Choosing your surgeon is the most important aspect of making the decision to undergo LASIK.

Patients should seek out surgeons who are sincere, qualified, use quality equipment and processes. LASIK is a surgical procedure, not a product taken off a supermarket shelf. Thus, surgeons of varying skill quality using the same tools will achieve different outcomes. Talented baseball players and golfers use tools to achieve results; the same holds true for surgeons. However, having state-of-the-art equipment does not necessarily make for a talented user of that equipment. It is best to have confidence in your surgeon based on a face-to-face meeting, and to receive reasonable responses to questions you ask.

I. Selecting A Surgeon With Sincerity

Part of being comfortable with elective surgery is to believe the surgeon is sincere. Patients should be given the opportunity to meet with the surgeon to discuss their individual condition before the day of surgery. If a patient meets the surgeon on the day of surgery, the meeting should happen before going into the surgery room. A patient should not be comfortable committing to surgery if he or she has not met or spoken with the surgeon before the procedure.

After meeting the surgeon, a patient should feel the surgeon is cordial, respectful, and caring. A surgeon who rushes in and out of the room during a consultation conveys a different message about patient care than the surgeon who spends time talking to the patient about his or her condition and concerns. Ultimately, you should feel the surgeon has your best interests at heart and really cares.

In elective surgery such as LASIK, there should be ample time to carefully read the informed consent document prior to surgery. The consent form should never be signed under duress.

ASK YOURSELF: How can quality patient care be given if the surgeon is not sincerely interested in you and your goals?

II. Selecting A Surgeon Qualified In LASIK

There are two ways that ophthalmologists learn LASIK:
1. A Fellowship in Refractive and Corneal Surgery
2. A LASIK course taken over one to two days

A Fellowship in Refractive and Corneal Surgery entails a year of advanced training that occurs follows the completion of a 3-year ophthalmology training program. This training promotes better and more individually tailored vision-correction treatments for each patient. In the Fellowship, several principles are taught, including:

• Basic and advanced LASIK techniques
• Determination of good candidates
• Managing postoperative complications
• Other surgical techniques beyond LASIK

Advertising caution: You may hear that a doctor is a "fellow of the American Board of Ophthalmology". This "fellow" designation does not indicate that the surgeon completed a year fellowship in refractive surgery.

It means that the surgeon completed the general ophthalmology exams - not a year fellowship in refractive surgery. One-year refractive and corneal surgery fellowships have only existed for the past seven years or so. Older surgeons who completed ophthalmology training before such fellowships existed are typically trained with a one to two day LASIK course. The course certifies the use of a specific laser and microkeratome and allows a surgeon to treat LASIK patients immediately after course completion.

There are excellent LASIK surgeons trained this way, who have excellent reputations in their communities and were performing refractive surgery prior to the arrival of LASIK on the scene. If you are evaluating a surgeon who has not performed a one-year refractive and corneal surgery fellowship, it is appropriate to inquire if the surgeon has performed earlier forms of refractive surgery such as PRK and RK, procedures that existed prior to LASIK.

It is also advisable to inquire whether potential surgeons are contributing to the field through research and/or are teaching other surgeons. You may read in their brochures that they "teach other doctors" and "perform important research". It would be appropriate to ask what they are teaching, to whom, and when? What are they researching, with whom and when? Is this a surgeon who taught glaucoma surgery at a meeting 10 years ago? Or is it a surgeon who is currently teaching the latest refractive surgery techniques to peers? And, is the surgeon being invited to conferences to teach about the latest diagnostic testing and surgical technique?

Excellent surgeons are often recognized through awards and special honors. Does the surgeon's literature list any such distinctions?

You many hear claims about clinic experience such as: "Our center performed more than 40,000 surgeries." If so, consider asking:

• How many were LASIK?
• How many were performed by a specific surgeon?
• How long has the surgeon been at that center?
• What are patient satisfaction levels of that surgeon?

Remember, a surgeon does your procedure, not a center.

A powerful way to determine whether the surgeon you are considering is a leader in the field is to search the Internet using the surgeon's last name. For example, go to www.google.com and type in the last name of a potential surgeon. This may identify attributable research or teaching presentations, or if the surgeon was featured in local or national news about refractive surgery.

Check your surgeon's medical license to see if there were any reports of disciplinary action or suspension by looking up your surgeon on his/her state's medical board web site (which can be found on an Internet search engine).

ASK YOURSELF: How can you be comfortable with the procedure, if you are not confident in your surgeon?

III. Selecting A Surgeon With Quality Equipment

The lasers used in the United States should be approved by the Food and Drug Administration (FDA). A key feature, which differs between FDA approved lasers, is the range of treatment zones. At the time of this writing, the maximum treatment zone is 8.0 mm, but not all lasers are that broad. Large treatment diameters allow treatment of patients with large pupils and higher degrees of nearsightedness.

The flapmakers should be the latest generation, which have a higher safety level than earlier models that are over 5 years old.

The surgical equipment is only as good as the surgeon who uses it.

IV. Selecting A Surgeon With Quality Process

1. Changing into surgical scrubs. Clothes worn outside, in the home, and in the office are not as clean as surgical tops and pants. It is proper surgical protocol to operate in surgical scrubs.

2. Use of Gloves. Bacteria are ubiquitous. These tiny organisms are especially prevalent on the skin, eyelids, and even on the surface of the eye itself. Some bacteria can cause infection, which is why using sterile technique in LASIK is important to minimize the risk of infection by preventing bacteria or bacterial debris from getting under the flap. The most sterile procedure is for surgeons to use separate sterile surgical gloves for each eye of each patient.

3. One or Two Sets of Microkeratomes and Instruments. There are three methods of performing LASIK on both eyes of a patient on the same day.

• Double Sterile: After LASIK is performed on the first eye, a second setup of freshly cleaned and sterilized microkeratome and equipment is used for the second eye. Therefore, each patient has two sets of microkeratomes and instruments.
• Single Sterile: After LASIK is performed on the first eye, the just used instruments, including the microkeratome, are again used on the second eye. In other words, one set of microkeratome and instruments are used on both eyes. Debris and bacteria can be transferred from one eye to the next by use of one set of instruments and blade for both eyes.
• Not Sterile: The same set of instruments and microkeratome blade are used on multiple patients without being cleaned and sterilized. Fortunately, this is not common practice; unfortunately, it still exists.

4. Instrument Cleaning Protocol. The surgical technician is responsible for the maintenance of the instruments. Therefore, all elements, including use and maintenance of the autoclave that heat-sterilizes the instruments, should be accomplished with a high level of meticulous care and diligence. If the autoclave is not cared for properly, bacteria can grow, which can contaminate the instruments with dead, toxic bacteria remnants.

ASK YOURSELF: How can you be confident in the safety process if shortcuts are taken?