Why Your Eye Surgeon Needs to be Local

A Word from Dr. Lipstock

Unfortunately, in the refractive surgery field, corporate medicine has taken a foothold.  This is not a good thing. With an eye towards maximization of profitability for share holders they have set up a system where the surgeon only operates and other tasks are delegated with a team approach. 

Sounds good. 

Sounds efficient. 

But the surgeon is moved from city to city, state to state only to show up on the day of surgery in those centers where LASIK surgery has been scheduled in advance. The surgeon does not examine the patient prior to surgery and is not available locally to see the patient after surgery. You would think nobody would ever consider having LASIK under such circumstances, but people do every day.  

In Richmond, there are two corporate operating LASIK centers. Each uses a different execution plan for their “team” approach. Let`s look briefly at their approach.

One of the corporate LASIK centers has a full time optometrist. An optometrist is an eye doctor, not a surgeon and certainly not an M.D. This person is introduced as “the doctor” who performs a thorough pre-LASIK exam. The actual surgeon who will perform the vision correction procedure is not even on the premises. The surgeon actually lives in another state and travels to different states to operate. This surgeon will review the results of the LASIK evaluation and determine, based on that data, whether the patient is a candidate for surgery. 

While this may sound okay, the truth is that there is an essential element missing from this flow. The surgeon never actually examined the eye. Tests were done and measurements were made. But the surgeon did not even look at the cornea before surgery! 

As a qualified, board-certified ophthalmologist, I know there are essential elements every surgeon should be examining his patients for. There are things we can delegate and things we can`t, and one of them is actually examining the patients ourselves prior to surgery. For example, say a patient has an old superficial corneal scar. Such scars can sometimes cause complications when making the LASIK flap. The surgeon should be carefully and routinely searching for such scars at the pre-op evaluation. If a scar is found, then clinical judgment based on years of experience will determine what surgical technique will be employed to avoid any problems during surgery. One might argue that a very well trained optometrist could perform this function, but it is a cost cutting short cut you need not subject yourself to. 

What is even worse is what happens post-operatively. The surgeon is not there the next day to examine you.  This traveling surgeon is likely not going to be there anytime you may call with a problem. If you do actually experience a problem, it is possible for a trained optometrist to accurately diagnose it. However, the surgeon is best trained for diagnosing post-operative complications and planning a course of action. This is especially important if you need surgical correction. 

For example, let’s say your surgery was performed flawlessly and your first day post-op check looks great. The next day you turn around and one of your children accidentally pokes you in the eye. You feel pain and your vision becomes very blurred. This could be because your flap is out of position. The longer it is out of position, the more difficult it is to remove wrinkles in the flap. This can lead to blurred vision.

The longer it is out of position the longer you feel the very uncomfortable foreign body sensation. You must see the surgeon for immediate repositioning of the flap. The surgeon is in another state. 

What do you do?

Good question. 

Over the years I have seen several slipped flaps. I saw the patients right away – weekdays, nights, weekends. I take the responsibility to always be on-call for my patients; if I am out of town, then I delegate this task to a corneal surgeon trained to perform LASIK. Otherwise, if you need me I am there as I should be. Not complicated. Simple medical ethics based on the best practice of medicine. 

The second corporate LASIK center’s surgeon also travels from city to city, state to state. The surgeon is only there on the day of surgery. This scenario is different in that there is no in-house optometrist that performs all of the pre-operative evaluation and the post-operative care. This center relies on a very controversial system called “co-management”. In this system, your local optometrist that has been caring for you over the years recommends this surgeon for your LASIK. Your optometrist performs the evaluation and post-operative care. 

Of course you trust the optometrist that you have seen for ages. If this optometrist says you should see this very experienced surgeon then you may very well take that advice, and you may feel very comfortable being sent back to your eye doctor for the post-operative care. It all sounds comfortable and cozy. This situation is called “co-management” because both doctors are caring for the patient and thus it is deemed legal and fair that both surgeons charge for this service. Usually your optometrist will get 20% of the total LASIK fee.

What is wrong with this scenario?

Well the same things as stated above for the other center. However, with the co-management system, all too often the referring optometrist is very inexperienced at managing the clinical care of LASIK. The optometrist may only refer one patient a year. This inexperience could certainly lead to dangerous misdiagnoses and delayed care.    

So, I ask you: Why would you even consider corporate LASIK centers? Because their marketing sounds great? Because the itinerant surgeon has done a gazillion LASIK procedures? Or maybe because they sound cheap (even though they are not lower in cost than most other local centers)? 

Is it really worth the health of your eyesight to take the chance that you might be okay?