The Last Word On Nothing

For as long as I can remember, I’ve dreamed of waking up, opening my eyes, and seeing clearly. I’ve worn glasses since age 8. Without them, I can’t see my partner’s face in the bed next to me. I can’t see the clock on the phone sitting on my nightstand, or stargaze when I’m sleeping outside. I’ve been saving up for laser correction surgery for many years, dreaming of the day where I can wake up with the world in focus.

I’m also very cautious. These are my eyes, after all. The procedure is expensive, and I want to choose the best surgeon possible. As I recently learned, that is no easy task. 

My first foray into vision correction surgery came after I saw an ad for a LASIK practice, featuring John Elway, in the Denver International Airport. I figured if they have enough money to get the most famous Bronco on board, maybe those doctors are doing something right. So I scheduled a free consultation.

The practice was spacious, with its own parking lot and a plush waiting room with nice magazines. A woman took some painless measurements to see if I was a good candidate. She used machines to measure the thickness of my cornea, and its symmetry. She also checked my prescription strength.

Then, the doctor came in. Tanned and lean, he looked like a tall, white-haired Pat Sajak. I did not see this as a positive. He dilated my eyes (no one had told me to expect THAT!) and told me that I was a great candidate for LASIK, no problem. The whole process took about 30 minutes. I was ushered to a receptionist, who went over a fee schedule ($999 an eye) and tried to schedule my surgery.

I balked. I was just exploring the possibilities. I hadn’t done enough research. And I didn’t trust that orange-skinned doctor. I told the receptionist I wasn’t ready to commit, and drove off, eyes shielded by heavy sunglasses.

After this experience, I settled in and did some real research on laser vision correction surgery. It turns out, there are at least two tiers of laser surgeons. I started to think of them in terms of clothing brands. The one I had just visited I thought of as an “Old Navy” practice. They do tons of surgeries every year. Prices start low: “Just $499 per eye!” But with this comes a lack of personal care. Like Old Navy clothing, if you have curves, or are not a standard size, it might not be the best fit.

My concerns about this surgery went in roughly this order:

• Safety
• Safety
• Safety
• Results
• Price

I wanted my doctor to recommend a procedure because it was the right fit for me — for my eyes, for my level of concern about side effects, for my conservative approach to what I viewed as a major surgery. Bonus points if he (or she, but female ophthalmologists are rare) wasn’t abnormally tan.

Try Yelping an eye surgeon.  I did. You might read the following comments, about the same practice:

“Had my Lasik here.  BIG BIG BIG mistake…they took off too much material. Then, to top it all off they put a wrinkle in one of the flaps and I had to have it lifted and reset which was the most horrible thing I have ever had to experience…Now I am stuck with no night vision (halos and starbursts), excessively dry eyes all the time, a forest of floaters and glasses again.”

“Surgery itself was super easy and relatively painless…Results have been good, and I was at 20/20 the next morning.”

Looking at online reviews, I decided, is not a good way to choose a surgeon. Every patient is different, and people have such varied expectations for outcomes.

I decided to visit some more doctors. I selected two more practices using a combination of Yelp reviews, proximity to my home and my own assessment of how professional and non-marketing-ey their website looked.

At each consult, I was taken through the corneal tests by a peppy female thirty-something. These women seemed vaguely nurse- or technician-like. They plied me with information and informed me that my eyes were “normal” or my pupils “larger than normal” and that I seemed like a “great candidate, and I wouldn’t tell you that if you weren’t.”

One important thing I learned at these new consults: I was a better candidate for a type of surgery called PRK. It has a longer recovery time, but is even safer than LASIK, and better for my type of eye — my corneas are a little thinner than average, and I have large pupils. It’s not that LASIK is exactly dangerous for me, but I would have had a higher chance of negative side effects like night halos or dry eyes with the procedure recommended by the Old Navy practice. I felt like I had dodged a bullet.

Even though these practices seemed more professional, marketing was still a big part of the package. I later learned those cheery women hold a position called a Refractive Coordinator. They’re not medically trained, but are sales/scheduling hybrid, responsible for converting potential patients into surgeries. A 2008 article in the Review of Opthamology, a trade journal, discusses one surgeon’s ideal coordinator:

“According to Dr. Lindstrom, in his experience, ‘the coordinators that are the best are vivacious, attractive women who have had LASIK. The model would be to find someone who has had refractive surgery, is really pleased with his or her own outcome, and is able to relate to an age population of 20 to 40.'”

Having a non-medically trained salesperson tell me I’m a good surgical candidate doesn’t engender a heaping amount of trust. I spent most of my visit with these women, and even though the surgeon followed up with his own opinion, I still felt like the subject of an elaborate sales pitch.

So I armed myself with questions. These mostly came from a combination of my intensive reading of Consumer Reports articles and what I could glean from Google Scholar. What were their complication rates? How many serious complications have they had? What are the chances for serious side effects? What kind of laser did they use? Is it the best for the type of surgery I was going to get? Did the two practices give similar answers to the questions I asked?

I got answers. But they came from the people trying to sell me the surgery. It all felt a bit…shady. I know doctors aren’t supposed to lie. However, I am an eye surgery neophyte, so it was hard for me to know if the practices were selectively doling out information in a way that might make them, or the procedure, look better. I also learned it’s really difficult to find out if your doctor is in good standing with the medical establishment, of if he has had lawsuits filed against him. Not exactly reassuring.

Eventually, through a combination of Google Scholar research and triangulation from my three consultations, I decided on a surgeon.  My operation is this week. I’m confident my surgery will be safe and effective. I’m far less confident in anyone’s ability to evaluate a surgeon based on the things that really matter: safety, success and complications.

The medical profession often cites the Latin phrase Primum non nocere as their creed. It’s meaning: First, do no harm. In my experience, it was a different Latin holdover that came to mind. Caveat emptor. Its translation: Buyer, beware.

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Stephanie Paige Ogburn reports on science, energy and a whole lot of other topics from Denver, Colorado, where she is a staff reporter at KUNC. Follow her @spogburn.

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 Eye illustration by Kevin Dooley, via Flickr.