Laser Vision Correction is highly technical Eye Surgery. You want to select a highly-experienced Ophthalmologist, an M.D. Eye Surgeon, who will perform every step of your Laser Vision Correction Surgery for you. If you aren’t selecting an Ophthalmologist to perform your Laser Vision correction Surgery, you are selecting a “Laser Vision Center”, who will pick your Ophthalmologist Eye Surgeon for you and where a significant portion of your care will be delegated by the Ophthalmologist to Optometrists. These “Laser Vision Centers” will emphasize low price or “special” equipment, but will not mention that Optometrists will be providing most, or all, of the pre- and post-op care. All high-volume “Laser Vision Centers” relegate most, or all, of the pre- and post-op care to Optometrists because the Ophthalmologist Eye Surgeon does not have the time to see you pre- and post-operatively. Substituting Optometrists to provide the care that, from my perspective, Ophthalmologists should be providing, is a highly efficient business model for doing high-volume Laser Vision Correction Surgery. This business model has a strong emphasis on sales and marketing, and less emphasis on the traditional doctor-patient relationship. This, in my opinion, is not the best way to provide you with the safest, highest-quality Laser Vision Correction Surgery. To provide you with the highest level of seamless continuity of care, you want just one Ophthalmologist, and no Optometrist, doing your Laser Vision Surgery and all of your pre- and post-op care.
The Ophthalmologist, the M.D. Laser Vision Eye Surgeon, is the one who will be using very sophisticated and precise Lasers on your eye. The Ophthalmologist, not the Optometrist, is the one who has the highest levels of training and expertise in all aspects of Laser Vision Correction. The Ophthalmologist, not the Optometrist, is the person ultimately, and legally, responsible for all aspects of your care. You want the Ophthalmologist, not the Optometrist, providing you with seamless continuity of care, throughout your Laser Vision Correction Surgery, from your initial consultation to your final post-op exam. And this is what I consider to be “The Fine Art of Laser Vision Correction”. This is the standard-of-care I will provide for you.
Laser Vision Correction Eye Surgery is performed by Ophthalmologists – MD Eye Surgeons, not Optometrists. Understanding the differences between an Ophthalmologist and an Optometrist is important because all high-volume Laser Vision Centers employ Optometrists to provide pre-op and post-op care for Laser Vision Correction patients. In fact, this is the ONLY way they can provide high-volume Laser Vision Correction Surgery. In high-volume Laser Centers, the Ophthalmologist Laser Surgeon does not have the time to do pre- and post-op examinations. I believe this pre- and post-op care is as important as the actual Laser Vision Surgery and should be provided only by the Ophthalmologist Laser Surgeon.
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 understanding this difference allows you to determine who is actually providing your care, and potentially, the quality of your care. 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. I have respect for Optometrists and I am not trying to demean or make disparaging comments about Optometrist. Optometrists are trained primarily to fit glasses and contact lenses, and they are very good at that. And Optometrists do receive some training in treating medical conditions of the eye, but not to the level or extent of training of Ophthalmologists. Optometrists do not perform Laser Vision Correction Surgery. Ophthalmologists do, and I believe Ophthalmologists are better trained to provide, and should provide, all aspects of care in Laser Vision Surgery.
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. How experienced is the Ophthalmologist and will the Ophthalmologist be providing ALL your care, or delegating your care to Optometrists? Laser Centers that allow Optometrist to provide care for Laser Vision patients blur this significant distinction between Ophthalmologist and Optometrist and do not emphasize the fact that they use Optometrists to provide most of your pre-op and post-op care. Care, in my opinion, that should be provided by the Ophthalmologist Laser Surgeon. Laser Centers that employ Optometrists to provide care tend to stress low price, the “special” Laser equipment they use, the extraordinary number of cases they have performed, or which celebrities they have treated. While these considerations are important, they are not as important as having the Ophthalmologist, not the Optometrist, provide all your care. A competent, experienced Ophthalmologist Laser Surgeon will select the appropriate equipment to perform your Laser Vision Surgery. How competent and knowledge is an ex-professional football star when it comes to evaluating and selecting a Laser Eye 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 much 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” who delegates responsibility for your care to Optometrists.
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, go elsewhere.
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.
The “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 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 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!
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 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 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, 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”.
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.
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.
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. 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 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.
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.
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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.
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, 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.
FDA studies on patients who had LASIK on the VISX Star S4 CustomVue Wavefront system showed:
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 or contacts.
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.
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 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.
This is what I would recommend to you if you are looking for the highest-quality Laser Vision Correction experience:
- 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.
- Be sure that all the preoperative and postoperative evaluations will be performed by the Laser Vision Correction Surgeon, not an optometrist.
- The 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.