How to choose

Make sure your eyes are in good hands

In the Consumer Reports survey of laser eye-surgery patients, satisfaction with one's surgeon and the location where the patient had the surgery strongly predicted the patient's overall satisfaction.

Choosing a surgeon: Questions to ask

If you want to be happy with your outcome, pay more attention to the surgeon who will operate on you than on the fanciness or convenience of the surgery center itself. In our nationally representative survey of 793 U.S. adults who had laser vision-correction surgery in the past eight years, satisfaction with one's surgeon was one of the strongest predictors of overall satisfaction. Respondents who thought their surgeon conducted the proper tests and thoroughly counseled them on the risks and benefits were more satisfied with their surgeon.

When you choose a surgeon ask if he or she is board-certified and experienced in performing procedures that involve the same equipment and technique that will be used in your surgery. Your surgeon should be able to discuss results, both short-term and long-term, of the surgery he or she has done. Specifically, find out how many patients no longer need glasses or contacts to do most of their daily activities, and how many complications patients have experienced.

Here are questions we recommend you ask when consulting a surgeon about laser vision correction.

What's your training?

Look for a board-certified ophthalmologist who has done at least 250 procedures a year, including many that involve the same equipment and technique that will be used in your surgery. Other credentials to look for are fellowships in corneal and refractive surgery, a related teaching position, and being published in professional journals.

What's included in your presurgical evaluation?

A thorough appraisal could take up to three hours, including time with a laser surgeon if available. Expect an assessment of the quality and quantity of your tears, the size of your pupils in dim and regular light, and the thickness, shape, and surface quality of your corneas. Abnormal results may reveal an unreasonable risk, for example, if your corneas are too thin for Lasik. Your medical history is also vital because conditions such as diabetes and medications such as corticosteroids may affect how your wounds heal, possibly making Lasik and other types of laser vision surgery a poor choice.

What's your rejection rate?

Programs with high screening standards typically reject 10 percent or more of their prospective patients.

How do my results stack up?

If you have borderline scores on some of the tests, ask how that might affect your outcome and the risk of side effects.

What results can I realistically expect?

Your surgeon should prepare you for the likelihood of dry eye, nighttime glare, and vision fluctuations as you heal, and for a 2 to 10 percent chance that you'll need a second procedure. In our survey, 53 percent of the respondents reported at least one side effect after surgery, and 22 percent of the respondents were still experiencing side effects six months later. We found that 12 percent of the patients had to repeat the procedure. Moreover, if your presurgery vision is very poor, research has found that you may still require glasses or contacts for some or all activities, and you're more likely to experience halos and glare. Some people find that their vision isn't as crisp after surgery. And most people still need reading glasses beginning in their 40s.

What type of equipment do you use?

Your doctor should use a laser approved by the Food and Drug Administration and provide information on the risks and benefits of using that specific type of laser for the procedure you need. You can look up patient information for the specific laser and other key information by going to the FDA's Lasik home page.

Do my eye problems require the newer "all laser" Lasik technology?

Using a special laser rather than the standard metal tool to create a hinged flap in the cornea is clearly a good option if your cornea is unusually flat, steep, or thin. And wavefront-guided Lasik, which uses a special mapping system, can tackle subtle optical defects. Those techniques can cost about $200 to $500 more per eye.

When to get a second opinion: Look for these red flags

If your surgeon minimizes the chance of complications, assures you that the surgery will enable you to get rid of your glasses forever, urges you to proceed as soon as possible, or is vague about the procedure or laser, be sure to get a second opinion.

Ideally, a conscientious surgeon will explain the risks and benefits to you rather than have someone else or a video do so. Videos are useful—pictures can be worth a thousand words—but it's up to your surgeon to make sure you have a full understanding of what the complications could be well before your surgery day.

Prospective patients should watch for the following warning signs that they might be in the wrong center or have the wrong surgeon. Hit the brakes if staff members or doctors say or imply that:

• The surgery is risk-free, or they deflect questions. They should be straightforward in discussing possible side effects and complications.
• You'll achieve perfect vision and be able to throw away your glasses and contact lenses forever. Patients may achieve 20/20 vision, but that does not always mean perfect vision. Detailed, precise vision may be slightly diminished, and you may still need eyeglasses as your vision changes over time.
• There are no former patients for you to speak with. They should be able to put you in touch with people who have given the practice permission to contact them and undergone the procedure you're considering so that you can ask them what the surgery was like and what they encountered afterward.
• They don't know which model of FDA-approved laser will be used. You should get the model and the FDA consumer information about it (or you can look it up yourself by going to the FDA Web site and clicking on the model).
• They can't provide details about the surgeon's training. Your surgeon should be an experienced ophthalmologist who is board-certified. It's best if they are fellowship-trained in corneal and refractive surgery. Other credentials to look for include a related teaching position and articles in professional journals. He or she should perform at least 250 procedures a year, including many that involve the same equipment and technique that will be used in your surgery.
• The surgeon is unavailable to meet with you at all. Ideally the surgeon will personally do the preoperative evaluation. But if that is not possible, staff members can do much of the patient education, and an eye-care professional may do the testing. But you should meet the surgeon before the day of surgery to ask how many patients he or she has performed the procedure on, the success rate (and how success is defined), and any other questions you may have in a way you understand.