Lasik eye surgery -- avoiding malpractice

Medical malpractice issues. Legal issues.

Lasik is the popular new procedure designed to reduce or eliminate the need for glasses or contact lenses in people with nearsightedness (myopia) or astigmatism. Although most who have the surgery are pleased with the results, there can be vision-damaging complications. You may be willing to accept these risks, but not to compound them unnecessarily. How can you ensure that you increase your chances of having a good result from Lasik?

1. Have Lasik Done by a Specialist.

Your surgeon must do Lasik on a regular basis. A general ophthalmologist can take a one-day class taught by a laser manufacturer and be certified to do Lasik the next day. Needless to say, the standards for certification are low given that the manufacturer wants more doctors using its lasers. Ideally, your surgeon will be either a corneal specialist or have done a one-year fellowship in refractive surgery.

2. Get a Second Opinion.

After your doctor has pronounced you a "perfect candidate," find another qualified refractive surgeon and tell him that you do not intend to have Lasik performed by him, but are there merely for a consultation to determine if you are truly a good candidate. What you pay for this second opinion is money well spent, especially if the financially disinterested second opinion is that you are not such a good candidate for Lasik, after all.

3. Have Your Pupils Accurately Measured in the Dark.

Have the pupils measured on two separate occasions because pupil size can vary depending on the time of day, how well rested you are, and your emotional state. Your pupils must be smaller than the size of the laser beam used to sculpt your cornea. Otherwise, you will most likely suffer from permanent glare, haloes, and starbursts post-operatively.

4. Have a Shirmer's Test to Determine if you have Dry Eyes.

If you have dry eyes pre-operatively, you will probably have even worse dry eye symptoms post-operatively. Most ophthalmologists neglect the Shirmer's Test pre-operatively in their rush to sign more patients up to have Lasik. Remind your doctor to do this test.

5. Don't Let Price Influence your Decision.

Price reflects the intersection of supply and demand, and is also used as a marketing tool. It is only loosely correlated with quality. Although an excessively low price for Lasik may indicate a tendency to cut corners on safety, a very high price can indicate nothing more than the desire to appear to be a high quality provider, rather than truly reflecting high quality.

6. Have Only One Eye Operated on at a Time.

Refractive surgeons generally prefer bilateral Lasik (both eyes operated on at the same session) because it is administratively easier and cheaper. However, bilateral Lasik is not in their patients' best interest. Risk of infection is increased and the surgeon loses the ability to fine-tune the laser for optimal results on the second eye based on lessons learned from the healing response of the first eye.

7. Avoid Optometrist Co-Management.

Co-management is a marketing tool designed to encourage optometrists to refer their patients to ophthalmologists for Lasik. Co-management is not designed with the best interest of the patient at heart. Despite their virtues, optometrists are not qualified to treat or even diagnose many post-operative Lasik complications. If you develop one of these complications and it remains undetected, you could suffer life-long visual problems.

8. Don't Have Lasik Performed by a Doctor Far from Home.

Should you suffer a post-operative complication, you will need repeated follow-up visits with your refractive surgeon. You will want to be close to your doctor, especially if you are experiencing substantial post-operative pain or visual difficulties.

9. Ask to See the Operating Room.

Although no Lasik facilities are completely sterile because refractive surgeons are not willing to incur the requisite expenses, some facilities are cleaner than others. Does the operating room staff wear surgical masks, booties, hats, and gloves? Does the operating room have a door? Select a facility where your chances of getting a vision-threatening eye infection are kept to a minimum.

10. Don't Have Lasik if you have Medical Contraindications.

Various medical conditions could disqualify you from having Lasik. Even the best refractive surgeons sometimes mistakenly operate on a patient who is contraindicated from surgery. You will receive an Informed Consent form to sign. Read it carefully and do not have Lasik if you fall into any of the contraindicated categories (e.g., strabismus, glaucoma, pregnancy).