This is probably the hardest choice to be made after the initial decision to have refractive surgery. Factors such as word of mouth, reputation, certifications, and membership in associations are clearly important.

What the educated patient needs is a surgeon and center that not only minimizes the risks as much as possible, but also does everything possible to maximize the visual outcome. Although it is tempting to assume the surgeon or center that advertises the most is probably the best, in many cases this is not true. The following factors and questions should help you decide on who takes your eyes as seriously as you do:


1. Do you see the doctor?

Some centers are set up to maximize the volume of surgery. The surgeon only operates, and does not perform any pre-operative exams and measurements, or any post-operative monitoring and follow-up. Often in these practices, you do not get a chance to even meet the surgeon during the initial consultation. Dr. Motwani believes this is not the way to achieve the best visual outcome. If the initial examination is not carefully performed by the surgeon, then factors making it unsafe for the patient to have LASIK can be missed.

The pre-operative exam also determines all of the measurements and parameters for the LASIK procedure, and unless carefully done, will result in sub-optimal outcomes (i.e. garbage in, garbage out). If the post-operative results are not carefully monitored by the surgeon, then problems that can be fixed can turn into complications. The most qualified person to catch a problem early is always the surgeon, so the degree to which the surgeon is hands on makes a significant difference in your overall results. And in the event there is a problem, you need to be aware who handles emergency care. Will the surgeon be available to you, or will you have to go to someone else?


2. What is the staff like?

The staff can say a lot about the doctor, his ethics, and the quality of work performed at the center. A professional, polite, knowledgeable staff says the center takes you seriously as a patient. The staff should be well educated concerning LASIK, and be willing to discuss your questions intelligently and thoroughly. It also is helpful if staff members have had LASIK, as their first-hand experience can be very helpful. If the "hard sell" is on the minute you step in the door, then the center may not be for you.


3. Is the surgeon and the center interested in performing procedures carefully and thoroughly, or just performing them in volume?

If the center schedules more than three patients an hour for surgery, you may be in an "assembly line center." No surgery can be safely performed by any surgeon if done too quickly, and patients should not be rushed through the process.


4. Does the surgeon have the trust of leading members of the community?

This includes not only people actively in the spotlight such as radio, TV, and sports personalities, but even more importantly, those whose careers depend on excellent vision such as surgeons and physicians, police officers, firefighters, and professional athletes. This usually points to a surgeon who is established in the community, and not just a temporary hire.


5. Does the surgeon have his/her own laser and equipment?

A surgeon that has his/her own center will indicate that they have made the significant financial and medical commitment to specialize in refractive surgery.


6. What is the level of the surgeon’s expertise?

Does the surgeon use such techniques as wide zone laser reshaping to minimize night glare and halos? Does the surgeon have experience in handling high amounts of astigmatism or nearsightedness? Does the surgeon have experience in repairing older refractive procedures? What is his philosophy on customizing monovision for each patient? If a surgeon is used to treating complex cases on a regular basis, that experience may translate into better safety and reliability for more mainstream cases.


7. What is the cost and what is included?

What does the surgeon and center cost? Are their hidden charges for exams and enhancements? Are there extra charges for medicines? Are their extra charges for emergency care? Asking these questions beforehand may prevent your "good deal" from turning into a financial fiasco.

Having your surgery performed at a center where the costs are all inclusive can really bring a much higher sense of security and indicate that the surgeon and center back up their work. Many of these low cost centers that advertise low, low prices to get people in will often have hidden costs to ensure that the actual amount that you pay is much higher. Unfortunately, the quality of care at these centers can also seriously suffer, and the surgeon usually only sees you for the surgery, with the rest of the care handled by ancillary staff.


8. Finally, make sure you are comfortable with the surgeon, the center, and the staff!

No matter how good the LASIK procedure is, if you are one of the few that has a problem, you have to feel comfortable that the surgeon and the center will take care of you carefully, professionally, and in a timely manner.