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What makes for “the best” LASIK, or is it all the same?

By Joel Hunter, MD | 11/20/17 8:01 AM
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As you start reading this, you may have the thought, “One thing we can all be sure of is that this guy isn’t going to say that all LASIK is the same.” And you were so right if you thought that. Sure, it would be compelling to start off with some big reveal that LASIK is basically a commodity with no real differences from place to place. As it is, we just have to start off with the most obvious answer possible to a question like this and say, “Of course LASIK isn’t the same wherever you go! What a ridiculous question for you to ask even though you only asked it because it was in the title.” There is, however, a deeper reason that undergirds the obvious answer that LASIK isn’t all the same.

The deeper reason behind LASIK being better at one place than another is the same reason this question has such an obvious answer. There must be a lot of detail involved in something as technologically mind-blowing as a laser procedure that can create clear vision for eyes that are blind without glasses. And when there is a lot of detail, a lot of room for variability shows up right alongside it. The reason we can answer “what makes for the best LASIK?” is because you can either get all those variables right, or only some of them.

What are the Variables?

Differences in brands and models of the lasers used in LASIK aren’t the only variables, but I’d take it a step further to say they aren’t even the most important ones. The differences in LASIK results at different practices is found first and foremost in the pre-operative evaluation before you ever make it to the LASIK suite. The top spot for most important factor in the best LASIK is a ruthlessly honest and transparent evaluation and discussion when determining LASIK candidacy.

A Transparent Evaluation

An adverb like “ruthlessly” isn’t so much about how the information should be presented. (“Your eyes are weak and pathetic. Your glasses make you look like the nerd in every Disney channel TV show.”) The ruthless honesty is what your LASIK doctor should be employing with themselves when they’re determining whether or not LASIK is the best choice for you. There is a world of difference between “could we do LASIK?” and “should we do LASIK?” As cliche as it sounds, the standard should be handling the decisions at a LASIK consult in a way that mirrors how those decisions would be made if it was the surgeon’s parent or spouse sitting in the chair. Genuinely making the evaluation that personal will make it ruthlessly honest, and in turn, set you up for the next step in “the best” LASIK possible.

Brands of Laser

While the different brands of laser aren’t the only variables, they are still important. Wavelight lasers really changed the scene when they showed up, and (in my opinion, which is supported by a lot of scientific data) it’s because Wavelight lasers are better than the lasers that came before it. No doctor wants to get rid of a super expensive excimer laser (which is the laser that does LASIK) and get a new one. Despite that fact, it’s challenging to find LASIK surgeons at the top refractive practices in the country that haven’t upgraded to the newer Wavelight laser. It wasn’t because of a branding decision. We can rest assured of that because no one knows what the heck a Wavelight laser is. It was a medical decision, because if you can do better LASIK on a wider range of patients, that’s a wise path to take.

Other Factors

There are other factors that make LASIK more accurate and more safe. All-laser instead of a blade is really important. Having a very specific and calculated post-op care plan in place matters a lot. Knowing that you can get in touch with the doctor if you need them and the office is closed is key. And beyond all this, there are myriad little decisions and protocols in place pre-op, intra-operatively, and post-op that all work together to make LASIK better at some places than all the others.

The reason honesty and transparency stands towering above every individual factor in a list like this is because it guides all those other factors. It’s kind of like if you were looking to have your car fixed and trying to decide who was going to do it best. You could hammer through every detail of the equipment and practices of the auto shop. But that becomes less necessary if you find a really good mechanic who you could trust and who is honest about how to get the best work done on your car. I have no idea how to find a mechanic like that. But I do know how to find a LASIK practice like that. If your doctor has an answer to the questions you’ve got about your eyes and your options, and has the time you require to communicate it in a way that makes you feel comfortable, it usually means all the behind-the-scenes tech details will match the level of care you feel went into that consult.

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