LASIK Surgeon Questions
Reviewed by Marc Michelson, M.D.
If you are like the vast majority of patients considering LASIK surgery, selecting a LASIK surgeon usually begins by obtaining some information about LASIK and asking acquaintances that have had LASIK Eye Surgery to suggest the names of reputable LASIK surgeons in your area. As we have stressed in this website, the best way to learn if you are a candidate for LASIK and to select a LASIK surgeon, is to arrange a screening or consultation. At that visit, you will have the opportunity to ask the LASIK surgeon, or their staff, a number of questions to help you decide if a particular LASIK surgeon is right for you. The following questions may be useful in helping you organize your thoughts in selecting a LASIK surgeon.
- When Did You First Start Regularly Performing Laser Eye Surgery for the Correction of Nearsightedness, Farsightedness and Astigmatism?
The United States Food and Drug Administration (FDA) formally approved the use of the Excimer Laser for Laser Eye Surgery on October 21, 1995. During 1996, 1997 and 1998 a large number of eye surgeons participated in the required training necessary in order to become certified. Thus there are a considerable number of LASIK surgeons who indeed have been performing Excimer Laser Eye Surgery for over 10 years. Those physicians who have recently completed an Ophthalmology Residency or Fellowship in Corneal and Refractive Surgery, should be expected to have at least 3 years experience with the Excimer Laser Eye Surgery. An important aspect to consider is not simply the length of time since their certification with the Excimer Laser, but the actual number of years that they have been performing LASIK Surgery on a regular basis. The combination of 3 or more years of experience and regularly performing Laser Eye Surgery is a key benchmark in determining LASIK surgeon experience.
- In the past 12 months, how many Laser Eye Surgery procedures did you perform with the Excimer Laser?
While one might be inclined to think that the greater the number, the better the surgeon, this may not be entirely true. There is however a minimum monthly threshold that a LASIK surgeon should perform in order to maintain the basic competence and skill level necessary to deliver good, consistent results. That number should be somewhere in the range of 20 procedures per month, at a minimum, or approximately 250 procedures in the last 12 months. It is reasonable for a single LASIK surgeon to perform as many as 150-200 LASIK surgeries per month without really compromising the care necessary to provide personal attention and ensure results. In very well run and established LASIK practices that have been performing surgery for many years, it may even be possible for a LASIK surgeon to perform as many as 300 procedures per month. However, as the number of surgeries performed by a single surgeon climbs much beyond this, it becomes necessary to delegate much of the clinical care to ancillary providers who may or may not be as skilled and experienced as the treating surgeon. Laser Eye Surgery is still surgery and thus requires a certain level of contact with the treating surgeon in order to consistently deliver quality care. When selecting your LASIK surgeon, consider whether you are comfortable not only the number of procedures performed monthly and annually, but whether that number necessitates a "low contact" approach in order to perform an exceptionally high number of procedures.
- What percentage of patients that you treat are able to pass a drivers test without glasses or contacts within 1 month after their LASIK surgery?
It is reasonable to expect that 95% + of those treated will be able to pass a drivers vision test without the use of glasses or contacts.
- What percentage of patients who see you for a LASIK consultation do you deem "not suitable" for treatment?
There is no right answer or wrong answer. However, there should be some percentage that the LASIK surgeon simply finds unsuitable. This number may be small in instances where the practice uses a very rigorous screening process before actually having the patient meet the LASIK surgeon. Nonetheless, there should be some nominal number of patients who simply are not good candidates for medical, optical or anatomical reasons.
- What percentage of patients that you treat have some type of complaint after their LASIK surgery? This would include dryness, haloes, etc., many of which would resolve within 3-6 months after surgery.
Since it is normal and expected to have some transient symptoms after LASIK surgery, it would not be acceptable for a LASIK surgeon to tell you that none of his or her patients experience any of these symptoms. You should be told that there are many common mild symptoms that you might experience and that they will gradually end on their own. It may not be possible for a LASIK surgeon to give you an exact percentage, but a range of possibilities is reasonable.
- Has any refractive surgery patient ever obtained a malpractice settlement against you for more than $25,000?
The greater the number of cumulative surgeries that a LASIK surgeon has performed, the more likely that he or she will have at least had a malpractice suit filed against them. Regardless of the number of surgeries performed, there should not be repetitive settlements for amounts that indicate that minor damages were awarded or even a single suit whereby the patient received a considerable amount of money as compensation for damages the surgeon is able to explain the circumstances in credible detail.
- What is the worst LASIK result you ever had? How did you handle it? What is the patient's vision today? Are they still your patient?
Even if the LASIK surgeon has really only had excellent results, there should be one case that stands out in his or her mind as the most challenging clinical result. They should be able to clearly tell you how they remediate it and how the patient is currently doing. This demonstrates a willingness to discuss things honestly.
- Have you ever been denied malpractice insurance or access to any insurance plan, or are you under professional board investigation, or have you ever had disciplinary action take against your license to practice medicine?
Obviously, the answer to any of these questions should be no. A positive answer to any of these questions requires careful review as it indicates that the surgeon may have been involved in conduct that is questionable by professional standards.
- Will you do an aberrometry measurement as part of my consultation?
This should be part of every consultation.
- What percentage of LASIK patients that you treat require an enhancement to achieve their goals?
While there is no exact number, the actual number depends not only on the surgeon , but on your prescription as well. So, a reasonable answer would be to expect somewhere in the 5-15% range depending on your prescription. It is not correct to assume that a surgeon with a lower number than the rest is a better surgeon however. The lower enhancement rate may in fact be due to that surgeon only treating less complex cases which would result in a lower enhancement rate.
- What preoperative testing will you do in order to evaluate my tears and their suitability for the LASIK procedure?
A thorough consultation should include at a minimum one or more of several testing procedures in order to determine tear film integrity. There are many types of tear tests that can be used along with direct observation of the overall quality of your tears. The LASIK surgeon should be able to explain this in detail as well as what preoperative treatments he or she may want to employ in order to get your tears healthy enough for the procedure.
- Who will be performing my follow-up examinations?
It is important to know how much of your care will be provided directly by the treating surgeon, how much will be provided by other direct members of the surgeons LASIK team, and how much may be delegated to others inside or outside the practice. Make sure that you are comfortable with who will be seeing you and that you have open access to the treating LASIK surgeon for any questions that you might have.
- What findings from my consultation indicate that I am a good/poor candidate for LASIK or another Laser Eye Surgery procedure?
You should expect the LASIK surgeon to have carefully evaluated your overall health and eye history, the health of the cornea in particular, the health of the retina and optic nerve, the intraocular pressure, the wavefront measurement (aberrometry), your prescription with and without drops, the stability of your prescription, the size of your pupils, the shape of your cornea measured by topography, the thickness of your cornea measured by pachymetry, the quantity and quality of your tear film and most importantly, your personal goals for having the surgery. The LASIK surgeon should be able to check off these criteria and explain that they have been examined and why you are a good candidate.
- If you believe that I am a good candidate, can you tell me any reasons that I might not have a good result?
The LASIK surgeon should be able to candidly review the risks and complications with you, and explain how they might or might not apply to your individual situation. This discussion may include a complete review of the Informed Consent document which will give you a chance to ask any additional questions that you may not have thought of during your consultation.
This list of discussion questions is meant to provide broad guidelines so that you can have meaningful dialog with LASIK surgeons and their staff in order to help you select a LASIK surgeon that is most compatible with your particular needs.