative visits. For instance, some practices devote themselves entirely to refractive surgery in general and LASIK in particular. These practices operate very differently from those that offer refractive surgery as part of their menu of ophthalmic services. Some practices offer a variety of staff to provide patient care. Others offer extensive surgeon/patient interaction. You need to decide which system works best for you.
We have provided a list of questions that you can ask to help you determine a practice's style of care.
- Is this strictly a refractive surgery center or a full-service ophthalmic practice offering refractive surgery as one of its specialties?
- How many times will you see the doctor prior to surgery?
- Who will be my main contact at the office? (Surgeon? Nurse? Refractive Coordinator?)
- Who performs the follow-up examinations?
- What are the qualifications of the person providing follow-up care?
There are no right or wrong answers to any of these questions. Ophthalmic practices approach patient care differently. The goal is to find a practice with an approach that suits your needs.
Look for Experience
| 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.In order to achieve good results, your surgeon should make every effort to meet or exceed benchmark standards. |
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It is important to note that, generally speaking, surgeons track their outcomes in order to improve their results, and it is up to the ophthalmologists to track and report their own results. Currently, there is no central reporting database of surgical outcomes for this ophthalmic procedure. However, there are various products and services to help surgeons benchmark themselves.
Patients should query surgeons about how they track their outcomes. The surgeon's response can tell you a great deal about him or her. If a surgeon has readily available numbers, charts and graphs or can quote specific outcomes, there is a good chance that this surgeon is benchmarking. Reviewing the information provided in the Expectations section of our web site should help you gain a very general understanding of what is being achieved internationally. However, you will also need to educate yourself about your national benchmarks. Ask doctors if they know what is being achieved nationally or if they know of national resources that provide such information. If your country has a national ophthalmic society, you should contact it directly with the same questions. Then, ask ophthalmologists how long they have been performing LASIK and about their success and complication rates. You will also want to know about a surgeon's experience with refractive errors similar to your own. For instance, if you are a high myope, you will want assurance that your surgeon has adequate experience and success correcting high myopia.
One more note about benchmarking: Given that there is no mandatory central reporting database, it is more important to determine if a surgeon is benchmarking than to worry too much about any one specific number. For instance, we would caution patients not be too worried if your surgeon says that after having done 386 eyes, 88.7% of his or her patient population is achieving 20/40 or better when your national benchmark is 90.0%. The fact that a surgeon tracks outcomes demonstrates his or her concern with achieving the best possible results, and your goal is to find someone for whom achieving excellence is a driving concern.
There are other issues related to a surgeon's patient population about which you should be aware. People over 40 years of age experience presbyopia, the natural deterioration of vision caused by loss of flexibility in the eye's lens as one ages. Post-menopausal women are sometimes afflicted with dry eyes. The physical characteristics of the eye differ among various races. Your surgeon should have adequate experience with people of the same age, gender and race as you because the surgical techniques needed to correct these various groups may differ slightly.
Other Criteria to Evaluate
Beyond the surgeon's experience, patients should investigate and evaluate the following criteria before deciding upon a surgeon:
- Training and education;
- Certifications - board certifications as well as manufacturer certifications on lasers and microkeratomes;
- Professional memberships and important offices held;
- Training and teaching activities;
- Research and writing activities;
- Awards;
- Reputation;
- The equipment the surgeon uses.
Although no single criterion will help you make your choice, a holistic evaluation of the above criteria should help you feel comfortable with the surgeon you choose.
Finally, if at any point in the decision making process you have any doubts about your surgeon or his or her medical opinion, do not hesitate to seek a second opinion.
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