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How Do You Choose a LASIK Surgeon?
A No-Nonsense Discussion

Dr. Joseph King is the Official LASIK Surgeon of the Vancouver Canucks.

Once you've decided that you are ready to see clearly without glasses, where do you go? For someone who is not in the field of laser vision correction, the process of selecting a LASIK provider can be more than a little confusing. Making a direct comparison between LASIK providers can be difficult because there are many ophthalmologists who perform LASIK that use different laser systems. You might ask your optometrist for a referral but find that you were referred to a particular clinic simply because your doctor has a business or financial relationship with that center. It is often a good idea to perform your own research in order to make an informed decision. After all, you only have one set of eyes during your lifetime. Choose carefully. Here are some tips to help you make a wise choice. The following frank and straightforward tips will help you have a better understanding of your options when making your choice regarding LASIK surgery.

A Surgeon's Experience

First, the amount of experience a surgeon has is one of the most important factors in determining the quality of care you will receive and obtaining a favorable outcome. Although LASIK is generally a very safe procedure, you will want a very experienced surgeon to perform the procedure. A more seasoned LASIK surgeon is not only less likely to experience complications, but is also more likely to be skilled and knowledgeable about how to manage those complications. Every surgeon will come across complications on occasion; they arise during all kinds of surgical procedures. However, the manner in which complications are managed can have a huge impact on the outcome.

Several published medical studies have shown that patients who receive treatment from surgeons with higher average annual caseloads have decreased complication rates compared with patients of surgeons who perform fewer procedures. Increased surgical experience has been proven to correlate with safer surgery and better outcomes. Just as a violinist may improve his or her skill with practice, a surgeon also refines his or her surgical skill with repeated performance of the same procedure. Additionally, a surgeon who has performed more procedures is also more likely to have managed rare complications in the past. Just as you would prefer a highly seasoned pilot as captain instead of an amateur pilot if a problem arose while on an airline flight, an experienced surgeon may make the difference in appropriate management of complications, whether during or after a procedure. In some cases there is only a small window of time for the right decision to be made. Good surgical judgment and experience are usually related and a careful, conservative approach is safest.

How can you determine a surgeon’s experience? The most important factor is how many times the surgeon has performed the same procedure. There is a big difference between performing LASIK surgery and other types of eye surgery. Eye operations such as cataract surgery and retinal surgery are completely distinct from refractive surgery and often use different instruments, techniques and staff. If a LASIK surgeon claims to have performed " X number of procedures" this may be a red flag because he or she may be lumping together all procedures that he or she has ever performed, including those that have absolutely nothing to do with refractive surgery.

Often, surgeons who claim to have performed “X number of procedures" without specifically stating "LASIK procedures" may be new or relatively inexperienced LASIK surgeons who may not want to state their limited experience with LASIK. To the layperson, it might seem better to read that a LASIK surgeon has performed 5,000 procedures, even though just 100 of those were LASIK procedures. Be sure to be persistent with your questioning and ask specifically how many LASIK, PRK or IntraLase procedures the doctor has performed. Settle for nothing less.

Another red flag includes the claim that a "laser center" is the "most experienced center" in a certain geographic area or that a "center has performed" thousands of procedures. LASIK centers don't perform the procedures, surgeons do. Such statements might be misleading in an attempt to mask the fact that their current surgeons may not be very experienced. Some practices may have been in existence for a long time, but often times, several surgeons have come and gone since its inception.

Many ophthalmologists advertise LASIK as part of a general ophthalmology practice. Most ophthalmologists who perform LASIK are general ophthalmologists who may perform LASIK on a very limited or part time basis as a small part of their comprehensive ophthalmology practice. Often, they will use a mobile laser that is delivered to their office once a month. On the other hand, there are refractive surgeons in some major cities who exclusively practice laser vision correction. These refractive surgeons usually perform more LASIK procedures in a single week than the national average number of LASIK procedures performed by all ophthalmologists in an entire year. Such a high level of experience may make all the difference in terms of your care and results.

In any area of human endeavor, to become good at what we do, practice is needed. In nearly every area of medicine, including areas like cardiac surgery, breast cancer treatment or bone marrow transplants, patients usually do better in specialized treatment centers. The keys to excellence in surgical outcomes are repetition and routine standardization. Repetition makes procedures routine and effortless. Patient outcomes can be complex on occasion and with experience, complication management becomes automatic and efficient. In nearly every city, it can be easy to find an ophthalmologist who performs LASIK as part of a general ophthalmology practice. There are relatively few surgeons who specialize exclusively in LASIK, and even fewer surgeons who have the experience of many tens of thousands of procedures. The surgeons at King LASIK specialize in and perform only laser vision correction. It’s what we do, day in and day out.

Some laser centers employ technicians instead of physicians to routinely perform pre- and post- operative eye exams. Patients’ eyes may not be dilated prior to refractive surgery and this may lead to inaccuracies in treatment as measurement of the patient’s prescription while dilated provides key information for surgical planning. Please be sure to demand a complete eye exam prior to agreeing to undergo vision correction surgery.

Equipment and Technology

In addition to a surgeon’s experience, the next most important consideration includes the technology used during the procedure. Traditionally, LASIK has been performed by using a blade to cut a flap in the cornea, whereupon a surgeon will reshape the cornea based on a patient's prescription. Newer technology has made the procedure safer and more accurate than ever before. The most advanced treatment available today is a Wavefront-guided laser vision correction procedure that creates a flap with a laser. Most laser-made flaps are created using the IntraLase laser.

The VISX Star4 laser is the most advanced laser available. It performs true Wavefront-guided treatments. A Wavefront-guided treatment is the only way to customize the treatment for an eye. Other lasers are available. Some laser centers may advertise the term "Wavefront" but the actual treatment may not be based on the Wavefront analysis of your eye. Confusing terms such as "wavefront optimized" or "zyoptix tissue saving" are sometimes used by some laser companies. Neither of these procedures are true Wavefront-guided treatments. Always ask to see your Wavefront analysis and the treatment plan for your vision correction. It's OK to ask for copies of these studies as well. Wavefront testing is just one important part of the pre-op exam. Your eyes should be dilated during your pre-op exam, not only to accurately plan your treatment, but to also rule out eye diseases that could be missed if the eyes are not thoroughly examined. Some centers do not routinely dilate patients’ eyes during the pre-op exam. If your eyes are not dilated as part of a pre-op exam, this is a large red flag that your exam is not complete.

The new laser flap creation method, Blade-Free IntraLase, was designed with safety, precision, and comfort in mind. IntraLase has allowed even some patients previously deemed non-candidates to undergo the procedure. Though a blade-made flap remains an option for many, patients still find comfort in the choices new technologies now offer. Whichever method you choose, if a surgeon doesn’t at least offer an option of a laser-made LASIK flap, they may not have invested in the most advanced technology.

» Print chart below (PDF)

 

Criteria to consider: Why King LASIK Other
Laser Centers
Other
Laser Centers
Experience Experience Experience Experience
How many laser eye surgeries has the
surgeon performed?
75,000+    
Expertise Expertise Expertise Expertise
Has the surgeon done an additional formal
one to two year long post residency training
at an accredited university with training
in laser vision correction?
YES    
Has the surgeon done research in the field
of refractive surgery?
YES    
Does the surgeon lecture to other doctors
on the subject of laser eye surgery?
YES    
Does the surgeon train other doctors how
to perform laser eye surgery?
YES    
Is the surgeon a member of the American
Academy of Ophthalmology and the American
Society of Cataract and Refractive surgery?
YES    
Is the surgeon board certified by the
American Board of Ophthalmology?
YES    
Is the surgeon board certified by the Royal
College of Surgeons Canada?
YES    
Precisions Precisions Precisions Precisions
Do the doctors perform full eye examinations
including a dilated eye exam?
YES    
Is Wavefront Analysis performed? YES    
Does the center have in-house optometrists
who are experienced in the field of laser
eye surgery?
YES    
Do the doctors at the center provide complete
information to you and give complete
answers to all of your questions regarding
laser eye surgery?
YES    
Are eye pressure measurements taken? YES    
Is computerized corneal topography offered? YES    
Does the doctor require the patient to not wear
contact lenses for a period of time before the
examination that determines final treatment
calculations?
YES    
Does the doctor base treatment prescription on
dilation (cycloplegic) refractive errors as well
manifest refractive error?
YES    
Does the doctor measure the thickness of the
cornea prior to making a recommendation?
YES    
Technology Technology Technology Technology
Does the center own its own state-of-
the-art laser with Wavefront-guided capability?
YES    
Does the doctor have laser "eye tracking"
technology to ensure the patient’s safety
when (not “if”) the eye moves during
the procedure?
YES    
Does the center own a microkeratome
used only by the center's surgeons
and use new blades for every patient?
YES    
Does the center specialize only in laser
eye surgery and nothing else?
YES    
Convenience Convenience Convenience Convenience
Does the center have flexible hours,
including evenings and Saturday hours?
YES    
Affordability Affordability Affordability Affordability
Does the center offer various financing
options, including interest-free financing?
YES    
Does the center provide affordable
pricing with the highest quality of care?
YES    

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