Ophthalmologists and Custom LASIK
VISX, Zyoptix and LADARVision are attractive to you if you want a more accurate, custom picture of your eye that achieves excellent results. The question is, will your ophthalmologist recommend one over the other? Does clinical ophthalmology prefer, for example, VISX to LADARVision?
The American Academy of Ophthalmology publishes clinical ophthalmology studies on their Web site, as recent as September 2005, that demonstrate custom wavefront-guided LASIK ablations and their results as compared to conventional LASIK. However, the AAO stops short of recommending one technology over another.
The decision of which technology to use is ultimately up to your ophthalmologist, who will use whatever technology he feels will give you the best results, but may offer both VISX and LADARVision, for example.
In your list of questions to ask your ophthalmologist, ask about success rates with the various technologies and the advantages and disadvantages. And remember, the diagnostic technology is only as good as the ophthalmologist who uses it, so choose your ophthalmologist first, then the technology.
Ophthalmology: M.D. a Must
True or false: Laser eye surgery is so advanced you don't need an ophthalmologist to heal your vision.
False. While consumers may be confused about the difference between clinical ophthalmology and optometry, the Academy of American Ophthalmology Web site says that consumers want a medical doctor certified and licensed in ophthalmology to wield a laser or microkeratome blade.
The National Consumers League survey of 600 adults reports that:
* 85.6 percent prefer the eye-care provider performing eye surgery to have a medical degree.
* 90.5 percent say that only a skilled, licensed ophthalmologist should perform surgery.
* 77 percent say that it's not acceptable for anyone without a degree in clinical ophthalmology to perform eye surgery.
* Respondents agree with the typical eye surgeon's Web site that laser vision correction procedures are surgical procedures.
The bottom line: Not only should the public have a skilled, licensed, certified medical doctor, an ophthalmologist, aim that femtosecond laser at eyes with astigmatism, the public wants a medical doctor in charge of laser eye surgery.
While you may have questions about the eye surgery procedures, you know that you want a professional with the latest information and the necessary care and skill to correct your vision. Don't settle for less.
Eye Exams and Eye Surgery
If you wear glasses or contacts and are considering discussing laser eye surgery with your ophthalmologist, your eye exams need to be current. According to the American Academy of Ophthalmology Web site, www.aao.org, if you have no vision problems diagnosed by clinical ophthalmology and you don't wear glasses, you should stick to a regular eye exam schedule:
1) At least once when you're in your twenties
2) At least twice when you're in your thirties
3) Every two to four years when you're in the 40 (presbyopia appears) to 64 age range
4) After age 65, every one to two years
The American Academy of Ophthalmology recommends that if you wear glasses or have eye problems, you should schedule more frequent exams--once a year if you're at high risk for vision problems, for example if you're African-American, have diabetes, or have had previous eye injury. These annual exams should be dilated-eye exams.
If you choose laser surgery, your eye exam history will help your ophthalmologist determine which surgery is right for you.
Medical Conditions and Ophthalmology
Diabetes--no one likes to think about it, but it can affect your eyesight. That's why, according to the American Academy of Ophthalmology, Medicare and the EyeCare America Diabetic Eye Exam Initiative help ophthalmology patients. If you're a Medicare beneficiary, you can have:
* an exam by a local ophthalmologist
* up to one year of covered eye care with no out-of-pocket cost
People with diabetes need to have a dilated eye exam at least once a year. But, you think, diabetes will squash your prospects for laser eye surgery.
Not so. In fact, people with autoimmune disorders such as lupus are generally excluded from treatment, but you can have laser eye surgery as a diabetic if your eye prescription is stable for at least one year and you are not taking any medication to control your blood sugar.
You may not like to think about diabetes, but now is the time to do something about it through ophthalmology, when you're young enough to stop vision problems before they worsen.
Optometrists Practicing Surgery?
You may have heard about a 2003 case at a Veterans' Affairs hospital in Kansas in which an optometrist was granted privileges to perform laser eye surgery. Remember, an optometrist typically does not perform laser eye surgery.
According to the American Academy of Ophthalmology, in 2004 the Department of Veterans Affairs responded to calls for patient safety from professionals licensed and trained in clinical ophthalmology and laser eye surgery, as well as from associations such as the American Medical Association, American College of Surgeons, the American Osteopathic Association, the American Academy of Family Physicians and American Society of Cataract and Refractive Surgeons. The VA revoked optometrists' privileges to perform laser eye surgery.
If an optometrist tells you he or she has hospital privileges to conduct laser eye surgery treatments, opt for an ophthalmologist's care instead. Therapeutic laser surgery, which is complex and delicate, should only be performed by a qualified ophthalmologist. Our country's respected veterans and its civilians deserve the best care from a qualified doctor certified in clinical ophthalmology.
Optometry vs. Ophthalmology
You may have received a referral from your optometrist to an ophthalmologist. Your optometrist examined your eyes and thought you would be a good candidate for laser eye surgery. Now your ophthalmologist tells you he needs to do a comprehensive eye exam to treat your eyes. Why? Shouldn't the first exam tell him everything he needs to know?
While clinical ophthalmology looks at the exam results provided by your optometrist, your ophthalmologist has more specialized equipment and will perform more detailed tests to get an accurate picture of your visual acuity and your vision abberations. Your ophthalmologist is a medical doctor and the chief expert of your eye care team.
The American Academy of Ophthalmology Web site recommends that your ophthalmologist perform certain tests to improve your surgery results, such as:
* slit-lamp tests, to look into the back of the eye for retinal problems, possibly with fluorescein staining to detect whether you need LASIK or PRK
* measuring corneas to reduce the risk of buttonhole flaps
* a refractor to determine your eye prescription
* a tonometer to measure intraocular or inside-the-eye pressure ¡ª a too-high reading may be an early symptom of glaucoma
* tests for dry-eyes so your ophthalmologist can treat and cure before you have laser surgery
This isn't a comprehensive list of the ophthalmology eye exam, which goes into greater depth than the optometrist's exam if you are considering surgery.
Optometrists provide routine eye exams to detect common vision problems, also to determine color and depth perception, while ophthalmologists detect and treat vision problems with surgery or implants. Make no mistake, both are vital to your eye care team before, during and after surgery.
Ophthalmology Advice
Your family care physician or internal medicine (or alternative medicine) specialist gives you guidelines: exercise, eat right, and so on. It's no surprise that clinical ophthalmology has words of medical wisdom, too.
If your ophthalmologist will perform LASIK, EpiLASIK, LASEK, PRK, or custom LASIK on you, she will probably give you some advice to better the your outcome. The American Academy of Opthalmology Web site points you to "Basik Lasik," a brochure produced by the FTC and the AAO.
"Basik Lasik," available at www.ftc.gov, advises that you:
* Not take Accutane or oral prednisone
* For myopia patients: Postpone LASIK until your myopic refraction has stabilized in your mid to late 20s
* Be in good general health, and discuss any diabetes, high blood pressure and other medical conditions with your opthalmologist
* Not be pregnant or breastfeeding since hormone changes can affect the outcome
Also, other risk factors such as smoking can affect LASIK results, so you have an excellent reason to follow your regular physician's admonitions. Besides, you want to get rid of your glasses and don't want to be out of breath when you're boogie boarding.
Board Certified Ophthalmologist
Your ophthalmologist should be board certified in clinical ophthalmology by the American Board of Ophthalmology, according to the American Academy of Ophthalmology Web site.
A listing of "board certified" on an ophthalmologist's Web site or a certificate on his wall gives you added reassurance that you're in good hands--especially since the American Board of Ophthalmology is the oldest specialty board in America, founded in 1917.
The board certification process involves a rigorous two-part exam, affirming that your ophthalmologist is:
* trained in how to treat chronic and acute eye diseases in a clinical environment
* experienced in follow-up treatment of eye problems such as diabetic retinopathy
* trained in sub-specialties such as pediatric ophthalmology or cornea and external disease, for example
* licensed to perform refractive surgery (a sub-specialty)
* able to prescribe contacts (which you want to get rid of)
Not all ophthalmology specialists are board certified and board certification isn't required to practice ophthalmology. However, board certification protects you, the refractive surgery patient, so you need to check with the American Board of Ophthalmology or check the credentials on your ophthalmologist's Web site. Look for "board certified" first. As of 2006, all ophthalmologists who are board certified must also pass the American Board of Physician Specialties recertification process.