Questions to Ask Your Surgeon
Once you have the names of refractive surgeons, the next step is to find out more about their credentials, reputation, and practice. Don’t be shy about asking penetrating questions. LASIK surgeons understand that patients have many questions about them and about the procedure, and they should be prepared to answer the questions for you. When you find a doctor with promising credentials, call the office and ask to speak with the LASIK coordinator or a staff member who can answer your questions.
What Are the Surgeon’s Credentials?
Consider only surgeons who are board certified. What does this mean? In addition to the medical education, internship, and residency program mentioned earlier, ophthalmologists must pass a series of exams given by the National Board of Medical Examiners; they must also pass two additional examinations administered by the American Board of Ophthalmology. After passing these final exams, physicians are certified by the American Board of Ophthalmology. About 90 percent of ophthalmologists eventually pass these exams, so the designation “board-certified” does not help you separate outstanding surgeons from merely good ones. However, lack of board certification is a warning sign- it means the doctor is in the bottom 10 percent of ophthalmologists in knowledge of the field.
Some ophthalmologists are fellowship-trained cornea or refractive surgeons. This means they have been offered one or two years of extra training in diseases and surgery of the cornea under supervision of leading physicians in the field. Fellowship-trained surgeons will likely have a lower incidence of complications, because they can diagnose subtle finding prior to surgery.
How Many LASIK Procedures Has the Surgeon Performed?
Be specific in asking about a physician’s experience with LASIK, because other laser procedures require skills different from those required for LASIK. Because there is a learning curve, surgeons should have performed a minimum of 1,000 LASIK procedures; research shows that the complication rate for surgeons is reduced even further after they perform 3,000 procedures.
It generally takes that many LASIK procedures before a surgeon’s nomogram is reasonably well developed. The nomogram refers to the formula the surgeon enters into the excimer laser computer for each procedure. Even though excimer lasers come from the manufacturer with recommended settings to correct the various refractive errors, the surgeon fine-tunes and customizes these settings with the nomogram. Based on a series of measurements the surgeon takes during the preoperative exam, the nomogram includes factors such as the degree of refractive error and the patient’s age. It also takes into consideration the surgeon’s own technique and the type of laser he or she will use. A well-developed and artful nomogram allows the surgeon to more accurately program the laser for each patient, increasing the likelihood of perfect vision.
How Many Procedures Has the Surgeon Performed on Patients with Your Refractive Error?
Perhaps as important as the total number of LASIK procedures a surgeon has completed is the number he or she has performed on patients with the same refractive error as yours, using the same laser equipment. The surgeon should have completed 100 or more such procedures. Even an experienced surgeon could have difficulty with certain less common refractive errors. And new equipment takes some getting used to as well. Additionally, the surgeon should have experience with patients of your age and race- relevant because the surgical techniques needed to correct refractive errors in these groups may differ slightly.
Ask to Speak with Former Patients
Ask a prospective surgeon for the names of two or three patients you can contact who had a refractive error similar to yours. This is not an unusual request. When you speak with them, ask how they felt about the surgeon, the staff, and the quality of their LASIK experience.
How Does the Surgeon Track LASIK Procedure Outcomes?
The surgeon’s response to this question will reveal much. If the surgeon has readily available statistics in the form of charts and graphs, he or she is most likely benchmarking, or tracking, LASIK outcomes. In addition, if the surgeon presents his or her data to other surgeons at well-respected national or international conferences, or publishes in professional journals, you can be confident that he or she is tracking outcomes.
Benchmarking is very important, because it indicates the surgeon is concerned about achieving the best possible results over time. There is no mandatory central reporting database for tracking LASIK outcomes, unless a surgeon is participating in a sanctioned clinical trial. Therefore, a surgeon’s doing so voluntarily indicates high personal standards of professionalism and performance.
It is important in tracking data that your surgeon has performed a statistically significant number of procedures. With data from 3,000 or more procedures, your sugeon would be able to predict outcomes fairly accurately.
What Are the Surgeon’s Success and Complication Rates?
The surgeon should be able to give you the percentage of LASIK patients whose procedures result in 20/20 vision or better. It’s normal for more than 80 percent of LASIK patients to achieve this level of vision. In fact, with wavefront-guided treatment, which uses newer diagnostic technology, most patients in a top practice today have a 95 percent chance of achieving 20/20 vision. With data based on 1,000 or more procedures, your surgeon should be able to tell your chance of achieving a good result with LASIK an whether you will need an enhancement procedure. Ask what percentage of LASIK patients report significant complications. Less than 1 percent is acceptable. Keep in mind that most complications, if they do occur, can be managed by an experienced surgeon.
Has the Surgeon Participated in Research Activities, Lecturing or Writing?
Doctors who have researched and written articles for peer-reviewed journals, been speakers at medical conference, and /or published books are usually well respected among their peers. This is an indication of a physician’s experience and competence. This level of professional involvement, above and beyond his or her ophthalmology practice, shows the doctor’s mastery of, motivation in, and passion for the field.
Has the Surgeon Ever Participated in an FDA Clinical Trial?
The U.S. Food and Drug Administration (FDA) authorizes some ophthalmologists to participate as principal investigators in clinical trials sponsored by laser manufacturers. A clinical trial is a research study, conducted with patients, that is designed to evaluate the safety and effectiveness of a new procedure or device. Typically, FDA- authorized ophthalmologists are chosen because of their demonstrated skill and ability and their complete understanding of laser vision correction and the laser being used. These surgeons are subject to detailed analysis and reporting and are willing to endure extreme scrutiny.
Not that an ophthalmologist may have never been asked to participate in a clinical trial, yet may be very competent to perform LASIK. Still, if you’ve found a surgeon who has participated in a clinical trial, you’re more likely to have found one of the best.