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USAEyes'
50 Tough Questions For Your Lasik Doctor
A detailed guide to selecting a Lasik surgeon who has not been certified
by USAEyes.
By Glenn Hagele
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The primary key to a good outcome is a good doctor. Our
Tough Questions help you evaluate a potential doctor.. |
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If you are seriously considering Lasik, Bladeless Lasik, PRK, LASEK, Epi-Lasik, CK, P-IOL, RLE, or any other refractive surgery technique, you need to
first and foremost consider the qualifications and experience of
your potential doctor. The doctor is even more important than the
medical devices used. No amount of technology can compensate for
an inferior doctor.
We help patients find the better doctors by evaluating and certifying
refractive surgeons. Click Certified Lasik Surgeon to learn if a USAEyes Certified
Refractive Surgeon is available near you. If a CRSQA evaluated doctor
is not available or you want additional options, we have created
this list of questions to help you evaluate any potential doctor.
You may also want to visit the state Medical Board to verify if there have been any problems
with the doctor's license that allows him or her to perform Lasik
laser eye surgery.
Do not expect your prospective doctor to respond with
our suggested answers for every question. Some are more important
measures of ability than others. Use your own common sense. Ask
for proof of all claims. Measure the willingness to respond as much
as the response. The doctor should offer to make arrangements for
any requested test or examination that the doctor does not normally
provide.
If you do not completely understand the relevance of any of these
questions, use the links provided or search our website for more
detailed information. Best of luck in your quest for an excellent
doctor.
-
The Council for Refractive Surgery Quality
Assurance's
50 Tough Questions For Your Lasik Doctor
and suggest responses.
- How long have you been performing refractive surgery?
Not less than three years.
- How many refractive procedures have you performed total, excluding
mechanical surgeries like RK, ALK, and AK?
Not less than 500.
- How many refractive procedures have you performed in the last 12
months?
Not less than 250
- How many refractive procedures of the exact type you intend to use
for me, with the same equipment, and the same refractive error, have
you performed?
Not less than 100. This is a very important question. Even a doctor
who has thousands of surgeries behind him or her is a rookie when using
new technology, new technique, or a new refractive error correction.
You don’t want eye surgery from a rookie.
- What percent of your refractive surgery patients receive Snellen Uncorrected Visual Acuity (UCVA) of 20/40 or better?
According to our Quality Standards Advisory Committee (QSAC), about 90% is the norm.
If the doctor gives a higher number, ask for proof.
- What percent of your refractive surgery patients receive UCVA of 20/20 or better?
About 65% is the norm according to QSAC. If the doctor gives a higher
number, ask for proof. If you have high myopia (greater than about 10.00 diopter), high hyperopia (greater than about +3.00 diopter), and/or high astigmatism (greater than about 2.00 diopter or more than half the
myopia or hyperopia) expect the probability of achieving uncorrected
20/20 to be lower.
- What percent of your refractive surgery patients report unresolved complications six months after surgery? This includes objective
and subjective complications such as halos, starbursts, dry eye, etc.
Less than 3% is the norm according to QSAC, with less than 0.5%
being serious complications that require either extensive maintenance
or invasive treatment. If the doctor gives a lower number, ask for proof.
Zero or a nebulous "almost never" should be cause for concern. No doctor
is perfect. No surgical procedure is perfect.
- What percentage of refractive surgery candidates do you decline?
Don’t be surprised if a solid number isn't readily available. The
only wrong answer would be "none". Patients being properly screened
away from refractive surgery indicates a doctor who is conscientious
about providing refractive surgery only when it would meet the patient's
needs.
- Have you had a successful refractive surgery malpractice claim of
greater than $30,000? Details if yes.
Not more than one for every 500 refractive surgeries. That's a 99.5%
success rate. Not more than five in the last five years, even if the
doctor has performed tens of thousands of surgeries. Discuss with the
doctor the circumstances of any malpractice case. Consider how they
were handled and how the circumstances may apply to you.
- Will you perform a wavefront technology diagnostic (not wavefront guided ablation) of my higher order aberrations prior to recommending refractive surgery?
The answer should be yes as this is a very important evaluation,
however not every doctor has the equipment to perform this test. The
doctor should be willing to arrange for wavefront diagnostic at a different
location and at your expense. Remember that this question is about a
wavefront diagnostic evaluation preoperatively, not about wavefront
guided laser ablation.
- What percentage of your pervious patients have had enhancement surgery? Explain your enhancement policy.
Under ten percent is a ballpark number but the "why" is much more
important than the percent. The doctor should explain his/her philosophy
on enhancement. Techniques such as overcorrection for accommodation of regression should be discussed.
You don't want a doctor who will almost never perform an enhancement,
but you also don't want a doctor who must perform enhancements too often.
- What is the worst refractive surgery outcome experienced by your
own patient? How was it handled?
You want a doctor who knows how to get you out of harms way if something
unusual occurs. You want a doctor that is cool under fire and is willing
to work with other ophthalmologists who may have specific expertise
outside of your doctor's realm of experience. All doctors with enough
surgical experience have had a poor outcome. You need to feel comfortable
that this particular doctor can handle problems appropriately. If your
doctor says s/he has never had a poor outcome or a problem, politely
excuse yourself to the nearest exit.
- If you intend to use an excimer laser, is it broad-beam, variable spot, or flying spot?
The type of laser beam may be very important or may mean very little,
depending upon your individual circumstances. Depending upon your circumstances,
only a flying spot laser would be appropriate or maybe any laser would
do. The laser used is much less important than the doctor’s proven abilities.
An inexperienced doctor with the fanciest equipment is worse than the
best doctor with an older laser. All good doctors understand the limitations
of their tools and techniques and will not perform surgery (no matter
what the laser) if there is not a high probability of you receiving
a good outcome.
- Have you ever had malpractice insurance coverage denied?
Answer should be no.
- Are you currently under investigation by the agency that provides
the license that allows you to perform refractive surgery? Has this
license ever been revoked, suspended, or otherwise restricted? Are you
on any sort of license probation.
Generally, the answer should be no, but if there are any licensing
concerns, consider the circumstances. As an example, a doctor who five
years ago was fined a few hundred dollars for an advertising problem
may not need to be automatically excluded. Surgeons new to that state
may be on probation for a period of time. Discuss any licensure issues
with the doctor and come to your own conclusion about disqualification
as a potential doctor.
- Have you ever had hospital or surgical facility privileges revoked?
Answer should be no.
- Have you ever had your Drug Enforcement Agency (DEA) certification
revoked, suspended, or otherwise restricted?
Answer should be no.
- Have you ever been convicted of a felony?
Generally, the answer should be no, but discuss the circumstances
and come to your own conclusion about disqualification as a potential
doctor. A problem 20 years ago when a college student may not be germane
to today.
- Have you ever been arrested for being under the influence of, or
in the possession of, any controlled substance?
Generally, the answer should be no, but discuss the circumstances
and come to your own conclusion about disqualification as a potential
doctor. A problem 20 years ago when a college student may not be germane
to today.
- Have you ever been treated for substance abuse or mental illness
as an adult?
Generally, the answer should be no, but discuss the circumstances
and come to your own conclusion about disqualification as a potential
doctor. A problem 20 years ago when a college student may not be germane
to today.
- Have your ever been refused participation as a provider in a health
insurance plan?
Answer should be no, except in the case of managed care, which excludes
doctors for reasons other than medical competency.
- Is the laser and equipment you will use specifically approved by
the Food and Drug Administration (FDA) for the recommended procedure
and intended parameters? If no, explain why it is not FDA approved and/or
off-label use.
The equipment should be FDA approved (hardware and software). The
parameters may not be FDA approved. Surgeons are legally able to use
FDA approved tools beyond FDA approved parameters in some circumstances.
This is called off-label use and should be discussed with your doctor
if applicable to your circumstances.
- If an enhancement surgery is required, what will you charge for the additional
procedure?
Answer should be no charge for an enhancement within a specified
period of time, usually about a year after surgery. If there is a charge,
consider the affordability if needed.
- If another doctor will be comanaging pre- and/or postoperative care, can I see you at any
time without my comanaging doctor’s authorization?
The answer should be yes. You should be able to go directly to the
surgeon at any time you feel it is appropriate.
- What should I expect my vision to be like for the first few weeks
after surgery?
The answer should include an explanation of minor fluctuations, regression, minor halos, minor starbursting, etc. These side-effects may occur, but normally resolve
during the six-month healing process.
- Will you perform a complete refractive examination including evaluating
the medical health of my eyes both before and after surgery?
The answer should be an unqualified yes and the medical component
of the exam must be performed by an ophthalmologist (medical eye doctor).
- Will my vision fluctuate after surgery? How long is the healing
period?
If the doctor says, "Twenty minutes and all will be fine" you may
want to move on. The surgery is quick but the healing and fluctuations
may continue for months or longer. Refractive surgery is more of a six-month
process than a 20-Minute Miracle even though it is possible you will
have perfect vision immediately after surgery.
- Will you perform a contrast sensitivity test before and after the
surgery?
The answer will probably be no, but should be yes. Contrast sensitivity
testing is not currently routine and not all doctors have the technology
available. Your doctor should offer to arrange for you to receive this
test at your expense at another location.
- Will you perform a glare sensitivity test before and after the surgery?
The answer will probably be no, but should be yes. Glare sensitivity
testing is not currently routine and not all doctors have the technology
available. Your doctor should offer to arrange for you to receive this
test at your expense at another location.
- Will you perform corneal topography before and after the surgery?
The answer should be yes.
- If you recommend Lasik, will you use a laser to create the flap or a mechanical microkeratome?
The femtosecond laser
may be a better alternative than a flap created with a blade, however
not all doctors have this equipment and it is not always be required.
Like the different types of excimer lasers, it may be that only a laser
created flap will be appropriate or a microkeratome created flap will
be fine. Discuss this with your doctor.
- Will you perform a test to determine tear volume (Schirmer) and
tear breakup test (TBUT) prior to making a recommendation about surgery?
Answer should be yes. These tests help determine if you have unusually
dry eyes.
- Will you measure the size of my pupils when naturally dilated in
a dimly lit room prior to making a recommendation about surgery?
The answer must be yes. This is an important test to determine if
you my have a higher than normal probability of postoperative problems
in low light environments. Dilation needs to be natural and without
medication. The ruler method will work but the infrared pupilometer
method is better. more
- Will you use a different microkeratome blade (Lasik only) for each
eye?
The answer may be yes, but many doctors use one blade for both patient's
eyes. You may request a new blade for each eye, but don’t be surprised
if the doctor asks you to pay a little more for the extra blade.
- Will you require me to be without contacts for a period of time
before the examination that will determine final calculations for surgery?
What is this period of time?
The answer must be yes and for a significant period of time. We
recommend four weeks without soft contact lenses, longer for hard contacts.
Some doctors feel two weeks or even a few days is enough, we recommend
longer. You want your surgery calculations determined after your cornea
has returned to its natural state, no matter how long that takes.
- Will my treatment prescription be based on cycloplegic refractive error as well as manifest refractive error?
The answer must be yes. Manifest examinations are always necessary,
but the eye will "focus around" some error that cannot be measured unless
a cycloplegic exam is also performed.
- Will you measure the thickness of my cornea prior to making a recommendation about surgery?
The answer should be yes.
- If an excimer laser is to be used, what size will be the optical
ablation zone not including the transition zone? Is this larger or smaller
than my naturally dilated pupil?
If the answer is less than 6.0mm or less than the size of your naturally
dilated pupils (whichever is greater), ask for a clarification and discuss
additional risks for low light aberrations such as halos, starbursts,
glare, etc. more
- Is a patient with more than ten diopters myopia, more than three
diopters hyperopia, or more than two diopters astigmatism a good candidate
for refractive surgery?
The answer must not be ideal, excellent, or anything of the like.
Although correction at these levels can be accomplished, someone with
this level of refractive error is not an "ideal" candidate and has a
lower than average probability of success.
- How often and when will you perform postoperative examinations?
Should be not less than the day after surgery, one week, 30 days,
90 days, and six months - or more if required. These exams might be
performed by an eye care professional other than the surgeon.
- When will you provide me with a copy of your written informed consent?
The doctor should offer to provide a copy immediately upon asking
this question. A week before surgery is adequate. You need to read and
understand every component. This is not just a legal formality, but
an explanation of what can happen.
- Will you provide contacts for me to wear to simulate monovision prior to surgery? How long will you want me to wear these
contacts before I make my decision about monovision?
Contacts should be provided free with at least four weeks wearing
time before monovision decision must be made.
- Will you provide me the names and contact information of at least
ten previous patients who have had the exact same surgery with similar
refractive error?
Answer should be yes, and doctor should already have such a list
compiled. Don't expect to get a list of dissatisfied patients, but these
people can tell you what going through the procedure is like. You may
want to talk with patients who had surgery recently and some who had
surgery several months ago.
- Will you allow me to observe a surgery?
Answer should be yes, however operating suite access restrictions
may preclude surgery observation.
- Does my occupation, leisure activities, and hobbies have any bearing
on my candidacy for refractive surgery?
Answer should be yes. People who require exacting and detailed vision
or rely heavily on good low light vision are possibly not good candidates
for refractive surgery and should be screened appropriately.
- Does my general medical and medication history have any bearing
on my candidacy for refractive surgery?
Answer should be yes. Some conditions that have nothing to do with
the eyes may complicate some types of refractive surgery. more
- Does being pregnant or contemplating pregnancy have any bearing
on my candidacy for refractive surgery?
Okay guys, you don't get ask this one but all women of child bearing
age should ask. Fluctuations in refractive error are often related
to pregnancy and lactation. more
- Who will pay for multiple corrective lenses if I experience fluctuation
in visual acuity while healing?
Whatever the answer, consider this as a part of the cost of the
surgery.
- Are there any reasons why I would not have excellent refractive
surgery results?
A blanket question to provide you and your doctor an opportunity
to discuss in more detail what you can reasonably expect from the proposed
surgery. Whatever the answer, it needs to be the same as what you perceive
to be an excellent result. If you cannot reasonably expect to receive
what you consider to be a successful result, don’t have surgery.
- What certification do you hold, if any, from the American Board
of Ophthalmology, American Board of Eye Surgery, and/or the Council
for Refractive Surgery Quality Assurance (USAEyes)? If not all, why?
It may be important for you to know if the doctor desires the additional
oversight of these organizations. Some are more valuable than others
The American Board of Ophthalmology (ABO) does not provide any evaluation
specific to refractive surgery. Certification is valid for a lifetime,
or 10 years if recently certified. ABO certification would be conspicuous
by its absence, but not terribly important by its presence.
The American Board of Eye Surgery (ABES) is an ophthalmic group that
provides procedure specific certification. They do have peer-reviewed
certification for Lasik, and RK, but not PRK, LASEK or any
other refractive procedure. ABES Lasik certification is valid for seven
years.
The Council for Refractive Surgery Quality Assurance (USAEyes) is a nonprofit
consumer/patient organization that evaluates a doctor based upon actual
patient outcomes. The doctor is reevaluated every three months.
Consider the relevance and value of these and other certifications the
doctor may have achieved.
Looking For Best Lasik Surgeon?
If you are ready to choose a doctor to be evaluated for conventional
or custom wavefront Lasik, Bladeless Lasik, PRK, or any refractive surgery procedure, we recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization.
Locate a USAEyes Evaluated & Certified Lasik Doctor.
Personalized Answers
If this article did not fully answer your questions, use our
free Ask Lasik Expert patient forum.
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