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,
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
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