Finding a Good Surgeon for Vision Correction
by David A. Wallace MD
Finding a good surgeon for your vision correction care, whether by LASIK, PRK, ICL or lens implant, is not as simple as it sounds. It would be great if there were the equivalent of a “Michelin Guide” for medical care, but ... there isn't. With any professional service including elective surgery, there can be wide variations in critical factors including diagnostic capability, treatment capability, surgeon experience, surgeon judgment, equipment, technology, staff training, and procedure price, among others. As with any significant purchase that you may contemplate, you would be well-advised to approach vision correction care with a careful, cautious, ‘buyer beware’ attitude.
Standard indicators of surgeon quality surgeon include experience, credentials, and reputation, for starters. In the arena of elective vision correction care, there are many additional criteria that should be investigated, including surgeon’s results (if available), accountability, willingness of the surgeon to stand behind his (or her) results, etc. In addition, it’s important if not critical that the surgeon and his/her staff build a personal rapport with you, and demonstrate a willingness to educate you about your options. Finding the right surgeon requires research on your part. As with any important decision, it’s vital to do your due diligence! Do not be afraid to ask questions, seek out others who have had similar care, etc.
If you find it helpful, use the following criteria as your own personal guide:
- Experience! This cannot be understated. I used to recommend that you find a LASIK surgeon who has done at least 1,000 procedures (that would be roughly 500 patients, since most have both eyes treated). But in his book Outliers, the Story of Success author Malcolm Gladwell makes an insightful observation about “the 10,000 hour rule.” One of his theses is that for the most accomplished practitioners in any arena – whether tennis player, musician, computer programmer or any other pursuit – the key to success is, to a great extent, a matter of practicing a specific task for a total of around 10,000 hours. So I have revised my thinking and now advise that you should find a LASIK surgeon that has performed at least 10,000 procedures (I’ve done over 20K).
- Case Volume (more is not necessarily better...). Certain specialists want you to be impressed with how many procedures they have done. However, high volume does not necessarily mean high quality. A good analogy here is that, if you are in the mood for a great burger, you wouldn’t necessarily go to McDonald’s simply because they claim, “Billions and billions served”.
- Results. The most important goal is that you achieve an excellent visual result from your care. I suggest you ask every LASIK surgeon, and staff member at each center, whether they publish their results. You will be shocked at the stunningly low number that actually do. At LA Sight, we publish our Statistical Analysis of Outcomes and update this on an approximately annual basis. This is how we are able to state that 98.3% of patients we treat achieve 20/20 vision, and almost 30% achieve results better than 20/20. The more meticulous and detail-oriented surgeons carefully track and statistically analyze their patient's outcomes. Ask the surgeon to can show you his (or her) results and complication rate. The surgeon and/or staff should be willing to discuss these issues with you candidly and openly (not defensively).
- Personal Recommendation. Often, the best recommendations come from friends, family, or acquaintances that have already been to a particular doctor for vision correction care. Additionally, recommendations can be sought from eye care professionals such as your local optometrist, or an ophthalmologist. While personal referrals and endorsements are persuasive, I advise doing your homework, checking out the surgeon through the other methods outlined here as well.
- Online Reviews. Look up online reviews on the major review portals, including Google+, Yelp, and others including Facebook, Yahoo, HealthGrades, Vitals and CitySearch. Letting non-professionals rate highly-trained specialists is a mixed blessing, and in some respects it’s analogous to letting the inmates run the asylum. But if reviews are uniformly positive, that’s definitely encouraging. And if they are mixed, that conveys a different message. LA Sight is very proud to enjoy consistently high rankings on all the major review portals, and this is no accident. The links shown above are to our review pages on these sites, and we’re very proud of what they say!
- Intuition, Emotional Sense or “Gut Check.” Women will instinctively understand and relate to this section. When you walk into any medical office (or any business, for that matter), almost before you even speak to a staff member, you get a sense of the place. Some medical offices will strike you as warm, comfortable, welcoming environments that place your priorities first. Others will strike you as (1) cold and impersonal; (2) the doctor’s needs are always more important than yours; or (3) it’s all about the bucks, and you’re going to pay dearly for the doctor’s time. Here’s my straight-forward advice: If you get a negative gut reaction, trust your instincts and leave immediately! You know the saying, your first instinct is likely accurate. Furthermore, if a physician, surgeon or staff member rubs you the wrong way, don’t be afraid to vote with your feet, and just leave! Why would you trust your eyes and your vision to people like this?
- Meet and Speak With the Surgeon Personally . In some practices, you don’t get a chance to meet the surgeon before the day of surgery. In my opinion (and that of many lawyers and medical authorities), this is less than desirable. If the doctor is “too busy doing surgery” to speak with you personally, my advice would be to leave and find another surgeon.
- Speak to Patients, View surgery. Ask to speak to some of the patients that have had their procedures done with this particular doctor or center. Also ask to view an actual procedure, and take note of the proficiency of the staff, the attention to detail of the surgeon, and other intangible factors.
- Enhancement Rate: In any practice, some small percentage of patients may benefit from a touch-up (sometimes called enhancement) to achieve ideal vision. One of the advantages of LASIK is that it can be "enhanced" or "touched up" if there is an under- or over-correction from the targeted goal. Seek out a surgeon who has an enhancement rate equal to or below the national average (about 8%). Our enhancement rate at LA Sight is now about 2% for patients with nearsightedness and astigmatism*, followed for one year after initial treatment.
- Medical License Status. State licensing boards issue medical licenses. Very few LASIK surgeons are ever investigated by state Medical boards, but you should check, to make sure. The Medical Board of CA website offers a physician license lookup page where license status and any past or pending investigations can be researched. Licensure means only that the doctor has satisfactorily completed medical school and a one-year internship, but does not guarantee specialty training or competence in a particular field.
- Board Certification. Find out whether a surgeon is board certified by the American Board of Ophthalmology ("ABO"). Board certification means that the doctor has completed a rigorous, accredited three-year residency in ophthalmology, and has passed both written and oral board examinations administered by the ABO. Unfortunately, there are many surgeons offering LASIK services who are not board-certified, and even some who have not completed residency training! In the ‘caveat emptor’ (“buyer beware”) business environment and legal climate, it is critical that you know whether your surgeon is board-certified. You can now also verify board certification online through the American Board of Medical Specialties.
- Litigation Search. If you are extra careful, you may want to check one of the public information databases on the internet, searching for evidence of malpractice claims against a particular surgeon and/or laser center. I have used and recommended knowx.com for this purpose. This information is not free, but may be worth it. Attorneys and law offices can subscribe to the Lexis-Nexus litigation database, so if you have a friend or relative who is a lawyer, you can ask them to run a search and review the results with you. The number of malpractice filings against a doctor does not in itself indicate the severity or culpability in any individual case; but in my opinion, more than a very small number of claims is usually not a good sign.
- Celebrity Endorsement? Our celebrity and entertainment-oriented culture involves a great deal of celebrity endorsement. I would caution that, more often than not, celebrity endorsement is a form of paid advertising: Entertainment figures and/or media personalities are offered free LASIK in exchange for their “enthusiastic endorsement”. While this is not necessarily a bad thing, I only offer that it should be recognized for what it is. Prospective patients might inquire whether any discount, trade, or other consideration was afforded in order to secure such endorsement from any celebrity.
- 50 Tough Questions: A consumer advocacy group, the Council for Refractive Surgery Quality Assurance compiled this extensive list of questions to ask a prospective LASIK surgeon. Though the questions are a bit dated (originally drafted in 2005), the questions, along with our answers, are shown.
- The FDA's LASIK FAQ page offers some helpful advice, but it’s pretty generic.
- Advertisements. Many LASIK surgeons and centers advertise; while this can be a starting point, do not let ads be your only search criteria.
At LA Sight, we take the responsibility for your individual care very seriously. LASIK is an extremely safe procedure when performed by a well-trained and skilled surgeon. I advise seeking an experienced surgeon that will make your LASIK procedure seem like a few effortless minutes resulting in improved vision. We invite you to come to LA Sight, learn about vision correction, then relax and enjoy the LASIK experience with the confidence of knowing you are in the hands of a caring, experienced, well-trained team using state-of-the-art technology.
* We report out outcomes separately for nearsightedness (with or without astigmatism) and farsightedness (with or without astigmatism). In our hands, with our laser technology, treating nearsightedness up to about -8.0 D (diopters) and astigmatism up to about 4.5 D, enhancement rate is as published. For higher amounts of correction, we explain that the likelihood of needing enhancment is statistically higher. This is because the accuracy of correction is proportional to the magnitude of the correction being treated. So, like putting in a golf context, the longer the first putt, the more likely it is that a second putt will be necessary to 'sink it.