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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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