TLCVision® has named Richard Levinson, MD as one of their Top 50 Laser Vision Correction Surgeons, selected from over 1000 LASIK Surgeons, nationally. This is the eighth consecutive year that Dr. Levinson has won this award.
How to Select Your
Laser Vision Surgeon
Colorado Custom LASIK Vision Correction
Surgeon Laser Eye Surgery with CustomVue Wavefront LASIK in the
Denver & Boulder Metro Area
How to select your Laser Vision Surgeon.
Laser Vision Correction is Eye Surgery. You want to select an Ophthalmologist, an M.D. Eye Surgeon, to perform your Laser Vision Correction Surgery. If you aren't selecting an Ophthalmologist to perform your Laser Vision correction Surgery, you are selecting a "Laser Vision Center", where a significant portion of your surgical care has been delegated to non-surgical staff, such as Optometrists. This is a not-so-subtle difference that will impact the quality-of-care you receive.
What's the difference between an Ophthalmologist and an Optometrist.
What's the difference between an Ophthalmologist and an Optometrist? Laser Vision Correction Eye Surgery
is performed by Ophthalmologists - MD Eye Surgeons, not Optometrists. Most people, quite understandably,
aren't aware and probably don't care about the difference between
an Ophthalmologist and an Optometrist. However, if you are considering
Laser Vision Correction, you need to understand the difference between
these two types of "eye doctors" because this difference
determines who is actually providing your care when you have Laser Vision Surgery. An Ophthalmologist
is an M.D. Eye Surgeon who, after four years of college, goes to four
years of Medical School, and then has at least four additional years of internship/residency
training, specializing in surgical and medical treatment
of the human eye. An Ophthalmologist will be your Laser Vision Surgeon. Optometrists are "eye doctors", too,
but they do not go to Medical School. They go to Optometry School where they earn an O.D. degree.
Optometrists are very intelligent, conscientious, caring, nice people, but
they are not Eye Surgeons. Optometrists are trained primarily to fit glasses and contact lenses.
Optometrists do not perform your Laser Vision Correction. The Ophthalmologist, the M.D. Laser
Vision Eye Surgeon, is the one who will be using very powerful Lasers
on your eye. And the Ophthalmologist is the one who has the highest levels of training and expertise in all aspects of Laser Vision Correction. And the Ophthalmologist, not the Optometrist, is the person ultimately, and legally, responsible for your care. So, the most important criteria that you should consider
when you select where to have your Laser Vision Surgery is
the Ophthalmologist, the Laser Vision Surgeon.
You have two basic choices in selecting
a Laser Surgeon. You can either directly, yourself, select an Ophthalmologist
Laser Surgeon in private practice, (for example, me), who will take complete responsibility
for every step of your Laser Vision Procedure. This, in my opinion,
is good. Or you can select a "Laser Center" where the
Ophthalmologist Laser Surgeon is only partially involved in your care, delegating significant responsibility to Optometrists who will provide most of your
care. These "Laser Centers" want to downplay the significant
distinction between Ophthalmologists and Optometrists. This, in
my opinion, is not so good.
The Ophthalmologist Laser Surgeon you select should be extremely
experienced in Laser Vision Surgery and in private practice, not a "team member" at a Laser Vision Center. The Ophthalmologist Laser Surgeon you select should take complete responsibility
for, and be directly involved in, every decision and every detail of your
Laser Vision Procedure. This means that the Ophthalmologist Laser Surgeon meets
with you at the initial consultation to determine if you are, or
are not, a good candidate for Laser Vision Correction, makes the decision if you should have LASIK or PRK, decides which Excimer Laser is appropriate for you, meets with
you at every pre-op and post -op visit, and performs your Laser
Vision Procedure. If you are not meeting the MD Ophthalmologist
Laser Surgeon at every visit, the Laser Vision Surgeon is delegating
responsibility for your Laser Vision Procedure to non-MD Optometrists, technicians or sales people. This is not
the meticulous commitment by the Ophthalmologist Laser Surgeon that
you want and this is not in your best interest.
I am almost done repeating myself about
how important I feel it is for the Ophthalmologist to meet with
you at every visit. Here is one last thought I want to share with
you. Fortunately, complications after Laser Vision Surgery are not
common, but they do occur. And if they do occur, most complications
are usually easily and successfully managed if promptly and accurately diagnosed
and appropriately treated. I feel very strongly that you would want
the Ophthalmologist, Laser Vision Surgeon, not an Optometrist, seeing
you at every one of your post-op visits so that any complications or concerns can be addressed and resolved as quickly as possible.
And what if you have a problem at night or on weekends? Do you think
the Ophthalmologist at a Laser Vision Center, the one who won't
even see you during regular business hours, will be on call and
available to see you if you have a problem at night, on weekends
or on holidays? I give my surgical patients my cell phone number
so they can call me directly if they have a concern. I don't get called often, but it makes both me and the patient feel better knowing that any potential patient concerns will be addressed immediately and directly by me, the Laser Surgeon, rather than by a non-Surgeon intermediary. I would suggest
that you ask any Laser Center you are considering for your surgery:
Who is providing emergency coverage if a problem may occur after
regular business hours or on weekends? The Laser Vision Surgeon? The Optometrist?
So here is your assignment when you
go for you Laser Vision Consultation. Directly ask the "doctor"
you meet at your initial consultation at the Laser Center you are
visiting: "Are you the Ophthalmologist Laser Vision Surgeon
who will be performing my Laser Vision Procedure and seeing me at
all my pre-op and post-op visits?" And if you aren't meeting
the MD Ophthalmologist Laser Surgeon at your initial consultation,
I think you should go elsewhere for your Laser Vision Surgery. The
following Laser Centers in the Denver area are staffed by Optometrists
who will primarily provide your pre-op and post-op care: ICON, 20/20
Institute, LasikPlus, Laser Vision Institute, TLC, Omni Eye Specialists,
Hines-Sight, InSight Laser Center, Spivack Vision Center and Dishler
Vision Center. If you don't care that your Ophthalmologist Laser
Surgeon has delegated significant responsibility for your Laser
Vision Procedure to non-MD optometrists and technicians, then go
to any one of the above listed "Laser Centers", they are
essentially interchangeable. Incidentally, these "Laser Centers"
are usually not less expensive than Ophthalmologists in private practice. If you want the Ophthalmologist
Laser Surgeon actively involved in every step of your Laser Vision
Procedure, select an Ophthalmologist Laser Surgeon in private practice,
not an Ophthalmologist associated with a "Laser Center".
If you live in a large city like Denver
where you have many Ophthalmologist Laser Surgeons available to
you, I see no reason for you to have optometrists, technicians or
"sales persons" responsible for the outcome of your Laser
Vision Procedure. If the Laser Vision Surgeon does not meet with
you at your initial consultation, go elsewhere to have your Laser
Vision Surgery. And when you meet the Laser Vision Surgeon, trust
your judgment. Does the Surgeon seem competent, caring, open and
honest with you in determining if you are a good candidate for Laser
Vision Correction and in discussing the benefits, risks and limitations
you can realistically expect from Laser Vision Correction? If you
are comfortable with the Laser Vision Surgeon, proceed. If not,
What am I sacrificing if I go to a "low
cost" Laser Vision Correction Surgery Center?
You face the eternal consumer dilemma;
quality versus price. You must ask yourself, what is most important
to you, low price or the safest, most accurate Laser Vision procedure
possible. THE TWO ARE MUTUALLY EXCLUSIVE. And I do acknowledge that
the most expensive Laser Center is not necessarily the best Laser
Center, but I feel very strongly that the least expensive Laser
Centers are definitely NOT providing the highest-quality care. Laser
Vision Correction is eye surgery, not a "product" like
an automobile that is the same quality no matter where you purchase
it, irrespective of price. Laser Vision Surgery results and complication
rates, as with any other surgical procedure, will vary between different
Laser Surgery Centers. Factors such as surgeon experience and skill,
the technological sophistication of the equipment used and the level
of competence of the ancillary support staff will significantly
effect your Laser Vision outcome. Some people are concerned primarily,
or exclusively, with price, and will choose the least expensive
option, and assume that they will still get adequate quality.
"Low-cost" Laser Centers focus your attention on the price
of Laser Vision Correction, obscuring the fact that Laser Vision
Correction results are not identical at every Laser Surgery Center.
Irrespective of the reason for selecting the "low cost"
Laser Center, no one ever selects "low-cost" realistically
expecting to receive the highest quality in technology and competence
of the Laser Vision Center staff. "Adequate quality" may
be acceptable in many products and services, but I don't believe
that it is acceptable in Eye Surgery. It has been my experience
in over thirty years of private medical practice as an Eye Surgeon,
that the highest levels of quality are not compatible with "low
cost" medical care. This "low cost" model is similar
in many ways to the HMO model of corporate, institutional medicine.
"low-cost" is misleading because the "low cost"
Laser Centers usually have many up-charges. Patients
almost always end up paying significantly more for their LASIK procedure
than the "$499" low price that was initially advertised,
i.e. "bait and switch". The "$499" fee is usually applicable only to patients with very minimal correction, which happens to occur very rarely, and usually only includes treatment with outdated technology, like the Nidek Excimer Laser. And the fee may not include a pre-op consultation with
the actual Ophthalmologist Laser Surgeon, to see if you are a candidate for LASIK or PRK. In fact, many of the "low-cost" Laser Centers don't even offer PRK as an option, probably because the post-op care for PRK requires more attention than LASIK post-op care. The "low-cost" Laser Center post-op
visits are usually with Optometrists or technicians, not the Ophthalmologist Laser Surgeon. The "low cost"
Laser Center may have a very restricted criteria for retreatments,
making it difficult for you get a retreatment even if it would be
beneficial to you.
Of course, most of your care is being provided by technicians
and Optometrists, not the Ophthalmologist Laser Surgeon.
The Ophthalmologist Laser Surgeon remains relatively
anonymous in a "low cost" Laser Center, often for good
reason. Usually, you would only meet the Surgeon at the time of
surgery. Your pre- and postop care will be provided usually entirely
only by technicians and optometrists. The Eye Surgeon in the "low
cost" center is called the "designated shooter";
a salaried employee of the "low cost" center. These centers
have difficulty finding well-trained, experienced Laser Vision Correction
surgeons because well-trained, experienced Laser Vision Correction
surgeons already have their own successful Laser Vision Correction
practices and do not want, or need, to work for a "low cost"
Laser center. The Eye Surgeons who typically work in "low cost"
centers may have only minimal, or no prior Laser Vision Correction
experience, and, like HMO physicians, are usually enticed to work
for the "low cost " center by the security of a salary,
or are interested in working only as a "part time" Laser
Vision Correction surgeon. They are often "itinerant"
Surgeons who live in another city and come to Denver only do to
Laser Vision Correction Surgery; these "itinerant" Surgeons
are not readily available to handle postoperative complications.
There is frequent "turnover" of Eye Surgeons in the "low
cost" clinics due to "burn out". No matter how highly
qualified the Eye Surgeon is in a "low cost" Laser center,
that Eye Surgeon does not oversee or take complete responsibility
for your entire Laser Vision Correction procedure, and is aware
of you only to the extent that you are the next "eye"
to be operated on. In fact, patients at some "low cost"
Laser centers are told specifically that they are NOT TO ASK THE
LASER SURGEON QUESTIONS AT THE TIME OF SURGERY because he does not
have time to talk to patients!!! That's just great medical care!!!
If you wear contact lenses the "low
cost" Laser Centers may make you stop wearing your contact
lenses for one month for soft lenses and three months for hard lenses
before they will examine you to determine if you are even a candidate
for Laser Vision Correction. This is an unnecessary inconvenience
for the you, the patient, especially if you aren't a Laser Vision
Correction candidate. In my practice, I do a free
consultation prior to having you stop wearing your contact lenses.
From this initial (free) exam, I can determine if you are a Laser
Vision Correction candidate and how long you need to stop wearing
your contact lenses prior to Laser Vision Correction. For the vast
majority of patients, one week for soft lens wearers and three weeks
for hard lens wearers is an adequate interval to allow the cornea
to return to normal. At the end of this waiting period, I will recheck
you to see if your corneas are stable (95% are). If they aren't
stable, I will have you wait longer before rechecking your corneas.
This extreme contact lens policy of the "low cost " Laser
Center is an example of the "low cost" Laser Center "cutting
corners" and significantly inconveniencing patients so the
Center won't have to spend any more than necessary with the patient.
The fee for the "low cost" Center may not include the
preoperative workup, and the fee may only provide for limited number
of postoperative visits, often for only six months after surgery.
I include one year postoperative follow up in my fee. The "low
cost" Centers may have an extra charge for correcting Astigmatism,
"high" amounts of nearsightedness or farsightedness, for
using the autotracker or for using the VISX Star S4, if available..
They may not offer Custom Wavefront. They often limit your access
to or charge extra for retreatments. The "low cost" Centers
will not provide you with free personal transportation, if needed,
on the day of your surgery or for your post-op exams. All of these
services are included in my fee.
The "low cost" Centers have
stringent "cost controls" that are not compatible with
highest quality eye surgery. These "cost controls" require
relying extensively on non-medical ancillary staff to make medical
decisions, limiting patient's access to the doctor, by "self-insuring",
and/or carrying inadequate malpractice insurance, and by allowing
corporate profit goals to influence medical decisions. Examples
of corporate profit considerations influencing medical decisions
are: not calibrating the Excimer Laser before every procedure, using
"off brand" blades for the Microkeratome, purchasing "refurbished"
(i.e. used) Excimer Lasers, by using "moonlighting" technicians
to repair and maintain the Laser, and by offering Laser Vision Correction
below cost to generate high volumes to then entice investors and
maintain stock value. Over 20 "low cost" Laser Centers
have already closed in Canada and America, some rather precipitously,
leaving patients without follow-up care. What good are "lifetime
guaranties" if the Laser Center goes out of business? Many
"low cost" Laser Centers are now also offering Botox,
Derm Abrasion and Cosmetic Products.
The "low cost" Laser Centers
can only keep their costs down by maintaining high surgical volumes
of hundreds of cases a month. This increases the risk of "human
error" while providing impersonal service, inordinate waiting
time, and little consideration for your personal, individual needs.
I limit the number of Laser Vision Correction procedures
I will perform in a month to 100 procedures. If I go above that
number of Laser Vision Correction procedures, I can not provide
the appropriate level of thorough, personal care that I am promising
Your post-op evaluations at
a "low cost" Laser Center will be performed by technicians
or optometrists, not your Laser Vision Surgeon. If you have a complication
(which can happen at any Laser Center!), the "low cost"
centers may not have the expertise available to quickly diagnose
and treat the complication. This can significantly delay treatment
for the complication. The "low cost" Laser Center will
limit your access to your Laser Eye Surgeon, the one person who
should really be treating you! In my practice, I see all LASIK patients
at every post-op visit and if there is a complication (which, happily
is rare), I will treat the problem immediately. I even give my Laser
Vision patients my mobile phone number so they can contact me directly
if they have a concern. I am also in a "call group" with
other Laser Vision Surgeons to provide backup emergency care if
I am not available. I encourage you to ask the "low cost"
Laser Centers who will be available for you on weekends or holidays
if you have an emergency. The sooner a problem is treated, the better
the chance of resolving the problem. Laser Vision Correction is
surgery being performed on your eye, and I have only one goal; to
maximize your chance of getting an excellent Laser Vision Correction
result. If I would choose to focus, instead, on a "low cost
" approach, I would not be providing you with same Laser Vision
Correction procedure that I now provide. I would have to "cut
corners", and in my experience, this inevitably compromises
quality. I can have only one "highest priority", either
quality or "low cost". My uncompromising commitment is
to quality, at a competitive, but not the "lowest" price.
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most important consideration when selecting a Laser Vision Surgeon...
The most important criteria that you should consider
in evaluating a Laser Center is the Laser Vision Surgeon, i.e. Ophthalmologist!
In my opinion, the "key" to a successful LASIK outcome
for you is that the Ophthalmologist Laser Surgeon is extremely experienced
in Laser Vision Surgery and will take complete responsibility for
every step and every detail in your Laser Vision Procedure. This
means that the Laser Surgeon meets with you at the initial consultation,
and at every pre-op and post-op visit, and performs your Laser Vision
Surgery. If you are not meeting with the Ophthalmologist Laser Surgeon
at every visit, you are meeting with either optometrists
(non-surgeons), technicians, or sales people. This is not the meticulous
commitment by the Ophthalmologist Laser Surgeon that you want and
this is not in your best interest. It is the Ophthalmologist Laser
Surgeon's responsibility to oversee every step of your Laser Vision
Procedure, not to delegate your care to non-medical assistants such
as optometrists or technicians. If you are not meeting the Laser
Surgeon at every visit, the Laser Vision Surgeon is delegating responsibility
for your Laser Vision Procedure. And if the Laser Surgeon is not
taking full responsibility for your Laser Vision Procedure, then
who is? The optometrist, the technician, the sales people, you...?
Arguably, at these "Laser Centers", you are the only person
who is actually present at each of your visits and, by default,
are "supervising" your own Laser Vision Procedure. I do
not think this a good situation for you to put yourself in. Be certain
you are meeting with the Laser Vision Surgeon at every visit!
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the difference between Laser Centers?
Laser Vision Centers come in three basic models.
I call these models "good","better" and "best",
based on the level of involvement and responsibility the Ophthalmologist
Laser Vision Surgeon commits to your care.
model is a corporate business model. This is the structure of ICON,
Laser Vision Institute, TLC, LasikPlus and
20/20 Institute. These Laser Centers are typically financed by investors,
are often national corporations with multiple Laser Centers, and are, most importantly, managed
by non-medical directors. These centers are staffed primarily with
administrators, marketing/sales people, technicians and optometrists.
The Ophthalmologist Laser Surgeon is called the "shooter"
and is a usually an "independent contractor", a part-time employee
of the Laser Center who often lives in a city other than Denver,
traveling to Denver only to perform Laser Vision Surgery. In this
model, you will be treated in an "assembly line" process,
being passed from sales people to technicians to optometrists to
Ophthalmologist Laser Vision Surgeon, back to optometrists and technicians.
You will, typically, only meet the Laser Surgeon at the time of
your surgery. Non-medical staff will be providing most of your care.
The Ophthalmologist Laser Vision Surgeon is only partially involved
in providing your care. In this scenario, you are picking a for-profit business
and letting the business select your Ophthalmologist Laser Surgeon
for you. The "assembly line" model may provide adequate
visual outcomes but I do not believe it is the "best"
way to provide your Laser Vision Correction, especially if you are
having concerns about or complications with your Laser Vision Procedure.
Fortunately, complications after Laser Vision Correction are not
common, but they do occur! And if you do have a concern or complication,
do you want the optometrist or technician treating you? No, at that
point, you absolutely want the Ophthalmologist Laser Surgeon treating
you, and they are usually not immediately available in this "Laser
Center" model, especially at night and on weekends. I think
it is unacceptable to have technicians and optometrists treating
The "better" model is the Ophthalmologist
Laser Surgeon-directed, but optometrist-staffed, model. This is
the structure of Spivack Laser Vision Center, Dishler Laser Vision
Center, Omni Eye Specialists, InSight Laser Center and Hines-Sight Laser Vision Center.
These Laser Centers are owned and supervised by the Ophthalmologist
Laser Surgeon, but these Laser Centers still have an "assembly
line" process for providing your care. Most of your care is
still provided by technicians and optometrists. You typically only
meet the Ophthalmologist Laser Surgeon the day of your surgery.
At least, in this model, you are selecting an excellent Laser Surgeon,
but the Surgeon is still delegating much of your care to non-medical
personnel, and this is not ideal.
The "best" model is, in my opinion,
the traditional Ophthalmology "private practice" medical
setting in which you are directly selecting your Ophthalmologist
Laser Surgeon and this Laser Surgeon is providing you with continuous
care throughout your Laser Vision Procedure, not delegating your
care to non-medical personnel. There are at least thirty Laser Vision
Surgeons in private ophthalmology practice in the Denver-Boulder
area. In this model, the Laser Surgeon is completely responsible
for every detail of your Laser Vision Procedure, from the initial
consultation, through the Laser Vision Surgery, to the final postop visit. This is the model of care I provide to my patients.
You would think that the "assembly line"
Laser Center models would have lower Laser Vision fees than Ophthalmologist
Laser Surgeons in private practice. Ironically, the fees you will
be charged by the "assembly line" Laser Centers are often
higher than the fees you will be charged by a private practice Ophthalmologist
Laser Vision Surgeon. "Assembly line" Laser Centers spend
many hundreds of thousands of dollars a year on advertising on TV,
radio and newspaper, which typically adds hundreds of dollars to
your fee, without any benefit to you. Laser Surgeons in Ophthalmology
private practice rarely commit to these costly marketing campaigns.
I do not recommend that you pick your Ophthalmologist Laser Vision
Surgeon based on price, but I do want to emphasize that "assembly
line" Laser Centers are not usually a "bargain".
I think one problem for prospective Laser Vision
patients is that they do not have an established relationship with
an Ophthalmologist and, often, do not know the difference between
a private practice Ophthalmologist Laser Surgeon and a "Laser
Center" Laser Surgeon (see the above 4 paragraphs). Many prospective
Laser Vision patients have been receiving eye care from optometrists
and when it is time to consider Laser Vision Surgery, the prospective
Laser Vision patients don't know how to find an Ophthalmologist
Laser Surgeon. Prospective Laser Vision patients ask friends for
a Laser Surgery referral, ask their optometrist for advice, do an
Internet search, or respond to radio, TV and newspaper advertisements.
Private practice Ophthalmologist Laser Surgeons rarely advertise
on TV, radio or newspaper so they may not be "household names".
If you ask your optometrist, they would probably never send you
to a private practice Ophthalmologist. Optometrists refer their
patients to Laser Centers because Laser Centers pay the optometrists
$500-$1000 "co-management (referral) fees". Internet searches
and asking friends for advice is, at best, confusing. So, how do
you find an Ophthalmologist Laser Surgeon in private practice? Obviously,
I think you should visit my practice for a free consultation, but
I would like to also recommend other Ophthalmologist Laser Surgeons
in the Denver area in private practice that are extremely experienced
and that I would trust to perform Laser Vision Surgery on me. I
would recommend Stuart Frankel, MD, David Drucker MD, Lance Forstot
MD, Jason Jacobs M.D., Tom Campbell, M.D., Steve Podgorski, M.D. and Stuart Lewis MD. There are many other excellent, experienced
Ophthalmologists in the Denver area but these are my "favorites".
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Why is it so
important to have the Ophthalmologist Laser Surgeon involved in
the initial consultation and the preop and postop exams?
Without question, the single most important step
in your Laser Vision Surgery is the actual surgery itself. And that
is why it is critical that you select an extremely experienced Ophthalmologist
Laser Surgeon. Nevertheless, every other step in the Laser Vision
process is also important in determining the success of your Laser
The initial consultation is important in determining
if you are, or are not, a good candidate for Laser Vision Correction
and if you would benefit from LASIK, PRK, Custom Wavefront, Monovision
and/or IntraLase. You need to be evaluated for corneal abnormalities,
pupil size, cataracts, glaucoma, retinal disease and any underlying
medical conditions that may compromise your Laser Vision Procedure
or put you at risk for complications. It is extremely important
that you are accurately assessed at your initial consultation to
ensure that your Laser Vision Procedure with be performed correctly
and safely. And you need to have a candid discussion regarding your
specific visual requirements, your expectations, as well as the
the risks and limitations of Laser Vision Correction. The initial
consultation must be thorough and I feel that the initial consultation
should be performed by the Ophthalmologist Laser Surgeon, not delegated
to an optometrist or technician.
The preop evaluation is important in collecting
the actual data that will be used to calculate your Laser Vision
Correction. After the data is collected and analyzed, you again
need to be assessed to determine which Laser Vision Procedure and
technologies are best suited for you, and if it is safe for you
to even proceed with Laser Vision Surgery. The preop evaluation
must be thorough and I feel that this evaluation should be performed
by the Ophthalmologist Laser Surgeon, not delegated to an optometrist
The postop evaluations are important to determine
if you are experiencing any complications from surgery. Fortunately,
complications are not common, but complications do occur, and complications
need to be identified and treated quickly, and correctly. I feel
that it is your Ophthalmologist Laser Surgeon's responsibility to
examine you at every postop visit. Delegating postop care to optometrists
or technicians can delay prompt and proper treatment and is, in
my opinion, not in your best interest.
I want to stress that it is misleading for me to
artificially compartmentalize your Laser Vision Procedure into freestanding
components, consisting of the initial consultation, the preop evaluation,
the surgery, and the postop care. I am not suggesting that Laser
Vision Correction should be seen as an "assembly line"
procedure in which different "parts" of the Laser Vision
Procedure can be effectively performed by different workers. In
my experience, continuity of care provided by the Ophthalmologist
Laser Surgeon who sees you at every visit is superior to the "assembly
line" system. The primary flaw of the "assembly line"
Laser Vision Procedure is the lack of quality control and supervision
of the "assembly line workers". In the "assembly
line" system, the Ophthalmologist Laser Surgeon is assuming/hoping
that the optometrists and technicians who did the pre-surgical evaluation
were thorough in their evaluation, assessment and calculations.
However, the Ophthalmologist Laser Surgeon really has no way to
verify the accuracy of the information she/he receives from the
optometrist and technicians, and this, I think, is not good.
so bad about optometrists and technicians?
I do not want to suggest that optometrists and technicians
are not competent. Most Laser Centers rely primarily on optometrists
and technicians to provide the initial evaluation and the preop
and postop care for their Laser Vision Correction patients, and
the outcomes from these Laser Centers seem to be good. My point
is that even though most optometrists and technicians are kind,
compassionate and caring, they do not have the surgical training
and expertise of the Ophthalmologist Laser Surgeon. Ophthalmologist
Laser Surgeons have attended at least four years of college, four
years of medical school, one year of internship in medicine, general
surgery or pediatrics, and at least three years of subspecialty
training in Eye Surgery. It seems to me that you would want the
most highly trained, surgically experienced person, the Ophthalmologist
Laser Surgeon, taking care of you throughout your Laser Vision Surgery.
This is not readily available at most "Laser Centers",
but it sure is available in my practice and other Ophthalmologist
Laser Surgeons in private practice.
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does a "Commitment to Detail" look like...
I would like to describe to you what a "commitment to detail" looks
like. LASIK is a procedure that requires, perhaps, 50 reasonably simple steps,
but each step must be done correctly. Each step is about as difficult, as say,
correctly writing down a telephone number. How difficult can it be to consistently
write down 50 phone numbers? To do this correctly requires a compulsive, meticulous
attention to detail.
Obviously, some Laser Surgeons provide better Laser
Vision care than others. However, I don't think there is a "best"
Laser Surgeon, but I do think there is a "best" way to
perform Laser Vision Correction. And
I think that if all Laser Vision Surgeons sat down together it would
be relatively easy to arrive at a consensus description of the "best"
way to perform Laser Vision Correction. In fact, this is done regularly
at Laser Vision Correction conferences throughout the year. I, and
thousands of other Laser Vision Surgeons, attend national and international
meetings regarding Laser Vision Correction. I regularly attend
the ASCRS (American Society of Cataract and Refractive Surgeons), the AAO (American Academy of Ophthalmology) and the New Orleans Academy of Ophthalmology Symposia annual
meetings. At these meetings, the techniques, equipment, results and
complications of many millions of Laser Vision procedures are discussed
in depth. Based on the shared data and surgical experiences presented
at these meetings, an ever-evolving picture of the "ideal"
Laser Vision procedure is established. It is my goal to provide
to you, as consistently as possible, this "ideal" Laser
There is no "secret equipment" or "special
technique" involved in the "ideal" Laser Vision procedure.
Any Laser Vision Center that claims to be the only one to have access
to some "special" technology should arouse your suspicion.
Either they are making misleading, boastful claims (which is usually
the case), or they are using new, unestablished technologies that
may or may not work long term. In my opinion, they are considering
their own best interests, not yours.
To understand the considerations involved in choosing
your Laser Vision Correction Surgeon, I would first like to describe
for you what I consider to be the "ideal" Laser Vision
Correction process. I have established my Laser Vision Correction
practice based on the premise that my highest priority is to provide
you with an uncompromising commitment to quality. So, in describing
the Laser Vision Correction process, I am presenting what I consider
to be the "gold standard" of Laser Vision Correction surgery.
This is the standard I continuously strive to maintain in my practice.
The first step in the Laser Vision Correction process is your complimentary
(i.e. free) Lasik consultation at which time you will meet me, Dr.
Levinson, and my staff. The consultation determines if you are a
good candidate for Laser Vision Correction. We explain the options
you have available and the benefits, risks and results you can expect
after Laser Vision Correction. We help you decide if Laser Vision
Correction is a reasonable procedure for you. In my practice, I
meet with you at your consultation. Since I will be personally responsible
for doing your surgery and insuring that you will get an excellent
outcome from your Laser Vision Correction procedure I want to be
certain you are a good candidate for Laser Vision Correction. I
will determine this myself; I do not delegate this most important
decision to a technician or optometrist. For clarification, I am
an Ophthalmologist. I went to medical school, have an MD (Medical
Doctor) degree and perform surgery. An optometrist is not a medical
doctor, cannot perform surgery and does not have the training or
experience of an Ophthalmologist.
The initial consultation should include a review
of your medical and ocular history, an examination of your eyes,
a Refraction, and Corneal Pachymetry,and Corneal Topography measurements.
The Refraction (the "which is better, one or two") determines
the numbers that will be entered into the computer to calculate
how much of your corneal tissue will be removed by the Laser. The
Refraction is probably the most important step in Laser Vision Correction.
If inaccurate numbers are put in the computer that runs the Excimer
Laser, your visual outcome after Laser Vision Correction will not
be acceptable. In my practice, I will perform your preoperative
Refraction. I feel the Refraction is too important to delegate to
anyone else. Corneal Pachymetry uses ultrasound to measure
the thickness of your cornea to insure that your cornea is thick
enough to safely accept Laser Vision Correction. Corneal Topography
produces a Topographical profile of your cornea to help identify
any evidence of corneal pathology that may make it unsafe for me
to perform Laser Vision Correction surgery on your eye. I also use
Corneal Topography to verify, if applicable, that your corneas are
not distorted by your contact lenses. If you wear soft contact lenses
you need to stop wearing your lenses at least one to two weeks prior
to surgery. If you wear gas-permeable or hard contacts, you must
stop wearing your lenses 3 weeks prior to surgery. After you have
stopped wearing your contact lenses for the prescribed length of
time, I repeat your Corneal Topography to make sure that any corneal
distortion has resolved. If the distortion persists, you will be
asked to wait longer, until the corneal distortion resolves.
If you are over 35 years old, the consultation should also include a discussion
and demonstration of the Monofit option. Monofit helps you to avoid the eventual,
and inevitable need for reading glasses around the age of 45.
We also discuss with you at the consultation the if the VISX Custom
Wavefront or WaveLightEX500 technology is the appropriate Laser for you.
The consultation must also include a candid discussion
of the risks, benefits, and limitations of Laser Vision Correction
by the Ophthalmologist Laser Surgeon. Although Laser Vision Correction
is an excellent procedure, it is not perfect. It is
imperative that you have realistic expectations of what your vision
will be after Laser Vision Correction. If you want perfect vision,
you need to be born with perfect eyes, and not age beyond age 40;
however, if you were not born with perfect eyes, Laser Vision Correction
is an excellent alternative to glasses or contacts. I will personally
discuss the risks, limitations, and reasonable results that you
can expect from Laser Vision Correction.
If you then decide that you want me to perform your
Laser Vision Correction, we will schedule your surgery appointment
and a preoperative evaluation 3-5 days prior to your LASIK Procedure.
At the pre-op exam, I recheck your refraction and your topography,
take Custom Wavefront measurements, and answer any questions you
may have about the procedure.
The final aspect of the Laser Vision Correction process
is the postoperative care. Fortunately, Laser Vision Correction
complications are relatively uncommon, but they do occur. 90% of
Laser Vision Correction complications occur in the immediate postop
period. If complications are promptly identified and treated, they
almost always resolve without causing negative long term visual
effects. I see every Laser Vision Correction patient at every postoperative
visit. I am available to answer any questions, or to address any
concerns that you may have.
Which Excimer Laser...
my experience, Laser Vision Correction has been a highly precise, technically
reproducible procedure if performed meticulously. Laser Vision Correction is,
however, a surgical procedure being performed on your eye, and must not be trivialized.
If Laser Vision Correction is not performed correctly, serious complications can
occur. I do not claim that my Laser Vision Correction results are superior to
any other Laser Vision Correction Surgeon's results, but I do make every effort
to maximize the chances of a successful Laser Vision Correction result by using
the highest quality equipment and the best-trained support staff available.
I do not own an Excimer Laser and, therefore, I am
not "tied" to any one Laser. (I am certified to use, and
have used, the VISX, WaveLight, Autonomous, Technolas and Summit Excimer Lasers.)
The Excimer Lasers that in my experience gives the best visual results
are the VISX Star S4 ActiveTrak Excimer Laser with the SmoothScan
and VISX CustomVue Wavefront Analyzer upgrades and the WaveLight EX500. Other Excimer Lasers
may give good results but the VISX Star S4 with the CustomVue Wavefront
system is the most advanced, state-of-the-art system available and
provides unsurpassed visual outcomes. (If it sounds like I am promoting
VISX it's because of the results I am getting with their Excimer
Laser; I have no financial interest in VISX or any Excimer Laser
Company. I do not own a VISX Laser). My laser of choice for treating nearsightedness and astigmatism is the VISX but I do prefer the WaveLight Laser for treating farsighted prescriptions.
We are now able to obtain extremely precise Laser Vision Correction with the addition
of VISX CustomVue Wavefront technology allows us to
correct your vision with extreme precision. Wavefront technology uses a laser
scanning system to create a 3 dimensional map of your cornea. The Wavefront measurement
of your eye is unique for your eye. Millions of people may have the same glasses
prescription, but no two people will have identical Wavefront maps of their eyes.
This Wavefront information allows us to more accurately reshape your eye with
the VISX Star S4 Excimer Laser.
Wavefront measurements are
25 times more precise than previous measurement systems and can identify corneal
imperfections that glasses or contacts cannot correct.
studies on patients who had LASIK on the VISX Star S4 CustomVue Wavefront system
98% of patients saw 20/20 or better
after VISX CustomVue Wavefront LASIK and 75% of patients saw better than 20/20!
Four times as many patients were very satisfied with their night vision after
the VISX CustomVue procedure, compared to their night vision before with glasses
I would strongly recommend that
you consider having the Custom Wavefront upgrade when you have your Laser Vision
We calibrate the VISX Excimer Laser
prior to each procedure. It is not mandatory to calibrate the Laser prior to every
procedure, and frequent calibration adds extra expense to the process, but this
helps maintain the continuous accuracy of the Laser. We also have state-of-the
art environmental controls to maintain the proper temperature and humidity in
the Laser room. We have an extensive battery backup system to prevent power surges,
or Laser failure from power outages.
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What is the IntraLase
and why does it make LASIK safer?...
When we perform LASIK, we first lift a thin flap
of tissue from the top of your cornea. There are two pieces of equipment
available for creating the corneal flap in Lasik. We can use either
the Bausch and Lomb Hansatome Microkeratome (a metal blade) or we
can use the IntraLase, a femtosecond Laser. The Micorkeratome has
been used safely for over ten years in LASIK, but the IntraLase
is safer and provides better visual outcomes than does the Microkeratome.
The IntraLase uses Laser technology, not a blade, to create the
LASIK flap. The IntraLase has less complications than the Microkeratome,
and when complications do occur with the IntraLase, the complications
are much less serious and are easier to safely remedy. Safety is
my highest priority in performing LASIK, and I strongly recommend
using the IntraLase for creating the corneal LASIK flap. There is
an additional fee for the IntraLase.
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is responsible for you care?
If you are not seeing your Ophthalmologist
Laser Vision Correction Surgeon at your consultation, pre-op and
postop visit, then your Surgeon is not taking responsibility for
every step of your Laser Vision Correction. And if the Surgeon is
not taking full responsibility for your outcome, then who is? An
optometrist, a technician? I would recommend
that you determine if the Laser Vision Correction Surgeon will also
be responsible for doing your preoperative and postoperative care.
As the Laser Vision Correction Surgeon, I take full responsibility
for all aspects of the Laser Vision Correction procedure in my Laser
Vision Correction practice. In my Laser Vision Correction practice,
I myself do the preoperative evaluation, including the Refraction,the
Laser Vision Correction Surgery, and all postoperative evaluation.
Happily, complications after Laser Vision Correction Surgery are
not common, but they do occur. Fortunately, if complications are
promptly identified and treated, almost all complications will resolve
without problem. For this reason I see all my patients at each postoperative
visit. I do not delegate this important aspect of Laser Vision Correction
to an optometrist or technician. Delegating post-op care to optometrists
and technicians can delay proper diagnosis and treatment of complications.
And if the Ophthalmologist Laser Vision Surgeon has delegated your
care and is not willing to see you during regular business hours,
how available will they be for you if you have a problem at night,
on weekends or on holidays. I give my Laser Vision Surgery patients
my cell phone number (303-525-9799) so they can contact me directly,
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the point? Will you please summarize how I choose a Laser Surgeon?
This is what I
would recommend to you if you are looking for the highest-quality Laser Vision
- Decide if your
highest priority in selecting your Laser Surgeon is quality, or price. The only
reason to have Laser Vision Correction performed at a "low cost"
Laser Center is to save yourself money. Do not expect to obtain the highest possible
quality standards of Laser Vision Correction care in a "low cost" Laser Center. These Centers have profit, not impeccable medical care,
as their highest priority. And they typically aren't that much less expensive than my fees.
- Avoid a "Laser Center". Select an Ophthalmologist
Laser Vision Surgeon in private practice, not a Laser Vision Correction
Surgery Center. Find an experienced, meticulous Ophthalmologist
Laser Vision Surgeon that you trust and who will make the commitment
to you to take full responsibility for your Laser Vision Correction
result; one who will meet with you prior to your Laser Vision
Correction surgery, and who will be actively involved in every
aspect of your Laser Vision Correction procedure. The Surgeon
should have an active Laser Vision Correction practice, but should
not be so busy that he/she does not have the time to meet with
you, evaluate you, and answer all of your questions.
sure that all the preoperative and postoperative evaluations will be performed
by the Laser Vision Correction Surgeon, not an optometrist.
Excimer Laser I would recommend is the VISX Excimer Star S4 ActiveTrak Laser with
CustomVue Wavefront for myopia (nearsightedness) and astigmatism, and the WaveLight EX500 for hyperopia (farsightedness).
- Be sure that your Laser Vision
Correction Surgeon has a kind, compassionate, easily accessible office staff to
help support you emotionally, and to address all of your concerns throughout your
complete Laser Vision Correction journey. My commitment to my patients to make
my staff and I easily accessible extends to the point that I give all my Laser
Vision Correction patients my cell phone number so they can contact me directly
if they have questions or a problem that they feel needs immediate attention.
- I would encourage you to visit two or three Laser
Surgeons before you make your decision; and I would invite you
to visit me and my staff for a free, complimentary consultation.
- If you are a good candidate for Laser Vision Correction and the procedure is performed correctly with the appropriate Laser technology by an experienced Laser Vision Surgeon, prepare yourself to experience the world without your glasses and/or contacts. Do it!
Richard Levinson, M.D.
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Rose Medical Plaza,
4545 East Ninth Avenue, #270, Denver, CO 80220