If you need an eye exam, or you are interested in LVC, you may find yourself in the office of either an ophthalmologist or an optometrist. What is the difference, and who will do your eye surgery? An ophthalmologist is a physician (or M.D.—Doctor of Medicine), just as a cardiologist or neurosurgeon is also a physician. An ophthalmologist has attended undergraduate school, four years of medical school, and one year of internship—rotating through various medical specialties and subspecialties. To specialize in ophthalmology, a physician must next complete a three-or-four-year residency in ophthalmology, where in-depth studies include ocular anatomy, physiology, pathology, diseases, and surgery. Some ophthalmologists take extra training in a fellowship to specialize in one area or disease of the eye such as glaucoma, the retina, or the cornea.
Optometrists also attend undergraduate school, followed by four years of optometry school, where they study the eye in courses similar to those in an ophthalmology residency, including the diagnosis and treatment of eye disease. In addition, their schooling emphasizes the science of vision, refraction, and the fitting, formulation, and sale of eyeglasses and contact lenses. Although not physicians, and therefore not able to perform surgery, optometrists provide a valuable eye-care function. They perform eye examinations, diagnose eye disease, and in most states, prescribe topical eye drops. Your optometrist can often tell if you are a good candidate for LVC or can refer you to an ophthalmologist. So, how do you find a doctor competent to perform LVC? Although there is no foolproof method of finding the right ophthalmologist for your surgery, the following methods may be helpful.
Staying with Your Current Ophthalmologist
If you are already under the care of a board-certified ophthalmologist who performs LVC (not all do), trust his or her skills, and are satisfied with the eye care you have received over the years, you probably need to look no further. Most eye surgeons are board certified, indicating that they have demonstrated an in-depth knowledge by passing a rigorous examination administered by the American Board of Ophthalmology. If you do need to start with a new ophthalmologist, I recommend that you seek one with experience performing LVC. Although even the most experienced LVC surgeon started with a first patient, the experience is a factor in successful LVC. How do you measure experience? Are twenty-five operations enough to pronounce your eye doctor experienced? There is no magic number, but most ophthalmologists would agree that an ophthalmologist would need to perform at least twenty-five to fifty LVC procedures to feel comfortable, and one hundred to two hundred to be even more competent. As in all professions, skill levels vary. An experienced eye surgeon who has done thousands of other eye operations, such as cataract or glaucoma surgery, may need to have performed fewer LVC procedures than a less-experienced surgeon to be considered competent. All ophthalmologists who perform LVC must attend training and educational courses given by different excimer laser companies and be certified by the company whose laser he or she will be using. In addition, Intralase and most microkeratome companies provide similar courses and require similar certification.
Referral from Your Optometrist
If your regular eye doctor is an optometrist, you might want to ask for a recommendation for an ophthalmologist who performs LVC. Who is better than an eye-care professional for recommending a good eye surgeon? This approach usually works well, provided your optometrist has your best interests at heart. However, some optometrists comanage their LVC patients with an ophthalmologist and receive a comanagement fee for their work. This arrangement might not influence your optometrist’s referral to an ophthalmologist, but as a patient, you should be aware of this practice. Comanagement works like this: An optometrist refers the patient to an ophthalmologist for LVC. The ophthalmologist completes all necessary testing, including deciding whether the patient is a good candidate for LVC and reviewing informed consent, risks, and complications. After surgery, the ophthalmologist will see the patient for one or two postoperative visits, after which all other follow-up care will be assumed by the referring optometrist. The surgical fee often includes the comanagement fee and is paid to the optometrist by the ophthalmologist. Comanaging LVC patients arose in rural areas where there were fewer eye surgeons than optometrists. Comanagement works well, as long as a financial reward does not affect referrals and quality eye care.
Referral from a friend or relative
Assuming 6 degrees of separation is really true, you probably know someone who has had LVC or someone who knows someone who has. A referral from a friend or relative is often extremely successful, since “word of mouth” is often a great way to learn of a good movie, a good restaurant and perhaps of a good LASIK doctor. But what was successful for one person may not apply to you since the chemistry between patient and doctor is important and your friend’s eye condition may be different from yours. “Go with your gut” may be a good rule of thumb for this and any means to locate Dr. Right.