Commentary by Joel Hunter, MD
About two years ago, I needed to have nose surgery to fix my septum and turbinates that were so weird-looking that the ENT doc looking at my CT scans seemed horrified and confused that I was just now getting around to checking it out. Of course, I just knew that I never breathed out of one of my nostrils, so I had to agree with whatever the ENT saw there and with whatever treatment she recommended. It gave me a whole different appreciation for what it must be like to try to find the right LASIK surgeon. Every ENT I researched was “an expert” and “best in the field” and had won multiple “Nobel Nose Prizes,” so it made it impossible to figure out who I actually should trust. And I’m a doctor! I had hoped for some secret book of "Actually the Best Doctors" to be available to me, but no such luck. The whole experience made me a lot more empathetic for the plight of the person researching LASIK. In that spirit, I was especially happy to add any helpful thoughts I could to this article.
Since the mid-1990’s the LASIK procedure has gone from being an esteemed, but uncommon surgical practice for eliminating the need for glasses, to a widespread vision correction choice that thousands of individuals elect each day. The number of LASIK surgery providers is also continually on the rise alongside that growth. So how do you go about deciding on the best eye doctor to perform your LASIK procedure?
When you want to make the best decision possible in choosing your LASIK surgeon, as with any major choice in life, information is vital. Improving your lifestyle through laser eye surgery is going to start with identifying how all the factors that make a great LASIK provider come together.
There are bragging points that LASIK surgeons use that just don’t matter, and some details rarely mentioned that matter quite a bit. The best example of this is “has performed over (x) thousand procedures,” which I see and hear in nearly every advertisement. After doing a couple hundred procedures, the lifetime total LASIK performed drops towards the bottom of the list of things that matter. Everything else being equal, yes 10,000 total is slightly better than 1,000 total, but everything else is never equal. And this is coming from a guy (I’m aware and ashamed of how much this sounds like a humblebrag, but it feels like the only way to seem credible about this) who has done many thousands of LASIK procedures. The technology is always improving, and anyone who has done more than a few thousand cases with the same technology isn’t upgrading quickly enough.
The field of eye surgery is no different than any other area of medicine. You’re going to run across practices that are great and others that are less than ideal. There are some LASIK providers whose only priority is to profit from every patron they can get through their door. Others honestly want to provide an opportunity for people to better their lives.
I’m not sure if this is totally fair, since it paints some folks as mustache-twirling villains. But I do think it is fair to say that some LASIK practices allow money to influence decision making. That influence being any amount above zero is dangerous.
So how do you tell the difference between the shady practice and the honest-to-goodness one? Here are some ideas of what to be aware of and questions to keep in mind to help you arrive at a well-educated choice.
Choosing the right LASIK provider
1. Rely on the experience of others.
With tens of millions of people having gone through the LASIK procedure, you are bound to have at least a couple friends or colleagues to help you find a good provider. Start asking people you see every day. More than likely those who have had LASIK will love sharing the experiences they had with their doctors, staff, and environments. The outcomes of and feelings surrounding their procedures, whether good or bad, will most likely generate the most genuine feedback you can get.
It may help to cast a wider net by asking people if they’ve heard anything about LASIK provider x, y, or z. This adds two layers of depth to your fact-finding: (1) People are reluctant to say, “I chose Dr. So-and-so and it was terrible,” because it feels to them like they’re saying, “I am a poor decision maker.” People are much more willing to say what they know about certain surgeons than to say what they regret. (2) You will be adding a much wider reach of information (“my cousin went there and still needs glasses”) to your research than you’ll get by just asking someone how their personal experience was.
2. Pick a surgeon that has been around a while.
You are going to want a provider that will not just perform the procedure and check you off like an item on a list. An established LASIK surgeon will be able to prove his/her ability to identify and meet the specific needs of each client—before, during and long after surgery.
A LASIK surgeon that has been around a while has achieved that durability in one of two ways. The first is that they are possibly a better business manager than doctor, so they have successfully “built out” the handling of pre-operative and post-operative (and scarily in some situations intra-operative) steps of the procedure that can be delegated to other doctors or technicians. If you see your doctor for the first time while laying on your back under a laser, that would fall into this category. The second is that they are an excellent surgeon that has successfully “built up” the practice by delegating only the parts of the experience that can be done as well or better by someone else. If your surgeon sits down with you before the procedure to answer questions, based on diagnostics and tests completed by a specialized technician, that is a sign you’ve found a practice like this. The answers to what can you delegate, and what should you delegate are not always the same. A pre-operative corneal imaging scan? Yes. That should be delegated to a technician that knows every trick in the book for getting perfect images. A pre-operative conversation about nuanced, personalized surgical planning? No, no, no. 95% of getting the surgery right is knowing what to do (a surgeon should be planning this) and 5% is actually doing it (a surgeon should be doing this too, but since it’s illegal for anyone else to, you’re good there).
3. Choose a provider that isn’t going anywhere.
To ensure the best treatment for your vision needs over time, it is crucial to have consistency. Any doctor that prescribes and follows your individual care through the years is going to be an enormous asset that will only grow in value as the years go by. In choosing an eye doctor, you want someone who is in it long-term. Better yet, go with a surgeon that owns and operates the LASIK practice where he/she works.
It’s really interesting to me that I meet one or two people a week who don’t know who did their refractive surgery 5 or 10 years ago. It means that the long-term part of this wasn’t a big factor in their decision making. If you’re doing enough digging that you are reading this specific article in your quest for good LASIK results, you’re probably the type of person for whom the long game is important. If I could give helpful advice on that front, the “lifetime enhancements” policy turns out to be a fairly poor indicator of being lifetime helpful. It usually has enough stipulations (e.g. mandatory annual exams) that it is more sales oriented than vision oriented. And honestly, a need for enhancement after the first year should be nearly non-existent if you’re at the right place anyway. A better metric is whether they are available for follow up exams when you might want one in the future, or how easily you could get your records to another clinic in the event that you move. The long-term plan should be in place, whether you ask about it or not, for how LASIK today plays into the future of your vision 10 to 25 years down the road.
4. “If something seems too good to be true, it probably is.”
As the saying goes, it’s prudent to be aware of the “too good to be true” traps, such as bold offers and flagrant advertising. Sadly, these things do work from time to time, but don’t be fooled! Promises of extravagant discounts are a red flag. LASIK surgery is never free. Consultations, on the other hand, should always be completely free of charge and obligation. Request a detailed list of all costs associated with any procedure, and if you ever don’t feel comfortable, you are welcome to leave at any time.
I don’t know a stronger way to make this point than to tell you that around 50% of LASIK procedures still performed today involve using a blade instead of a laser to make the LASIK flap. It has been confirmed by a giant mountain of studies that a femtosecond laser is objectively safer and provides better vision than a blade. The biggest of these studies, involving over a million eyes, showed bladeless LASIK was 10 times safer than using a blade. Yet still, 50% of the time, advertising is clever enough to get people to willingly choose an objectively inferior surgical technique for their eyes. I’m a big believer in the idea that a rising tide raises all ships, and so I make a point never say to patients “LASIK stinks over there, get it here instead!” That’s because I want people to get the (I sincerely believe) correct impression that LASIK is usually a better idea than contacts. But I’m talking about current LASIK with that idea. Let an ebbing tide sink all the old ships. Take time to research a compelling discount, to discover why cheap LASIK is cheap. The reason is always poor peri-operative care or poor technology. That’s because no practice can stay open asking for less money than they are spending on you.
5. Ask for second opinions.
A good provider is going to want you to make the best decision you can and will support you in being aware of your options. Under no circumstances should you have to pay for any consultation. Don’t be afraid to check out multiple practices, and get educated!
A skilled LASIK surgeon may care more that you have your LASIK procedure with them than that you feel like you have options, but a good LASIK surgeon won’t. I mean good in the old-timey, Golden Rule, love-one-another kind of way. A bonus to finding a doc that isn’t afraid to give you the names of some other good surgeons is it is rare to find an incompetent one who is willing to “risk” you going somewhere else. No one is going to submit to a Taste Test Challenge when they are selling mop water.
6. Trust your own judgment.
This is probably the most important tip of all: trust yourself! Your comfort level with a provider will be your best indicator for a successful experience. Ask questions until you know you are ready to make a decision. LASIK surgeons should be willing to help guide you and never be too pushy.
Vision correction may be what LASIK providers do every day, but for you, it is a very infrequent occurrence. Be convinced you’ve made the right choice before you follow through, and if you’re not, keep looking.