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How to Select Your Lasik SurgeonColorado Custom LASIK Vision Correction Surgeon Laser Eye Surgery with CustomVue Wavefront LASIK in the Denver & Boulder Metro AreaYou may just be curious about Laser Vision Correction and would like basic introductory information. Or you may have decided that you are ready to have Laser Vision Correction Surgery and are now trying to decide who you will select to perform your Laser Vision Surgery. Either way, I would like to share my thoughts and experience with you regarding your selection process. I will address these questions with you:
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. Duh... "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 twenty 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. The "low-cost" is misleading because the "low cost" Laser Centers usually have "hidden charges". Patients almost always end up paying significantly more for their LASIK procedure than the "$299" low price that was initially advertised, i.e. "bait and switch". And the fee may not include a free consultation with the Surgeon to see if you are a candidate for Laser Vision Correction, may include only a limited number of follow-up visits, and there may be an additional charge for retreatments. 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. And, 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!!! One last thought on this subject, and this is probably a little picky because I know I have some spelling errors in my website, but LasikPlus, on their website as of 6.01.06 says: "Your Lasik surgeon will be one of America's leading ophthamologists (sic)." Take note that they spelled Ophthalmologist incorrectly. (They left out the first "L" in ophtha"l"mologist.) How much respect, oversight and control does your "ophthamologist" have at LasikPlus, and other "assembly line" Laser Centers? 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 to you. 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.
The single 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!What's 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. The "good" model is a corporate business model. This is the structure of ICON, Laser Vision Institute, TLC, LasikPlus, InSight Laser Center and 20/20 Institute. These Laser Centers are typically financed by investors, are often national corporations, 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 a "part-time contract labor" employee of the Laser Center and 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 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 post-op complications. 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 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. 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 and Stuart Lewis MD. There are many other excellent, experienced Ophthalmologists in the Denver area but these are my "favorites". 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 Vision Procedure.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 or technician.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.(Return to top.)What's 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.What does a "Commitment to Detail" look like... Now 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. Each spring I attend the ASCRS (American Society of Cataract and Refractive Surgeons) meeting and each fall I attend the AAO (American Academy of Ophthalmology) meeting. 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 Vision procedure. 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. Your Preoperative Evaluation... 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 Custom Wavefront technology. Not all patients are candidates, or even need Custom Wavefront technology, but if you have large pupils (greater than 6.5 mm), moderate level of astigmatism or are considering Monofit, you need to consider Custom Wavefront. 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. In 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, Autonomous, Technolas and Summit Excimer Lasers.) The Excimer Laser that in my experience gives the best visual results is the VISX Star S4 ActiveTrak Excimer Laser with the SmoothScan and VISX CustomVue Wavefront Analyzer upgrades. 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.) 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. FDA studies on patients who had LASIK on the VISX Star S4 CustomVue Wavefront system showed:
I would strongly recommend that you consider having the Custom Wavefront upgrade when you have your Laser Vision Correction procedure! 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. 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.
If Laser Vision Correction is so safe, why am I scared?Laser Vision Correction is scary because it's Eye Surgery! The thought of Surgery is unnerving, and the thought of Eye Surgery can be really unnerving. Laser Vision Correction can be stressful for you emotionally, and can cause you considerable anxiety. I share your concern about the safety of Laser Vision Correction and take every possible precaution to make Laser Vision Surgery as safe as possible. I find it extremely comforting for me that if I meticulously perform Laser Vision Surgery with properly maintained, state-of-the-art equipment, the outcomes are extremely safe and predictable. It is the unknown that frightens us, and we can decrease the fear of Laser Vision Correction by preparing and understanding what is happening to us at each step of the procedure. I want no surprises for me or my Laser Vision Correction patients. I have fourteen members of my office and medical support staff who are specifically trained in Laser Vision Correction patient support. My staff and I are involved with each Laser Vision Correction patient during the preoperative evaluation, the actual Laser Vision Correction procedure, and the postoperative period. It has been my experience that if you have established confidence in me and my support staff by meeting us at the preoperative evaluation, and we prepare you to understand what to expect at each step of the Laser Vision Correction procedure, and we provide a kind, compassionate, and supportive environment for you during your procedure, then we can significantly decrease your emotional stress during Laser Vision Correction. And if kindness and information aren't enough to relax you, we also provide you with Valium! Who 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, if needed. I respect the fact that patients may have a long-standing relationship with an Optometrist, a non-surgical eye care provider. If the patient desires to have their own Optometrist involved in their Laser Vision Correction care, and the Optometrist is experienced in evaluating Laser Vision Correction patients, I will co-manage the patient with their Optometrist. However, I will still personally meet and examine the patient prior to Laser Vision Correction, perform the Laser Vision Correction Surgery, and do the immediate postoperative follow-up exam. The patient then returns to their Optometrist for subsequent follow-up examinations. In this co-management situation, I am informed by the Optometrist of the patient's postoperative progress, and I am available to the patient any time the patient wants to see me. 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. 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 affect 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. Don't be fooled. YOU GET WHAT YOU PAY FOR! "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 twenty 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. The "low-cost" is misleading because the "low cost" Laser Centers usually have "hidden charges". Patients almost always end up paying significantly more for their LASIK procedure than the "$299" low price that was initially advertised, i.e. "bait and switch". And the fee may not include a free consultation with the Surgeon to see if you are a candidate for Laser Vision Correction, may include only a limited number of follow-up visits, and there may be an additional charge for retreatments. 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. And, 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!!! One last thought on this subject, and this is probably a little picky because I know I have some spelling errors in my website, but LasikPlus, on their website as of 6.01.06 says: "Your Lasik surgeon will be one of America's leading ophthamologists (sic)." Take note that they spelled Ophthalmologist incorrectly. (They left out the first "L" in ophtha"l"mologist.) How much respect, oversight and control does your "ophthamologist" have at LasikPlus, and other "assembly line" Laser Centers? 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 to you. 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.
So what's the point? How do I choose a Laser Surgeon? This is what I would recommend to you if you are looking for the highest-quality Laser Vision Correction experience:
Phone
(303)393-0347
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The Levinson Eye Clinic, in Denver Colorado, and its laser vision correction surgeon, Dr. Richard A. Levinson, M.D., provide the latest technology in eye care and Lasik vision correction surgery for Custom Wavefront Lasik in the Denver and Boulder Metro area. Dr. Levinson and his refractive eye surgery staff use the Visx Star S4 excimer laser for Lasik or PRK refractive eye surgery with Customvue Wavefront Lasik. Contact Dr. Levinson and his Denver, Colorado laser vision correction staff for more information or to schedule a complimentary Custom Lasik vision correction consultation.
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