Choosing the right laser vision correction surgeon is vital, but how do you choose between the handful of surgeons located in every city around you? In this two part series, we’re providing you tips for choosing the correct surgeon for you. In part 1, we discussed looking into the experience and training of the surgeon. In this article, we’ll discuss technology and practice situation to help identify the right laser vision correction surgeon.

The latest technologies can have a major impact on your vision correction experience.

Technology: It is important to see a surgeon who has access to—and experience with—the latest technologies, including the latest lens technologies. Most surgeons who perform LASIK or PRK (photorefractive keratectomy, laser eye surgery similar to LASIK) offer this procedure as their only recommendation to the patient. Additionally, many surgeons only have one type of laser (often shared with other surgeons) to perform surgery. In many cases, while LASIK/PRK is possible for the patient, Lens Exchange with an Intraocular Lens (IOL) or the Vista Vision Implantable Contact Lens (ICL) procedure utilizing the Staar Visian Implantable Collamer Lens may be a better alternative for the patient. However, the patient may never know unless a doctor mentions these alternatives.

When it comes to laser vision correction, the more lasers the better!

If the surgeon is either relatively inexperienced or does not offer the alternative lens technologies to the patient, patients will often be encouraged to undergo laser vision correction, even though they would likely do better with a lens implant placed by an experienced surgeon. It is important to look for a surgeon who has access and experience with multiple types of lasers, because some laser delivery systems work better for certain situations than others. Many surgeons can only afford a single brand of laser and “shoehorn” every patient into this technology. Lastly, many surgeons share lasers, which can be a detriment to overall success, as each laser has its own nuances, advantages, and disadvantages: a distinctive “personality,” if you will. I recommend that the patient find a surgeon who has his own lasers with his/her own treatment algorithm or “nomogram” based on the historical outcomes of his/her previous patients.

Practice situation: I recommend choosing a surgeon who is in professional private practice rather than going to a laser company who hires part-time (often weekend-course trained) surgeons. In private practice, the surgeon’s focus and commitment is to the patient, not the shareholders. Early in my career, I worked for a vision surgery company whose management answered to its investors. There was both subtle and overt pressure to increase surgical volumes to increase profits. In my experience, laser companies often use non-medical staff that are given bonuses based on productivity and are responsible for convincing patients to book surgery, even if the patient is only a borderline candidate for a particular surgery. This scenario puts even more pressure on the employee surgeon to go along with the treatment plan decided by the laser center staff member, rather than the surgeon since the surgeon would not evaluate the patient until the day of surgery!

Recently I evaluated a patient who presented for a second opinion prior to surgery, after having been scheduled for LASIK by the staff at a corporate laser center. After my examination, I realized that this patient would have been  at very high risk of having a vision-threatening complication from LASIK called ectasia (bulging of the cornea) due to her thin corneas. Instead, I performed the Vista Vision ICL procedure on her with an excellent outcome.

Look for stable vision center when you are choosing a doctor.

Another shocking problem with choosing a laser company surgeon is that, over the years, many laser companies go bankrupt or shut down if they are not profitable. The latest national laser company to file for bankruptcy protection is TLC Vision (which later became NVision in Southern California). TLC is the company that utilized golfer Tiger Woods as its paid spokesperson. Historically, many laser companies have gone bankrupt or shuttered their doors. In some of these cases, when the patient goes for follow-up with the surgeon, the center is closed, and the patient is forced to find another surgeon—frequently costing the patient more money if additional surgery on their eyes is required and making it difficult or impossible for the new surgeon to have access to critical past medical records. Lastly, if retreatment or financial issues arise after surgery performed by a corporate laser center, the patient must wade through the bureaucracy of the laser center management (often off-site) for a solution, rather than dealing directly with the surgeon or the staff member who works for him. In a professional private practice, the surgeon is directly accountable to the patient for all medical, financial, and logistical issues and has no accountability to shareholders in making a decision that is in the best medical interest of the patient.