Find a LASIK doctor in your area

Choosing an eye surgeon is probably the most important decision that you have to make when considering a refractive surgical procedure, and yet it is the one decision where I can give you the least advice. However, there are a few extremely important points that I’ll make in this chapter that should help you in this decision.

Obviously, I cannot give each and every reader specific advice on the surgeon they choose. And there are many, many great eye surgeons, from the smallest towns to the biggest cities. But, there are some not so good ones and there are some surgeons who probably shouldn’t be practicing. Some surgeons have done 20,000 surgical cases similar to yours. Some have done one! You don’t want the one who has done one! But, do you want the one who has done 20,000? Read on and I’ll try to answer that question and a few others to help you determine how to choose a great surgeon.

Let me start by saying that, in the U.S. for example, there are approximately 17,000 practicing EyeMDs (ophthalmologists). There may be as many as three to five thousand or more ophthalmologists that offer one or more refractive surgical procedures. However, there is a much smaller number that actually practice comprehensive refractive surgery. If you’ve read much of this website, you obviously realize by now that there are quite a few refractive procedures that are available and we are definitely not in the era where “one size fits all”. If you’re seeing an ophthalmologist who only offers traditional LASIK, and he or she tries to make LASIK the procedure of choice for every refractive surgical candidate who walks through the door, then there’s a huge problem! You should know by now that LASIK, in my opinion, is never suitable for anyone who has over +4.0 diopters of hyperopia or greater than about –8.0 or –10.0 diopters of myopia. So, if you’re seeing a surgeon who tells you that it works great in your range and you fall into one of those categories, be wary. Just because the procedure is FDA approved for those individuals doesn’t mean it is the best for them! Again, that is the purpose of this website… That is, to steer you to the best procedure and surgeon for your eyes.

Many of you reading this website probably don’t realize that board certification is an elective process. That is, a physician may elect to take the extra steps and often invest hundreds of additional hours of self-education after formal training, in order to prepare for board exams. The American Board of Ophthalmology requires a high score on a stringent written examination be achieved in order to receive a passing score. This is followed approximately six months to one year later by a rigorous six-part oral board examination. For those who complete this daunting task, a 10-year time-limited certificate is issued. Had I myself never been board-certified, I wouldn’t give this much thought when choosing a physician. However, having undertaken this enormous additional hurdle in my own training, I can appreciate it in every specialty. The bottom-line for you, in my opinion, is just this: choose a board-certified ophthalmologist. It shows his or her dedication to the specialty. This alone doesn’t make for a good refractive surgeon, but to me, it’s an important element.

Sometimes I hear patients say, “I want a young doctor – one fresh out of training – up on all the latest”. As a physician myself, I know what they’re driving at. Their belief is that a physician’s practice is probably the most state-of-the-art immediately out of training. This belief has some truths, but it has faults as well, especially when it comes to surgery. Let me explain.

Speaking from personal experience, when it comes to surgery, I would always prefer the surgeon with the experience and years under his belt to the recently trained surgeon. As much as it hurts me to say that regarding my slightly younger colleagues, I know that experience is a great teacher. In general, I would advise you to find a surgeon who has been out of residency or fellowship training (not medical school) at least four to eight years or more. In fact, I believe that many of the very best surgeons are well into their 50’s and 60’s, and occasionally beyond. Why? Again, experience.

If you asked me, when it comes to surgery, would I rather have the surgeon fresh out of training, who was top of his medical school class and had every honor in the book, or the bottom of his medical school class, never-been board-certified, but highly experienced 58 year-old surgeon, I would choose the latter surgeon every time (assuming we had to make a decision on those criteria alone). Why? Experience, of course!

The highly esteemed New York refractive surgeon, Eric D. Donnenfeld, MD, makes some very insightful observations regarding this topic in an article published in Cataract and refractive surgery Today, February, 2004[i]. Dr. Donnenfeld analyzed the data submitted by the Ophthalmic Mutual Insurance Company regarding a series of 100 consecutive claims and lawsuits filed against ophthalmologists. In the study of these claims and lawsuits, published in the journal Ophthalmology, an attempt was made to draw conclusions regarding surgical volume as it relates to risk of lawsuits, as well as other risk factors for a lawsuit[ii]. The study authors asserted that high-volume surgeons had a greater risk of lawsuits. However, Dr. Donnenfeld asserts that the study’s authors never addressed the question: “will a patient achieve the best result with a high-volume or a low-volume surgeon? Stated another way,” he adds, “instead of the absolute number of complications or lawsuits, what is the rate of complications or lawsuits per patient encounter?” According to Dr. Donnenfeld, the answer to this question lies within the data obtained in the study.

The study did confirm that surgeons who performed 20 or fewer surgeries per year were at a lower risk for malpractice litigation than surgeons who performed more than 1,000 procedures per year. But Dr. Donnenfeld points out that the risk to the patient was quite the opposite! That is, and I’ll quote, “The cumulative surgeries performed by the highest-volume surgeons were, at a minimum, more than 19,000 procedures (and most likely much higher). Of that number, only six complications led to litigation, an incidence of less than 0.03% (or one in 3,167 procedures). By contrast, the lowest volume surgeons had an average complication rate of 0.12% (or one in 863 procedures).” In fact, if one does the math, this does indeed confirm that the patient’s risk of incurring an outcome that leads him or her to seek litigation is 3.7 times higher when a low-volume surgeon does the surgery than when a high-volume surgeon does the surgery. In general, this indicates that the more volume a refractive surgeon has, the lower his or her risk of having a complication.

In another study completed by Yo et al[iii], which analyzed the visual outcomes of beginning refractive surgeons, the investigators examined the outcomes of just 33 procedures completed by a beginning refractive surgeon who was proctored by an experienced surgeon. In this study, the researchers noted an intra-operative complication of a free cap during a LASIK procedure “which was replaced under the guidance of the proctor”. A free cap indicates that the flap was cut entirely free from the eye, that is, no hinge was left – a potentially major complication. However, the study authors draw the following conclusion: “Out data suggest that results achieved by beginning surgeons are comparable to those reported by experienced surgeons.” In my own analysis, I would submit to you that a “free cap” complication is exceedingly unlikely to occur in any 33 consecutive cases by an experienced surgeon. The authors who made the aforementioned statement regarding this study, in my opinion, truly had blatant disregard for the facts of the study itself. One could have just as easily made the statement that “beginning LASIK surgeons have a much greater complication rate, although the visual outcomes in this small case series were comparable to those of more experienced surgeons.”

In a much larger study completed by Stulting, et al, 1530 refractive surgical procedures were evaluated and the study authors found that the rate of complications was 1.1% with experienced refractive surgeons, 3.1% with low-volume refractive surgeons, and 9.1% with inexperienced refractive surgeons[iv]. This study much more clearly demonstrates the decreasing risk as the surgeon’s volume increases. And why wouldn’t it? Think of your own job, whatever it is that you do. Didn’t you make the most mistakes as you first learned your job? After you performed those tasks over and over, didn’t you learn the skills that decreased your incidence of mistakes? I would certainly hope so! Whether you’re waiting tables or performing brain surgery, experience is the best teacher, in my opinion.

Eye surgery, although not entirely related to the dexterity of one’s own hands, requires that a skill be learned. Can’t you imagine that, as a surgeon’s level of experience increases, so does his mastery of that surgical skill? Obviously, being a great surgeon requires much more than just surgical technique. There’s as much cognitive skill (knowledge) involved in being a good surgeon as there is manual dexterity. The great surgeon’s have mastered both.

Needless to say, you should only allow a highly experienced surgeon to complete your eye surgery. Ask how many refractive surgical procedures your prospective surgeon has completed. In fact, find out before you ever go for a consult if possible. If he or she has completed less than one thousand refractive procedures, I would advise that you keep looking! Let others be that surgeon’s first thousand or more cases. You know better – which is why you’re reading this website. In fact, I would advise that you try to find an eye surgeon who has completed several thousand refractive procedures. Your risk will be lower, period.

Do not let your emotions drive your decision. Don’t choose a surgeon because he did your friend’s or family member’s surgery. Don’t choose a surgeon because he did your Aunt’s cataract surgery and “she loved him”. Don’t choose a surgeon just because he’s a nice guy. Don’t choose a surgeon because his advertising looks impressive. Don’t choose a surgeon based on anything other than your own thorough investigation.

Yes, you will need to do some investigation. Take your time and be as thorough as you can be. Ask how many refractive procedures he’s completed. Ask what kinds of refractive procedures your surgeon provides. Ask how long he’s been in practice. Ask about board-certification. Ask for patient references, if you wish. If you have a general ophthalmologist who does not offer refractive surgical procedures, ask who he would choose if he were going to have a refractive procedure. That may be your very best opinion! Finally, use the internet and educate yourself about your prospective surgeon as much as possible.

Choosing your refractive surgeon is one of the most important decisions that you have to make. You must be diligent in your investigation. Remember, above all, choose a highly experienced surgeon to provide your care. You cannot afford to have your eyes operated on by an inexperienced surgeon. You cannot afford the risk. You’ve only got two eyes. Make this decision only after careful consideration and thorough investigation.

[i] Donnenfeld, ED, “Surgical Volume and Patient Care”. Cataract and refractive surgery Today”. Feb. 2004.

[ii] Abbott RL Ou RJ, Bird M. Medical malpractice predictors and risk factors for ophthalmologists performing LASIK and photorefractive keratectomy surgery. Ophthalmology. 2003; 110:2137-2146.

[iii] Yo C, Vroman C, Ma S, et al. Surgical outcomes of photorefractive keratectomy and laser in situ keratomileusis by inexperienced surgeons. J Cataract Refract Surgery. 2000;26: 510-515.

[iv] Stulting RD, Carr JD, Thompson KP, et al. Complications of laser in situ keratomileusis for the correction of myopia. Ophthalmology. 1999; 106:13-20.

Additional Bibliography

1. Lindstrom R. New and emerging technologies in refractive surgery. Symposium on Cataract, IOL and refractive surgery. Program and abstracts of the American Society of Cataract and refractive surgery (ASCRS)/American Society of Ophthalmic Administrators (ASOA) 2002 Symposium and Congress; June 1-5, 2002; Philadelphia, Pennsylvania. Course 2302.

2. MacRae S, Yoon GY, Porter J, et al. Changes in the eye's aberrations after cutting a corneal flap. Program and abstracts of the American Society of Cataract and refractive surgery (ASCRS)/American Society of Ophthalmic Administrators (ASOA) 2002 Symposium and Congress; June 1-5, 2002; Philadelphia, Pennsylvania. Abstract 131.

3. Aron-Rosa DS. LASIK, LASEK or PRK. Innovator's Session. Symposium on Cataract, IOL and refractive surgery. Program and abstracts of the American Society of Cataract and refractive surgery (ASCRS)/American Society of Ophthalmic Administrators (ASOA) 2002 Symposium and Congress; June 1-5, 2002; Philadelphia, Pennsylvania.

4. Davidorf JM. Pediatric refractive surgery. Program and abstracts of the American Society of Cataract and refractive surgery (ASCRS)/American Society of Ophthalmic Administrators (ASOA) 2002 Symposium and Congress; June 1-5, 2002; Philadelphia, Pennsylvania. Abstract 195.

5. Donnenfeld E, Solomon K, Perry H, et al. The effect of hinge position on corneal sensation following LASIK. Program and abstracts of the American Society of Cataract and refractive surgery (ASCRS)/American Society of Ophthalmic Administrators (ASOA) 2001 Symposium and Congress; April 28-May 3 2001; San Diego, California. Abstract 77.

6. Donnenfeld E, Ehrenhaus M, Mazurek J, et al. Effect of hinge width on corneal sensation and dry eye after LASIK. Program and abstracts of the American Society of Cataract and refractive surgery (ASCRS)/American Society of Ophthalmic Administrators (ASOA) 2002 Symposium and Congress; June 1-5, 2002; Philadelphia, Pennsylvania. Abstract 19.

7. Stulting RD, Randleman JB, Freeman JY, et al. Risk factors and prognosis for corneal ectasia after LASIK. Program and abstracts of the American Society of Cataract and refractive surgery (ASCRS)/American Society of Ophthalmic Administrators (ASOA) 2002 Symposium and Congress; June 1-5, 2002; Philadelphia, Pennsylvania. Abstract 132.

8. Nordlund ML. IOP induced DLK. Complications of refractive surgery from cornea specialists perspective. Symposium on Cataract, IOL and refractive surgery. Program and abstracts of the American Society of Cataract and refractive surgery (ASCRS)/American Society of Ophthalmic Administrators (ASOA) 2002 Symposium and Congress; June 1-5, 2002; Philadelphia, Pennsylvania.

9. Nordan LT, Slade SG, Dishler J, et al. Expanded uses of the Pulsion FS femtosecond laser keratome. Program and abstracts of the American Society of Cataract and Refractive Surgery (ASCRS)/American Society of Ophthalmic Administrators (ASOA) 2002 Symposium and Congress; June 1-5, 2002; Philadelphia, Pennsylvania. Abstract 173.

10. Fine IH. Bimanual microincision cataract surgery and refractive lens exchange: outcomes. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

11. Dell SJ. Crystalens: 3-year FDA clinical trial update. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and Refractive Surgery; April 15-20, 2005; Washington, DC.

12. Starr CE. Distance and near acuity with the AT45 Crystalens in the first year after FDA PMA. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

13. Verges C. Crystalens accommodating IOL implantation: 24-month follow-up. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

14. Feinerman GA. Measuring accommodation: Crystalens IOL versus monofocal IOL. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

15. Siganos D. Clinical evaluation of the Crystalens accommodating IOL: 3-year follow-up. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

16. Kaufer RA. Patient satisfaction with the ReStor IOL in Argentina. Program and abstracts from the American Society of Cataract and Refractive Surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

17. Souza CE. Visual performance of the Acrysof ReStor pseudoaccommodating IOL: prospective comparative trial. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and Refractive Surgery; April 15-20, 2005; Washington, DC.

18. Carones F. Pseudoaccommodating ReStor IOL to correct defocus and presbyopia in refractive lens exchange: clinical results. Program and abstracts from the American Society of Cataract and Refractive Surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

19. Roy FF. Pseudophakic diffractive multifocal IOL: early results. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and Refractive Surgery; April 15-20, 2005; Washington, DC.

20. Lehmann R. Visual acuity results of the Acrysof ReStor IOL. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and Refractive Surgery; April 15-20, 2005; Washington, DC.

21. Pinto LF. Preliminary results of bilateral pseudoaccommodating apodized IOL implantation. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

22. Cionni RJ. Quality of life with AcrySof ReStor IOLs: vision satisfaction, visual disturbances, and social satisfaction. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

23. Maxwell A. Night driving and clinical contrast sensitivity results with the AcrySof ReStor IOL. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

24. Rau MB. Multifocal Array SA40N versus multifocal Array 2 Acrylic AA50EU IOLs. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

25. Chalita MR. Comparison of custom LASIK outcomes with femtosecond and conventional microkeratome. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and Refractive Surgery; April 15-20, 2005; Washington, DC.

26. Naranjo-Tackman, R. Confocal microscopic analysis of flap interfaces made with a femtosecond surgical laser and mechanical microkeratome. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

27. Tran DB. Comparative corneal stromal bed ultrastructure analysis of mechanical and femtosecond laser microkeratome. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

28. Solomon R. SEM comparison of femtosecond laser and microkeratome lamellar keratectomy stromal beds at different corneal depths. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

29. Bottros AM. Ultrastructure of lamellar keratectomy: microkeratome versus femtosecond laser with differing parameters. Program and abstracts from the American Society of Cataract and Refractive Surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

30. Binder PS. Interface epithelial ingrowth: IntraLase versus microkeratomes. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

31. Dishler JG. LASIK enhancement 3 to 7 years postoperatively using the IntraLase FS laser for side-cut creation. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and Refractive Surgery; April 15-20, 2005; Washington, DC.

32. Coskunseven E. Epi-LASIK for low myopia: 1 year results in 92 eyes. Program and abstracts from the American Society of Cataract and Refractive Surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

33. Katsenavaki V. Epi-LASIK: clinical results of an advanced surface-ablation procedure. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

34. Lipshitz I. Epi-LASIK: clinical results of correcting myopia and astigmatism using the VisiJet epitome. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

35. O'Brien TP Wavefront-guided Epi-Lift treatments. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

36. Kalyvianaki MI. Comparison of corneal sensitivity after myopic Epi-LASIK and LASIK. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

37. Stulting RD. ISRS/AAO 2004 International refractive surgery – Science and Practice: Safety and efficacy of the Verisyse phakic IOL: update from the FDA clinical study. refractive surgery Subspecialty Day. Program and abstracts from the American Academy of Ophthalmology 2004 Annual Meeting; October 23, 2004; New Orleans, Louisiana.

38. Galvis V. Long-term experience with the artisan phakic IOL: safety and efficacy. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

39. Vukich JA. ICL versus LASIK for myopia of -3.00 to -7.88D: refraction-, age-, and sex-matched study. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

40. Gunderson KG. Toric implantable contact lens: 2-year results. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and Refractive Surgery; April 15-20, 2005; Washington, DC.

41. Rohit S. Clinical outcomes of wavefront-guided LASIK with iris recognition technology in myopic Indian eyes. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

42. Wolff J. Wavefront-based LASIK: influence of cyclorotation and pupil shift. Program and abstracts from the American Society of Cataract and Refractive Surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

43. Stevens JD. Cyclotorsional registration and its potential impact on clinical outcomes. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

44. Stevvens JD. Driving wavefront ablations with a new algorithm: Fourier analysis. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

45. Cochener B. Presby-LASIK using the S4-WaveScan platform: initial approach. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

46. Swanson MM. Intacs for keratoconus using the steepest-axis incision technique: 2-year results. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

47. Chao L. Single-segment Intacs procedure for LASIK-induced ectasia and keratoconus and the lower-upper ratio. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and Refractive Surgery; April 15-20, 2005; Washington, DC.

48. Martiz JR. Treatment of keratoconus using Intralase and intracorneal rings. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

49. Shabayek MH. Asymmetric implantation of intracorneal rings for keratoconus. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

50. Marinho A. Intacs in keratoconus: new approach. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and refractive surgery; April 15-20, 2005; Washington, DC.

51. Smolyar A. Intralase-assisted Intacs in corneal ectasia. Program and abstracts from the American Society of Cataract and refractive surgery 2005 Symposium on Cataract, IOL, and Refractive Surgery; April 15-20, 2005; Washington, DC.

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