Read this before you have laser eye surgery (LASIK)

#1

During the past 10 years I have assisted in over 40,000 LASIK/PRK cases and provide consultiations and advice to ophthalmologists on all matters related to Laser Vision Correction aka LASIK or PRK. Recently I had a friend from another city ask me for some pointers on what to look for as he contemplates his vision correction options. I wrote up an "insider's guide" for his reference which I am also posting here in the hopes someone else may also find it useful.

To find a surgeon you are comfortable with, take advantage of the free consultation that any successful LASIK practice will offer. This is a great way to go and "get a feel" for a doctor, his staff, and his office without having to pay for a whole eye exam. Talk to friends or relatives that have had it done to see where they went and what their experiences were. The websites listed below have "locate a doctor" features built in so you should be able to find a long list of surgeon's in your area. Anyone listed on the sites I linked below will have the appropriate credentials to perform LASIK.

Some important questions to ask during the consultation:

How do you track the results of surgeries you have performed?
It is imperative that anyone you consider to do your procedure has a method for tracking previous patient's and their results, preferably with software that has been written specifically for this task. If the doctor claims to track his results with software, ask for a report of patients that are +/- 3 years of your age and +/- 2 diopters of myopia from your prescription. If you have a significant amount of astigmatism, also have the results filtered to +/- 1 diopter of astigmatism. If the doctor truly does track his results, they should be able to generate this report in less than 1 minute and it does not have to include any information that would violate any HIPPA regulations. The report should include things like average post operative visual acuity at 1 day, 1 month and 3 months and/or the percentage of patients that are able to see 20/20 or better at those same time periods along with enhancement rates for procedures in the range of what you need.

What brand of laser do you use?
VISX STAR S4 with Iris Registration is the most advanced and gets the best results, do not let anyone tell you otherwise.

Will you be using WaveScan and CustomVue for my treatment?
Unless the wavescan measurement does not match up well with your subjective refraction, there should be NO reason not to get a CustomVue treatment, you will have less glare and halos at night and will get a much better result. Look at the pictures at the websites below to get familiar with what the VISX laser looks like. I have heard it happening before where patients are told they are getting treated with one kind of laser and really get treated with an inferior, cheaper laser. CustomVue treatments when coming from the laser will have a variable pulse rate that has a distinctive sound. If the pulses coming from the laser come at the exact same rate throughout the treatment, you are not getting a CustomVue treatment. If you are wondering what WaveScan and CustomVue are, refer to the VISX Website for educational material.

Will you be making a flap? If so what kind and with what?
I would strongly urge anyone considering refractive surgery to either have CustomVue PRK, Epi-CustomVue LASIK, or IntraLase CustomVue LASIK. The recovery time with PRK and Epi-LASIK is slightly longer, but there is much less risk and fewer variables that can affect the predictability of the laser treatment when compared to a manual bladed microkeratome.

What is the temperature and humidity of the laser room and how do you regulate it?
These two environmental factors can play an important role in the laser treatment.

Do wear cologne on surgery days? Do you allow your staff and patients to wear cologne or perfume in the laser room on surgery days?
Cologne and alcohol vapors can make the laser energy fluctuate dramatically, making the overall treatment much less predicable.

Do you use re-usable or disposable instruments? What about the cannula used to irrigate the flap back into place? What method do you use to sterilize the instruments between cases?
DRY HEAT Sterilizers offer significant advantages over steam cassette sterilizers. Unless meticulous attention is spent on cleaning the water reservoir of the steam sterilizers AT THE END OF EACH AND EVERY DAY and the reservoir is left empty when not in use, bacteria and mold can grow in the reservoir which then gets broken down and mixed with the steam when the water gets heated for a sterilization cycle. The left-over cellular debris and cytotoxins from these organism can cause significant post-operative complications if they end up underneath the flap from a re-usable cannula or other instrument that has been sterilized in a steam cassette autoclave.

Some things that some doctors like to make a lot of noise about that do not really matter:
"I own my own LASER and it does not ever get moved."
This is not an advantage, generally speaking, lasers that get transported from office to office are maintained better than lasers that are stationary. Also, the experience level of the technicians that accompany the traveling laser will be much higher than that of a technician for a stationary laser. The traveling technician will be doing surgeries 3-5 times a week with different doctors, whereas the stationary technician will only be doing surgery one or one and a half days a week at the most. The only exception to this is if the stationary laser is so busy that it is being used 4-5 full days a week. The average service contract for one year on a laser is around $50,000. A stationary system should be pretty busy to be able to amortize this expense over a larger number of eyes. If the laser does not move and is not busy, I would be suspect that the service records on that system are not being kept current.

"I have performed over X number of refractive procedures"
Ask them specifically how many LASIK/PRK/Epi-LASIK procedures they have performed. Most inexperienced surgeons will lump in cataract surgery and RK into the "refractive procedures" number. Look for a surgeon that has performed over 3,000 cases

Here are some links to investigate:

Laser used to make the flap in IntraLase LASIK: http://www.intralase.com
Laser used to actually correct the prescription of the patient's eye and the Wavescan device that takes the measurements to generate CustomVue treatments: http://www.visx.com

#2

I recently inquired about this surgery my last eye exam, about 3 weeks ago...After he told me it was strictly cosmetic, which means my insurance wouldn't pay for it, I quickly squashed the idea, lol...

Ahh, but this is great information nonetheless, thanks e...

#3

How much do you think you will spend on glasses, contact lenses and solutions over your lifetime? I'll bet it is more than double the cost of refractive surgery. Busier offices will have financing options available at very low interest rates or 0% for 12-24 months.

#4

I have been wanting this bad! With as much time as I spend in sports and outdoor activities, glasses and contacts are a huge nuisance!
This is great info!

Thanks e!

#5

I've been considering this. Thanks E

Bot · #6

I will never get laser surgery. It don't matter how much positive information you throw at me. It'll never be an option for me. lol

#7

Unfortunately for someone my age, the long run costs don't equal that of glasses/contacts. If/when my insurance decides to cover this, then, I'll consider the surgery.

The thought of anything near or in my eye totally freaks me out, but I think with the help of a little Valium, I'd be OK.

#8

QUOTE(deepdiver32073 @ Mar 10 2007, 12:16 AM) Unfortunately for someone my age, the long run costs don't equal that of glasses/contacts. If/when my insurance decides to cover this, then, I'll consider the surgery.

The thought of anything near or in my eye totally freaks me out, but I think with the help of a little Valium, I'd be OK.

just out of curiosity, what was the dollar value you placed on losing a contact lens while scuba diving and then being chased by a shark as you swam around blindly?

heh

#9

It looked like generally good advice, but, being cynical, did the author have any relationship with CustomVue or any of the other products they recommended?

#10

the author at the time of the writing did not have any financial interest in any of the products mentioned. Just a happy, well informed customer.