How to Choose a LASIK Surgeon

Once a person has decided they are interested in LASIK, the next step is to decide upon a surgeon. The safest method is to be referred a name by a friend who has undergone the LASIK procedure. If you do not know a number of different people you can ask, then please use the following tips in helping choose a surgeon.

You will find that there are a number of different types of environment where a surgeon will perform LASIK. The most visible location is a corporation that provides the LASIK surgery. These companies are often very large with multiple locations across the country. The surgeon performing the surgery will likely be an independent contractor who is hired by the company to perform the surgery. Some of these companies are publicly traded. All of these companies put a tremendous amount of money into advertising. The advertisements usually suggest very low prices for treatment, and advertise the large amount of procedures the surgeon has performed. This location is excellent for a person who wants to spend as little money as possible and it willing to give up so perks.

What do I mean by this? Well, usually the person performing the pre-operative and post-operative care is not the surgeon. Rather it is often a doctor of optometry, who often are quite qualified to perform the care. Many of these optometrists have provided thousands of patients with post-operative care. However, they do not perform the surgery. They are certainly not more qualified than the surgeon who performed the procedure to recommend surgery of follow a patient post-operatively. This is a trade off for having a lower priced procedure. The other important thing is that the numbers of surgeries performed by the facility are often artificially enlarged because they include all procedures at all facilities. This gives the impression that they are more experienced than they may be. Third, the cheaper procedure is likely going to be on an older technology laser. While you will likely have an option to upgrade to newer technology the price will go up. Often, the price will go to a level where you can go to a different location with better access to the surgeon for the same price.

The second environment is a facility that is owned by the surgeon. In these situations usually there is a high level of service and a high level of access to the surgeon. The surgeons have often dedicated themselves to refractive surgery and are very experienced. In addition, you will most likely see the surgeon as part of the preoperative and post-operative evaluation. The only downside to this environment is that the surgeon has a secondary gain to do the procedure because they own the facility. This hopefully will not cause a recommendation of surgery to a patient who may be a borderline candidate.

The third environment is a surgeon who uses a facility that he/she does not own to perform the procedure. These surgeons often do not dedicate themselves exclusively to laser eye surgery. However, many of them have performed thousands of procedures. The benefits of this is that the surgeon is independent from the facility and can choose to change facilities if another location offers superior technology. In these situation, there is probably the highest level of access to the surgeon both before and after the procedure. The only perceived downside to this situation is that the surgeon may not do very many LASIK procedures. In these situations, it is usually beneficial to go to a surgeon who has fellowship training experience in refractive surgery.

In summary, price and access to the surgeon are the main differences between the various environments that LASIK is performed. The fact that all these locations coexist means there is something for every one.

What is the best age for LASIK?

My opinion would be in the late twenties. I will explain to your the reasons why in this article.

The main consideration with having LASIK too young is that the eye is still growing and the prescription may still be changing. There is a large amount of variation as to when this occurs. But generally, most peoples eyeglass prescription stop changing around their early twenties. The most important thing is that on your eye exam the prescription remains the same for a couple of years. If you visit a LASIK surgeon for the first time make sure to bring your most updated prescription. Otherwise, its difficult to know if your eye prescription is changing. Why is this an issue? Well, if you treat someone and there prescription changes then the effect of the LASIK is going to wear off. As far as we know, LASIK does not affect eye growth.

How about being too old? Well as you get older there are two issues. The first issue is that another medical condition in the eye may be limiting the vision. If this is the case it is usually a cataract; a natural clouding of the lens. LASIK does not treat cataracts, the only surgical treatment for cataracts is to remove the cataract and place a lens implant. So, as people get older they may have other eye conditions.

However, there is another issue. At the time of cataract surgery a lens implant is placed into the eye. This lens implantation gives us the ability to treat the eyeglass prescription in many people at the time of surgery. The downside to LASIK is that our measurements to ascertain the correct lens implant power is less accurate in a patient who had LASIK. Therefore in patients who are older the effect of the LASIK may be shortened by the development of cataracts and once the cataracts develop our lens implant measurements are inaccurate.

The third issue is presbyopia, needing additional power to read up close. Patients who are presbyopic or emerging into presbyopia may find they will still need reading glasses after LASIK. This can be treated with monovision correction, but not everybody is a good candidate for monovision. Presbyopia usually begins to occur around age 40. People who are nearsighted can often offset the presbyopia by taking off their glasses to read. This crutch is gone when the nearsightedness is corrected by LASIK.

Everybody wants to know that the LASIK treatment will last forever. While this is unrealistic due to other conditions that effect the eye. There are age considerations will dictate on average how long you can expect the surgery to last. That is why I recommend the late twenties as the ideal age. A person's eyes will likely have stopped growing and there are many years before presbyopia and cataracts develop. The second best time is probably early thirties and early to mid fourties. Early thirties because there are still a number of years before cataracts and presbyopia. Early to mid forties because if you have developed presbyopia by this time you can make a very educated decision if you would like monovision or not.

Am I too old or young for LASIK?

The main consideration with having LASIK too young is that the eye is still growing and the prescription may still be changing. There is a large amount of variation as to when this occurs. But generally, most peoples eyeglass prescription stop changing around their early twenties. The most important thing is that on your eye exam the prescription remains the same for a couple of years. If you visit a LASIK surgeon for the first time make sure to bring your most updated prescription. Otherwise, its difficult to know if your eye prescription is changing. Why is this an issue? Well, if you treat someone and there prescription changes then the effect of the LASIK is going to wear off. As far as we know, LASIK does not affect eye growth.

How about being too old? Well as you get older there are two issues. The first issue is that another medical condition in the eye may be limiting the vision. If this is the case it is usually a cataract; a natural clouding of the lens. LASIK does not treat cataracts, the only surgical treatment for cataracts is to remove the cataract and place a lens implant. So, as people get older they may have other eye conditions.

However, there is another issue. At the time of cataract surgery a lens implant is placed into the eye. This lens implantation gives us the ability to treat the eyeglass prescription in many people at the time of surgery. The downside to LASIK is that our measurements to ascertain the correct lens implant power is less accurate in a patient who had LASIK. Therefore in patients who are older the effect of the LASIK may be shortened by the development of cataracts and once the cataracts develop our lens implant measurements are inaccurate.

The third issue is presbyopia, needing additional power to read up close. Patients who are presbyopic or emerging into presbyopia may find they will still need reading glasses after LASIK. This can be treated with monovision correction, but not everybody is a good candidate for monovision. Presbyopia usually begins to occur around age 40. People who are nearsighted can often offset the presbyopia by taking off their glasses to read. This crutch is gone when the nearsightedness is corrected by LASIK.

Everybody wants to know that the LASIK treatment will last forever. While this is unrealistic due to other conditions that effect the eye. There are age considerations will dictate on average how long you can expect the surgery to last. That is why I recommend the late twenties as the ideal age. A person's eyes will likely have stopped growing and there are many years before presbyopia and cataracts develop. The second best time is probably early thirties and early to mid fourties. Early thirties because there are still a number of years before cataracts and presbyopia. Early to mid forties because if you have developed presbyopia by this time you can make a very educated decision if you would like monovision or not.

When should I get a retreatment?

A retreatment or enhancement is performed when the initial treatment either wasn't 100% effective of the effect has worn off over time. The percentage of patients needing retreatment varies from doctor to doctor and generally increases as the amount of treatment perfomed increases.

Some doctors charge for retreatments, some offer free retreatments for a limited time and some offer for extra money a lifetime guarantee.

A decision to undergo a retreatment should be taken as seriously as the decision for surgery. In some cases an undercorrection may be beneficial in the long run, especially if a person wants to be free of glasses for near activities.

In general, if the retreatment is needed because the initial treatment didn't work it's best to wait until the post-operative refraction(eye glass prescription) stabilizes. It's important not to do a retreatment if the eyeglass refraction is fluctuating as this will lead to a higher likelihood of an unhappy result. Usually after about 8-12 weeks the refraction stabilizes and a retreatment can be performed.

The second indication for a retreatment is a regression of the initial laser treatment. Basically, the effect of the laser has worn off. This is usually a number of years after the initial treatment. Often times the flap is tightly healed at this point and sometimes lifting a flap many years later can increase the risk of a complication called epithelial ingrowth. This occurs if the surface layer of the eye growths beneath the flap. The incidence of epithelial ingrowth is higher in retreatments than in initial treatments.

When undergoing a retreatment years after surgery, it's very important to do a trial with contact lenses to insure that you will be truly happy with the enhancement results. The retreatments are often less accurate and have a higher risk of certain flap complications. It should not be a procedure that is made to seem trivial.

Presbyopia Treatment and LASIK

The only current option for treating presbyopia at the time of LASIK is to perform monovision. Presbyopia is the condition that causes the eye muscles to fatigue beginning around the 5th decade of life. At the time of LASIK one eye can be corrected for distance and one eye corrected for near. This is called surgically induced monovision. This is similar to contact-lens related monovision. It is mandatory for a person who is considering a LASIK monovision correction to undergo a simulation with contact lens. This simulation should include the person wearing the lenses home and for a few days. This allows a person to assess how much they like monovision during their daily activities. Just trying monovision in the doctor's office is not an adequate method and could lead to unhappiness with the post-operative result. If a patient undergoes a proper contact lens monovision simulation and understands the benefits and limitations they will often be very happy with the results. Please keep in mind that the eye muscles continue to fatigue with time so the effect of the monovision may wear off over time.

Astigmatism Treatment

A major advance in the treatment of astigmatism has been the development of iris registration. This device picks numerous points on your iris and determines how much rotation in the eye has occured when someone lays underneath the laser compared to sitting up. Studies have shown that the amount of rotation is unpredictable and the significant undercorrection in the treatment of astigmatism can occur when the rotation is not compensated for. With the new iris registration technology, the treatment is adjusted for whatever rotation has occured when going into the sitting position. This is available as part of customvue treatment.

Skin Cancer

I recently received the following email from Betsy.


I have a history of skin cancer on my lower eye lid. I can send you a picture of the skin cancer if necessary. I am very interested in laser eye surgery. I am wondering what the potential for a laser eye surgery complication as a result of have skin cancer. Is there a chance the skin cancer can return?


Betsy,

The excimer laser is an Ultraviolet Laser. I would speculate that theoretically this may increase the chances of a skin cancer recurrence. I would discuss this with your skin cancer doctor