NAVIGATING THROUGH THE LASIK LANDSCAPE

Everywhere you turn these days there are LASIK advertisements. It seems like each LASIK center claims it was the first or is the best, and that could certainly be confusing. With such an important decision as choosing where to go for your eye surgery (and these are your eyes we’re talking about!) you want to be sure that you’ve made an intelligent choice. It could be simple to just price compare, but this is not clothing or a household item you are shopping for. As with anything else you get what you pay for. Some cheap LASIK centers would have you believe they also provide superior care but that is simply not true. You may not be able to afford the best car or house, but when it comes to your vision you must insist on nothing but the best! Now the best in LASIK need not be the most expensive, but it definitely isn’t the cheapest. So how do you navigate through the hype and find a LASIK team you can trust will provide the quality you demand? Here we will try to help you learn to navigate your way through the LASIK landscape.

FOUR FUNDAMENTALS OF A REAL LASIK EXPERT

When evaluating a LASIK center one should realize at the outset that the safety and accuracy of LASIK being performed at different centers is not equal. LASIK is not simply performed with the push of a laser button. A laser reshapes your cornea underneath a protective corneal flap. It is the flap that makes LASIK so convenient and fast. And it is the expert creation and handling of the flap by the LASIK surgeon that makes LASIK real eye surgery and demands four basic things :

1. A well trained surgeon
2. An experienced surgeon
3. A surgeon that cares enough to pay very close attention to his or her patients both before, during and after surgery and thereby screen out poor candidates and modify unexpected outcomes to obtain an excellent result.
4. State of the art laser technology

DECEPTIVE ADVERTISING

Only when you`ve found all four of these things can you rest assured that your LASIK surgery will be very safe and effective. But how do you actually know when you`ve found them when some LASIK centers offer misleading information. To illustrate this here are some true incidents that have occurred right in Richmond:

1. The refractive surgery coordinator of one surgeon was telling patients that the surgeon at their center had been performing LASIK for over five years and had done over 1,000 cases when in fact the surgeon had performed his first case eight months earlier and had performed fewer than 100 cases.
2. A surgeon ran a large ad in the newspaper stating that he was a pioneer in refractive surgery, and he requested attendance at his upcoming LASIK seminar. In fact he had performed one of his first cases of LASIK just that week!
3. One group of LASIK surgeons advertising LASIK states they were the first in the state to perform "refractive surgery". It is true they were first to perform some old and outdated form of refractive surgery first but they were certainly not first when it came to LASIK; indeed some of them performed LASIK years after it was being performed elsewhere in the state.
4. One LASIK center has an ad stating they are about high quality and not high price when in fact their surgeon unbelievably does not examine his LASIK patients the days before and after surgery leaving that very important responsibility to a non-physician staff member.
5. Another surgeon claims he is the "surgeon to the stars" since he has performed LASIK on some professional athletes and that he has performed tens of thousands of LASIK procedures. This surgeon literally flies in an out of Richmond on the day of surgery not examining his patients on the equally important days before and after surgery delegating this very important part of surgery to local co-managing optometrists many of whom have relatively little LASIK experience.
6. One low cost Corporate Laser Center advertises how excited it is that it achieves just about 100% SUCCESS! Sounds too good to be true ... cheap LASIK and 100% success. But in their print ads, if you look at the small print at the bottom, you will see their disclaimer that states they consider "success" as 20/40 vision. That is like buying a cheap car that works 100% of the time, but who's top speed is only 40 miles per hour. Buyer beware.
7. The same low cost LASIK center claims it uses the “latest” and “best” technology and has two lasers to better “customize” your treatment, yet they don’t let you know that their cheaper laser is an old outmoded laser discarded by most LASIK surgeon’s years ago.

WHAT TO IGNORE

Board Certification:
When reviewing the curriculum vitae of the surgeon be aware that some items can look good and help to fill up a page, but in actuality are meaningless as far as your LASIK outcome is concerned. For example, many surgeons will state that they are Board Certified. This is not important in this instance since 99% of the ophthalmic surgeons in Richmond are board certified in general ophthalmology (and the 1% that are not do not perform LASIK). Some list that they are Diplomats of the American Board of Ophthalmology. All this means is that they are board certified ("diplomat" is the word used for board certified).

Professional Societies:
Some list the various professional societies they are members of (Va. Society of Ophthalmology, the International Society of Refractive Surgery, etc.). These are open societies to those willing to pay dues and are a very poor clue to the skill of the surgeon.

Education:
Even a list of the general educational background of the surgeon may not be very helpful for the understanding of his or her skill level for the subspecialty of LASIK Undergraduate school, medical school and even the Ophthalmology training programs are far removed from the practice of LASIK Hands on LASIK training is not offered as part of Ophthalmology residency training. LASIK is usually learned in only a two or three day course after the surgeon is already in private practice (there are some fellowship trained LASIK surgeons but they are the exception to the rule). The surgeon then must go on to perfect the technique on patients as well as observing others operate and reading surgical journal reports and attending surgical conferences.

Experience:
The amount of years performing "refractive surgery"or "vision correction" is little help since these years could include RK surgery, now an outmoded technique. The amount of years performing "laser surgery" could also be quite misleading, since it could include the PRK laser technique, another outmoded form of surgery. Also if a large clinic states that its doctors have a large amount of experience be aware that the number must be divided by the number of surgeons in the clinic if you are trying to decipher individual doctor experience. And if doctors in a laser corporation with numerous centers around the US advertise that their doctors have a lot of experience be aware that this may be referring not to the local doctors but to others in entirely different states.

Celebrity Testimonials:
We all are influenced one way or another by the powerful marketing technique of product endorsements by famous people. But in evaluating a surgeon this is another poor clue. In some large cities where sports superstars and movie stars live this has become a commonly used marketing technique by some laser centers. In fact one company has made it a corporate policy to provide LASIK for free to all PGA golf pros and features a famous golf pro as its spokesperson. Influential? Yes. An intelligent way to pick a surgeon? No.

Optometric Referrals:
We certainly respect the invaluable role of optometrists (non-eye surgeons) in the delivery of eye care. And we respect the relationship you may have developed over the years with your local optometrist. But in Richmond we must be aware of something called "co-management". In this scenario the Optometrists are paid about $1,000 for each referral to a LASIK surgeon and for examining the patients for the surgeon before and after the surgery. Co-management may be a reasonable option for you if your Optometrist is experienced at following LASIK patients and he or she works closely with an experienced and conscientious LASIK surgeon. However, what all too often happens with co-management is that the Optometrist and not the surgeon is the only one examining you before and after surgery. Co-management practiced in this way is very poor medical quality. In regards to Optometric Co-management we recommend 1) you are carefully examined before and after surgery by the surgeon, and 2) you evaluate for yourself the local LASIK surgeons available along with any LASIK surgeons your optometrist may refer you to, baring in mind that your optometrist is being paid to work with the surgeon you are referred to.

A Very Cheap Price:
In Richmond when you see LASIK advertised for a very cheap price, expect that this will include treatment with an out of date laser and it will exclude being examined by the surgeon himself the days before and after the surgery, and it will be performed at a center that defines 20/40 and not 20/20 as success.

With more and more advertising of LASIK, with publicly owned LASIK chains getting into the practice of medicine and with LASIK co-management it certainly has become difficult to determine who is the best. Unfortunately it sometimes boils down to who does the best or most advertising. Let's see what things you can look for to help you wisely choose a LASIK surgeon.

WHAT TO LOOK FOR

FOUR FUNDAMENTALS

Remember the four fundamentals of a real LASIK expert. If every surgeon is implying that somehow they are the best then put them to the test. They qualify if they have all four: expert training, experience, careful examination of the patients by the surgeon before and after surgery, and state of the art laser technology. A great laser with a novice surgeon certainly doesn`t qualify. Experience without expert training doesn`t qualify. A surgeon with little expert training may get to perform a lot of cases quickly if he works for a corporation that sells LASIK to the unknowing public at a very cheap price. A very skillful surgeon who refuses to examine his patients during the critical days before and after surgery definitely doesn`t qualify! And an expert surgeon with inferior laser technology won`t qualify. Let`s see if we can help you look for clues to whether or not all four of the fundamentals have been fulfilled.

Fellowship Training:
True sub-specialists in all fields of medicine do further training in their area of subspecialty. This is called a fellowship which usually lasts one to two years. For ophthalmology excellent fellowship programs have existed for many years for such areas as glaucoma, corneal disease and retinal disease. Several refractive surgery fellowships have recently begun to train young surgeons in LASIK in depth. Ask your surgeon if he or she is fellowship trained in LASIK (not to be confused with a fellowship in cornea that included no hands on training in LASIK). Whether the surgeon answers yes or no ask where and for how long they trained in LASIK Despite much experience there is no substitute for expert training.

Experience:
In addition to LASIK education ask how long the surgeon has been performing LASIK and how many cases he or she has performed. Despite the best education there is no substitute for experience. Look for a surgeon who has performed over 2,000 cases.

Attention to Detail:
An extremely important clue to quality care is how carefully the surgeon evaluates your eyes prior to surgery and after surgery. Some laser centers in the name of efficiency use a system where the surgeon DOESN`T EXAMINE THE PATIENTS the days before or after surgery! They delegate this all important task to a non-surgeon, an optometrist. Could you imagine having heart surgery and the next day being examined by your family doctor only? Of course not! As with any surgery you expect to receive the skill of the surgeon examining and evaluating you carefully prior to your procedure and after. Skillful surgery is only just one of the responsibilities of the surgeon. Look for a surgeon that will examine you before surgery, evaluate his or her findings and discuss with you the plan of action for your particular case. After the surgery the surgeon should again examine you and plan your postoperative care. Other technicians and doctors may be involved in your care as well, but there is no substitute for the in depth knowledge of the surgeon for your pre and postoperative evaluation.

Attention to detail very often manifests itself in what appear to be simple and easily overlooked details. One example would be how long you are told to keep your contacts out prior to your pre-LASIK evaluation and your LASIK surgery. For soft contacts this should be a minimum of 2 weeks and for gas perms it should be at least 4 weeks. Anything less could lead to significantly less accurate results. If a center has more lax guidelines this may sound convenient, but it is actually an excellent clue of the quality of care provided there, and we suggest you go elsewhere.

Technology:
Try to be aware of the laser technology available. Now that Custom LASIK with WaveScan technology has been FDA approved this is even more critical than ever. There are three significant differences in the lasers that one should not overlook.

1. Some lasers have the new CUSTOM LASIK WaveScan guided capability that gives incredibly safe and accurate results.
   
2. Some lasers have a tracking device that better guarantees that the laser treatment is properly centered and focused.
   
3. Some lasers give a deeper corneal treatment than others leading to a thinner cornea and thus more of a potential for an unstable corneal shape and permanent blurred vision.
   
   Some laser centers can be misleading when it comes to describing the accuracy of the results from their laser (see Accuracy below). Let’s look at these three significant aspects of laser vision lasers so you won’t be so easily mislead.

1) CUSTOM LASIK Capability
With the approval by the FDA in 2003 of WaveScan technology enabling CUSTOM LASIK, the whole ballgame has changed. With Conventional LASIK, 20/20 vision is attained with the first treatment about 70% of the time. With Visx CUSTOM LASIK this was attained 98% of the time in a multicenter clinical study. Enough said! You must determine if a LASIK center has true CUSTOM LASIK with WaveScan technology that will drive the laser treatment automatically.

Visx Versus Ladar Vision Custom LASIK:

2) Tracking Lasers are Better:
Eye tracking technology enables a laser to lock onto the center of a patient’s pupil and follow it even if the eye moves. This helps to guarantee a consistent delivery of laser energy to the center of one’s cornea, and this allows a smoother and more accurate change in the corneal shape resulting in sharper vision with less chance of halos, glare and ghost images. With eye tracking technology both the patient and surgeon can relax and feel more assured that the treatment is taking place in the correctly centered location on the cornea.

If tracking technology is not available this is an excellent clue to the quality of care you will be receiving and we strongly advise you go elsewhere.

VISX S4 versus Ladar Vision Tracking:
Let us here compare the VISX S4 tracker to that of Ladar Vision.

1. Unlike Ladar Vision tracking which was adapted from military tracking technology, VISX designed its tracker specifically for ocular laser surgery use.
   
2. Are annoying dilating drops required? Visx: NO. LadarVision: YES
   
3. With VISX the laser automatically locates the center of the pupil and activates the tracker. With Ladar Vision a picture is taken of the undilated pupil. The pupil is then dilated and the center of the dilated pupil (which can dilate irregularly) is mathematically derived. This leaves some room for error in locating the pupil’s center with Ladar Vision.
   
4. With both lasers, if the eye moves, the laser will follow it still locked onto the center of the pupil. But only with VISX will the laser immediately stop if the eye moves more than 1.5 mm. away. If the laser continued its treatment beyond this point the tracker would indeed keep it centered but the treatment would be at too great an angle for a good quality result. This so called "passive" tracking ability of the VISX tracker is another reassuring feature of VISX technology not present with Ladar Vision.

3). Lasers Should Not Waste Precious Corneal Tissue
If the laser treatment goes too deep the cornea loses its structural stability and becomes irregularly shaped providing blurred vision even with eyeglasses. What you want is a laser that preserves the most corneal tissue. Of all the lasers VISX does this best. It takes about twice as long to perform a treatment with Ladar Vision and B&L lasers than with VISX, and in doing so over 4 times the volume of precious corneal tissue is removed with the B&L and up to 25% more with Ladar Vision!

Beware of Of Ads That Highlight an extremely Cheap Price
There are some laser centers that will boldly advertise a very cheap price, but when you go there for your exam there is a good chance you will be quoted about two to three times the advertised price for the use of another laser that they recommend. But now you’ve gained some knowledge about these lasers and so you should feel more confident in your ability to evaluate a centers recommendation.

Accuracy:
In the end always ask about outcomes. What percent of the laser center's patients see 20/20 or better without eyeglasses, or what percent end up needing a repeat procedure to fine tune the result (an "enhancement".) This will vary depending on whether you are talking about nearsighted patients or farsighted patients and the amount of the prescription being treated as well as the amount of associated astigmatism. The national average for the attainment of 20/20 for the full range of nearsighted and astigmatic prescriptions is about 70% for Conventional LASIK. The VISX CUSTOM LASIK clinical study attained 20/20 vision an amazing 98% of the time.

Safety:
Accuracy of LASIK refers to how well one sees after LASIK without glasses. Safety refers to how well one sees after surgery even with glasses. If your vision ends up blurry after LASIK even with glasses then that means you’ve had some sort of complication. Be sure to ask for a center's safety rate Serious complications leading to permanent and very blurred vision should be very rare (less than 0.1%). Mild complications leading to permanent but mild distorted vision occurs after LASIK about 1% of the time as a national average. With an excellent surgeon that carefully examines you before and after surgery and utilizes the latest technology this incidence should be even lower especially if Custom LASIK technology is available

Enhancement Rate:
Also ask for the enhancement rate of the center (the percent of time the LASIK surgery needs to be repeated to eliminate a lingering prescription significant enough to cause blurred vision without eyeglasses). The enhancement rate reflects the accuracy of the LASIK performed at a center. It's nice that LASIK can be repeated, but it is also nice if the laser center has at least an average enhancement rate (national average is about 10% to 15% for the full range of prescriptions utilizing Conventional LASIK and it should be significantly lower with Custom LASIK.

LASIK is an extremely safe and accurate procedure when performed by a well trained and skilled surgeon who is there for you when you need him or her. What you want to look for is a masterful surgical team that will make your LASIK experience seem like a few effortless minutes resulting in clear vision. Many may claim that they are such a center, but now you have the tools to better research who actually is. So find a great one, relax and enjoy the LASIK experience!

Why Lipstock Laser Center