Evaluating the options: Finding Dr. Right

INTERACTIVE: The human eye KEY QUESTIONS FOR SURGEONS: What is their surgical training? What is their practical experience? Any experience as clinical investigator? Any published eye surgery findings? Do they belong to a professional organization? What is their success rate? What are their surgery practices? Is surgeon pushing one procedure exclusively?

August 25, 1999
Web posted at: 8:09 a.m. EDT (1209 GMT)

From Kathleen Doheny
Special to CNN Interactive

(CNN) -- The decision to undergo laser surgery or other procedures for permanent vision correction is rarely made quickly.

Case in point: Hobbs Allison, a 32-year-old ski boot salesman in Santa Monica, California, whose life revolves around the outdoors. Wearing his contacts was becoming a nuisance. "I lost a contact lens four or five times," he says. Once, a lens fell out into his ski goggles. The prospect of being as active as he wants without fear of losing a lens persuaded him to undergo LASIK (laser in-situ keratomileusis) this summer.

The decision to have surgery, however difficult and time-consuming, may be easier than the next step: choosing to whom you will entrust your vision.

Finding Dr. Right can be a nerve-wracking undertaking

Competition for patients is fierce. Advertising is plentiful and enticing, offering zero-down financing with low monthly payments and the promise of results that sound nothing short of miraculous.

To find a skillful surgeon and improve the chance of a successful result, begin by getting referrals from your optometrist or from organizations such as the American Academy of Ophthalmology. (Click on "Find an Ophthalmologist" on the academy's Web site, http://www.eyenet.org, and type in your location and "refractive surgery" to get a list of surgeons who specialize in the field. Their education and training are noted.)

Interviewing surgeons: What questions should you ask?

Then interview the eye surgeons you consult. But what exactly do you ask?

For suggestions, we asked three ophthalmologists who specialize in laser refractive surgery:

• Dr. Doyle Stulting, professor of ophthalmology and director of the cornea service at Emory University School of Medicine, Atlanta, and member of the refractive special interest group of the American Society of Cataract and Refractive Surgery;
• Dr. Peter Hersh, director of The Cornea and Laser Eye Institute at Hackensack (New Jersey) University Medical Center and chief of cornea and refractive surgery at the UMDNJ-New Jersey Medical School; and
• Dr. Robert K. Maloney, director of the Maloney Vision Institute in Los Angeles and formerly on faculty at UCLA's Jules Stein Eye Institute.

Among their suggested questions:

1. Have you completed fellowship training in cornea and refractive surgery?

2. How long have you performed laser eye surgery? If a doctor is not fellowship-trained but has extensive practical experience, that could be fine, says Hersh. But if a doctor just began offering laser surgery last month, you probably want to find someone more experienced.

3. Have you been a clinical investigator for any of the laser surgery studies to evaluate specific procedures? "If a doctor was a clinical investigator, that's good," says Hersh.

   Stulting adds a caveat, however. If a doctor is or has been an investigator for several studies, that's probably a good sign, Stulting agrees. But if a doctor is or has been an investigator in a single study, don't give it as much weight. The laser company might have made the selection because the doctor is a major stockholder, Stulting says, or a friend of a friend.

4. Have you published your findings about eye surgery in medical journals?

5. Are you a member of, or do you hold offices in, professional organizations such as the American Academy of Ophthalmology or the American Society of Cataract and Refractive Surgery?

6. What is your success rate? And how are you defining success? Is success "some improvement in vision" or "no need for contact lenses or eyeglasses" or another definition?

7. Ask about common practices during the surgery. A lot of doctors are too casual about maintaining sterile conditions, Maloney says. "You want someone fastidious." That means, for instance, that a surgeon always wears gloves during the procedure and drapes the eye area to minimize infection risk.

8. Beware of physicians who seem to push one procedure, since it may not be right for your particular vision problem. Physicians should tailor the kind of surgery to your specific vision problem. It's even possible that the best surgical solution for your vision problem is still in development. An excellent surgeon will tell you that.

Certain health conditions may rule out refractive surgery or may simply warrant closer follow-up care. During pregnancy, when the refraction of the eye can change with fluctuating hormone levels, laser surgery isn't recommended.

Those with well-controlled glaucoma in the early stages (an eye disease in which increased pressure within the eyeball can cause optic nerve damage and vision loss) are potential candidates, says Hersh. It's crucial, he adds, that glaucoma patients be evaluated on a case-by-case basis and that the prospective patient consult the doctor treating the glaucoma.

Being at high risk for glaucoma due to family history does not rule out refractive laser surgery, Hersh says. "Refractive surgery by itself does not increase the risk of glaucoma." Such patients would be evaluated carefully and followed closely anyway, simply because of the family history of glaucoma, not the refractive surgery.

Nor does diabetes, if it is well controlled, rule out refractive laser surgery, experts say.

Having LASIK now won't jeopardize successful cataract surgery later, says Dr. Marguerite McDonald, a New Orleans ophthalmologist specializing in cornea and refractive surgery at the Southern Vision Institute and a clinical professor at Tulane University.

Cost comparisons

Once you've settled on a surgeon, it might be tempting to comparison-shop. But fees for the procedures don't vary much across the country. One East Coast ophthalmologist charges $2,750 per eye for LASIK, including follow-up care, while a West Coast surgeon sets his fees at $2,500 per eye, also including follow-up care. The price for Intacs (the tiny crescents placed in the eye to reshape the cornea) is roughly the same.

The costs are rarely covered by insurance, which views the procedures as cosmetic, says Carrie Tydings of the Health Insurance Assn. of America, a Washington, D.C.-based organization. It's conceivable, she adds, that someone who is legally blind whose vision cannot be corrected by glasses might be covered for refractive surgery.

As the surgeries become more common, might the policy change for everyone? ``It's difficult to say,'' she adds.

In retrospect, some patients say the costs weren't worth it. Bill C. had LASIK on both eyes in March 1998 and is one of several patients who tells his story on the Web site of Surgical Eyes, http://www.surgicaleyes.com. Since the surgery, he writes, "I have not been able to enjoy a film on TV or at a cinema, take a walk in the evening without seeing all objects with a fuzzy halo or starburst."

But Hobbs, the avid skier who is now seeing 20/20 without lenses, is delighted. "Knowing what I know now," he says, "I would have paid double."