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How do I shop for LASIK?
February 15, 2014 3:34 PM   Subscribe

I've decided that I want to get my vision corrected with LASIK surgery. How do I go about figuring out where to get it done? As you might expect, I want the best possible results at the best possible price.

I am moderately nearsighted with a slight astigmatism, and am 29 years old. I've wanted to get my vision corrected for a long time, and I think I'm going to have it done fairly soonish. I've decided that I want to go with LASIK rather than PRK or LASEK. However, I have no idea how to choose the best place to actually do the procedure and I'm hoping that y'all can provide some recommendations or at least point me in the right direction to find a place on my own.

Obviously I want the best possible work done so that I can have the best possible results. We're talking about making permanent modifications to my eyes here, which is a subject of such importance that I'm not willing to cut any corners. I realize that even with the most skilled technician and the most state-of-the-art procedure there's still a bit of variation in the final result, but I want to leave as little to chance as possible.

My understanding is that the state of the art right now is vector-assisted, wavefront-guided LASIK. I've also heard that it's a good idea to get one's pupils checked beforehand in order to ensure that the corrected area is large enough to cover the pupil at maximum dilation in order to avoid artifacts under low-light conditions. (Anything else I need to know about?) All well and good, but how I do I find a place that does all that? And how do I know whether the place I am looking at is excellent or terrible in terms of their skill and diligence? It's about more than just the technology, after all; the people doing the work still need to be great at their jobs.

Also of course there's the price issue. How much should I expect to pay? Do you have any advice for making sure that I find the best possible price? I live in New Orleans, but would be willing to travel (even internationally) for this if necessary. I'm not willing to sacrifice quality, but I'd like to be able to find a place that offers me the least expense for that top-quality procedure.

Thanks for your advice. Specific recommendations are welcome, but anything that points me in the right direction would be appreciated.
posted by Scientist to Health & Fitness (21 answers total) 23 users marked this as a favorite
 
A good rule in seeking out a quality professional is to ask another professional. In this case, a general opthalmologist can offer a recommendation for a Lasik-qualified practitioner.
posted by megatherium at 3:59 PM on February 15 [1 favorite]


I went to the guy in the nearest city (portland, or) that handles a lot of the professional athletes for lasik. Those guys really depend on their eyesight and have the money to go wherever, so I figure they are the best. I had a really tough myopia and astigmatism right at the limit of what they are willing to do and they weren't sure I could get to 20/20 at all. He did it on the first try. So I would check who handles the surgery for the teams in New Orleans or Houston.
posted by bartonlong at 4:11 PM on February 15


To be honest, I yelped it. That got my search narrowed down to a few doctors, and then I just spent an evening checking those doctors' credentials. I ended up going to a consultation with the doctor I liked best, and at the end of the consultation I made the appointment to get surgery done.

The surgery and follow-ups were $2,400 total. I paid $1,600 down, and then $300/mo for four months following. (This was with a UC-educated doctor with a practice in Koreatown, Los Angeles. Previous to surgery, I had a -1.25 prescription for both eyes.).

That was about a year ago and I still think every day how happy I am that I did it. Feel free to memail me if I can be of any help.
posted by rue72 at 4:48 PM on February 15 [1 favorite]


Like any surgery, if you really want to know the nitty gritty numbers that show they know what they're doing, you're gonna want to know how many of this exact type of surgeries they've done, both in total and within the last year. In surgery, repetition is skill. There is a sweet spot between age of the surgeon and age of the technology currently in use, but more than anything it is because older surgeons rarely sustain the same workload they used to carry.

They are much less likely to give out accurate numbers for their rate of complications and in the case of corrective eye surgery, do-overs, but you can still ask. They might get offended though.

Ideally you're looking for someone who only does one kind of laser eye surgery, for the last two to five years.
posted by hobo gitano de queretaro at 4:59 PM on February 15


I started looking around myself recently:

1) I talked to my eye doctor first -- he has a center he recommends. Honestly, I'm not sure how much I trust that arrangement. The center's guarantee is based on me going back to him once a year, so I wouldn't be surprised if there was some sort of kickback involved.

2) I talked to friends and coworkers who've had it done. A couple of them highly recommended the same place as my eye doctor (so clearly they're good, despite my misgivings), but it also gave me a few other options to investigate. Some people even gave me a price range, so I knew what to expect going in.

3) I checked all the places on Yelp to make sure my friends' experiences were representative.

(Per bartonlong's advice, I just googled LASIK + my local pro sports team, and what do you know -- another win for the doctor's recommendation.)

That's as far as I've gotten, but my plan is to do the free consult at 2 or 3 different places, and see which one I feel most comfortable with. Everyone I spoke to was very happy with their surgeons, but I expect I'll see some variance in the price anyway.

For less high-stakes services like landscaping and remodeling, the advice I've been given is to get 3 estimates and, all other things being equal, take the middle one. I'm less willing to cheap out on my eyes than on house paint, but it still sounds like good advice to me.
posted by natabat at 5:08 PM on February 15


As far as costs, you can certainly save in another way: Do you have the ability to get an HSA or FSA through your employer or privately? If you know you're getting the procedure, you can essentially pay for it by using pre-tax money by putting it into an HSA or FSA.
posted by homesickness at 6:19 PM on February 15 [1 favorite]


My doc said to find someone with at least 10,000 surgeries under his or her belt to do the surgery. Also, when you have your consultation with the surgery office (which may not include the surgeon in person), they'll measure your cornea's thickness. Ask them what sort of number they're looking for at minimum, and at what point they will decline to operate on you. The majority of bad LASIK results, so far as I can tell, are from borderline candidates.

LASIK is the best money I've ever spent, hands down. I hope it goes well for you.
posted by Sunburnt at 7:01 PM on February 15 [2 favorites]


Something else that I think you might like to know about:

I had LASIK, admittedly 10+ years ago. This, from bartonlong, describes my experience exactly:

I had a really tough myopia and astigmatism right at the limit of what they are willing to do and they weren't sure I could get to 20/20 at all. He did it on the first try.

BUT, and it's a massive 'BUT'...what they don't tell you (because they cannot accurately predict it) is how much regression from that 20/20 you will experience over time. And no, the surgeon cannot always do a 'touch up' procedure. If, as is very likely with a strong prescription, they have lasered a large amount from the surface of your cornea, they may not be able to go near it with a laser again. Ever.

I had a very strong prescription (somewhere around -10) with astigmatism, pre-LASIK. The day after the surgery, I was utterly elated to have 20/20 vision. Nobody could believe it.

Unfortunately, I went from 20/20, to -4 and -4.25, in less than five years. I'm now at about -5.25 and -5.75. Even worse, because LASIK flattened the surface of my cornea I can no longer wear soft contact lenses. I now have RGP (hard) lenses custom-made at $1300 a pair. They have just developed a more comfortable type of rigid lens, but they'll run me $2500 a pair. I have huge issues with dry eyes (another LASIK complication), and with debris getting trapped under the lenses.

I'm not necessarily trying to put you off: my surgery was a long time ago. That said my (brilliant) specialist optometrist says that the same problems persist. He basically does not recommend LASIK to anybody, but especially not to people with strong prescriptions and/or astigmatism. LASIK surgeons love these candidates, because they experience the most dramatic short-term results, and tend to go around evangelizing about how brilliant it is.

Anyway, I just want to offer another perspective, because I ran around saying this:

LASIK is the best money I've ever spent, hands down

to anyone who would listen, for the first five years. Now, I wish I had never gone near it. It's not so much about the skill of the surgeon (mine was, and still is, considered the best in town). The fact is, the long-term results of LASIK surgery for any individual are just not that predictable. It is entirely possible for you to be in a worse position than you were pre-surgery, in a few years' time. On the other hand, it may end up being the best money you've ever spent. Do your research very, very carefully.
posted by Salamander at 7:27 PM on February 15 [12 favorites]


Salamander: I hadn't come across that in my research. Do you happen to have a link to a source? It's not that I doubt you, but I'd like to confirm what you said by seeing it in a study or some other authoritative document. Something like that would definitely be of concern to me.

Do you happen to know whether similar concerns exist with PRK or LASEK? The reason I had ruled those out was that in my own research it seemed like the rate of complications with LASIK were pretty much as low as with the other two procedures, making the speedier healing time the deciding factor. If it's really markedly less stable over time, I might go with PRK or LASEK instead.
posted by Scientist at 7:45 PM on February 15


When I looked for a LASIK doctor I found a handful (country-wide) who all had the typical awesome qualifications: 10K+ surgeries, worked on the local basketball team and airline pilots, were MD doctors, went to great schools, had the latest tech and seemed to have only glowing reviews. This might be irrational, but what tipped me to one vs. the other was whether or not the doctor also had the procedure done to his own eyes.
posted by BabeTheBlueOX at 8:11 PM on February 15


Scientist - I wish I had something to hand, but I don't. I will email my optometrist's office tomorrow and see if they have anything they can pass on.

I've had a bit of a think about the timeline, and I had LASIK 15+ years ago (!). I can't remember the year, but I'm pretty sure it was '98 (as I went overseas to live in '99). I went to see my LASIK surgeon when I got back into the country in 2003, expecting him to redo the procedure. He told me he had 'no cornea left to work with', and basically shrugged his shoulders and sent me to a shopping-mall optometrist to get soft contact lenses. They took one look, said there was no way they could fit me with a soft lens that would stay on my eye and also give me acceptable vision, and referred me to the specialist optometrist who now makes my RGP lenses.

My current optometrist gets a lot of post-LASIK patients referred to him. He is strongly anti-LASIK. From memory, he was of the opinion that the surgeon I used should have refused to perform LASIK on my eyes, and possibly recommended PRK instead. I think he said PRK has better (or more predictable, not sure which) outcomes for patients with extreme myopia/astigmatism. (I know nothing about LASEK, I'm afraid.)

He has also pointed out (albeit a few years ago) that none of the LASIK surgeons in our city have had the procedure themselves. :/

I don't think that choosing the best surgeon or equipment is the main issue. If you're getting lasered in a large city in a first-world country, chances are that there are numerous perfectly competent surgeons to choose from. However, what they don't stress to potential patients is that LASIK surgery is too new for anyone to know the long-term effects yet, and surgeons are not gods.

I would strongly recommend talking to a few highly-regarded optical specialists in your area who are not LASIK surgeons.
posted by Salamander at 11:38 PM on February 15 [2 favorites]


P.s. To be clear: I am not anti-LASIK, and I am sure it is long-term wonderful for some people, particularly people with mild myopia and no astigmatism. But just bear in mind that LASIK surgery is big business, and even the best practitioners are more concerned with turning a profit than with the individual outcome in 15-20 years' time. You're the one who will have to live with that.
posted by Salamander at 11:44 PM on February 15


I got wavefront-guided LASIK in January of 2013 (just had my 1-year checkup; A-OK!)

I went through LASIK MD, who has an office in our city (Syracuse). I can't help you shop around, but I would definitely check and see if insurance will cover anything and see if you have access to a flex spending account.

I believe I spent just north of $3000. I have lifetime bi-weekly checkups covered and any secondary touch up surgery that I may or may not need down the line will be covered. Wavefront-guided LASIK was pricier, but I'm glad I got it. Getting the surgery was the 2nd best thing I've ever done *winks at fiancé*

Finding "the best" surgeon isn't something to be concerned about. As long as you aren't getting surgery in a van from a drunk hobo, whoever you choose will get the job done. LASIK is big business now. Go in for a free consultation, get checked out and see what price you'll be working with.
posted by JimBJ9 at 4:25 AM on February 16


I had PRK one time and they messed it up. After that, I consulted with a board-certified opthalmologist who did both surgeries; he recommended PRK and did both my eyes.I picked this guy because he had treated a family member with a very complicated condition. When I have seen him for followups, he has spoken with me about evolving thought on which procedure to do, and on whom. I like that he is not totally rah rah rah about any one procedure. He does at least LASIK too. I would suggest you go to a really good general eye doctor for advice.
posted by BibiRose at 7:04 AM on February 16


FWIW, I asked my optometrist about LASIK at my last appointment, thinking that since my moderately bad vision (-2, -2.25) seems to have stabilized I might be a good candidate for the procedure. The optometrist told me that he doesn't recommend it for anybody because the results don't last, and you end up spending a huge amount of money for ~5 years of benefit, and then you have to figure out a new solution because contacts may no longer work.
posted by Cygnet at 7:56 AM on February 16


I had LASIK and wish I had considered PRK or LASEK instead. First, I have dry eyes, and there is some indication that the dry eye problem is lessened with PRK and LASEK. This overview from UCLA is a nice discussion of how PRK type operations leave more cornea, which can help with dry eye.

Also, when you visit a place, make sure that it focused on personalized care and the the surgeon also sees you for post-op visits. I went to a large place headed by a woman who has written textbooks on LASIK, but vey much felt like I did not get personalized recommendations. Since I already had dry eye, I wish they had recommended the surgeries more appropriate for dry eye. Instead, I felt like they only cared about getting more operations through the door. The fancy surgeon never even saw me for post-op care, that was all through the other
(less experienced) surgeons. They missed a few small things that were picked up quickly by a different practice. So ask LOTS of questions about post-op care.

And not to beat a dead horse about PRK/LASEK, but military operations tend to prefer PRK because it leaves a more structurally intact cornea. LASIK creates a flap that heals at the edges, but those are edges that are (probably) never fully at strength again. Unless you are a boxer, or in the military, LASIK folks tell you it won't matter. However, looking back, I wish I'd put up with a few more uncomfortable days post-op for less dry eye and more/stronger cornea left afterwards. In the details of this DoD article, note LASIK is not allowed for some military ops because integrity of flap edges not proven yet.
posted by lillygog at 8:49 AM on February 16


OK, so I've found an optical surgeon in my area who does both custom wavefront-guided LASIK and custom wavefront-guided PRK (I'm leaning toward PRK now; a few extra days of discomfort and inconvenience would definitely be worth it to make sure that my eyes stay good) who has over 30,000 surgeries under his belt, and has excellent Yelp reviews. His prices are reasonable, and he offers a variety of financing options as well. I think I'm going to book that initial examination! Thanks so much for all the advice, everyone.
posted by Scientist at 9:25 AM on February 16


BUT, and it's a massive 'BUT'...what they don't tell you (because they cannot accurately predict it) is how much regression from that 20/20 you will experience over time. And no, the surgeon cannot always do a 'touch up' procedure. If, as is very likely with a strong prescription, they have lasered a large amount from the surface of your cornea, they may not be able to go near it with a laser again. Ever.

I had a very strong prescription (somewhere around -10) with astigmatism, pre-LASIK. The day after the surgery, I was utterly elated to have 20/20 vision. Nobody could believe it.

Unfortunately, I went from 20/20, to -4 and -4.25, in less than five years. I'm now at about -5.25 and -5.75. Even worse, because LASIK flattened the surface of my cornea I can no longer wear soft contact lenses. I now have RGP (hard) lenses custom-made at $1300 a pair. They have just developed a more comfortable type of rigid lens, but they'll run me $2500 a pair. I have huge issues with dry eyes (another LASIK complication), and with debris getting trapped under the lenses.


I am almost at the 5 year mark and as of august still at 20/20. I have had some very minor degradation from the initial surgery-at one checkup I was at 20/15 about 6 months after the surgery, every other check up has been at 20/20. Due to my prescription (I was at -7 in one and -6.25 in the other) they did extra checking for cornea thickness and dry eye screening. I was on the very good side for both and there is enough thickness left for minor touchups as I age if they are necessary (the doctors say unlikely at this point). I still face the inability to read fine print as I age and that is showing up a little bit already, at 42. This has nothing to do with the lasik but rather just the normal ageing process. My eyes have always been very healthy, just mishappen and the only chronic problem I have is fatigue after staring at a computer screen all day (it is actually better since recover from the surgery). A weird side effect no one told me about was getting my eyes back into shape after the surgery. I had worn glasses since about the 3rd grade and my eyes didn't have much muscle tone due to this. So they would get really, really tired for the first two or three months after the surgery until I had them conditioned for looking at stuff without the aid of lenses. A huge factor in recovery for most people is making sure you get a wide range and frequent change in viewing distance during the early recovery-i.e. don't sit inside all day and stare at a computer screens until you have fully recovered. I limited it too no more than an hour or two at a time with at least 30 minutes between. This might have been critical in my outcome.

I am still a little light sensitive but polarized sunglasses take care of that. I wasn't before the surgery at all and didn't need sunglasses ever.

Some other unusual things that seems to have helped me-i had a 'flatter' cornea than normal, so my base curve was off and this made contacts hard to wear before the surgery and my axis was weird so the contacts didn't stay focused well, but this worked in my favor according the surgeon.
posted by bartonlong at 2:38 PM on February 16


Salamander: I hadn't come across that in my research. Do you happen to have a link to a source? It's not that I doubt you, but I'd like to confirm what you said by seeing it in a study or some other authoritative document. Something like that would definitely be of concern to me.


Here's a paper comparing patient outcomes 7 years after PRK and LASIK surgery. Though, one of the difficulties with these longitudinal studies is that surgery techniques improve all the time (especially over 8 years ago), so it's hard to tell if someone getting the surgery now would have the same outcome.
posted by bluefly at 2:50 PM on February 16 [1 favorite]


I had PRK done 8 years ago. I still think it was the best investment I ever made. I wore glasses since 3rd grade, and by the time I had my surgery I couldn't wear contacts anymore due to severe dry eye and irritation. I found my surgeon through word of mouth from coworkers and family, turns out he worked on several NBA players from our local team and some area celebrities too. He insisted on doing PRK because he said it's safer with better results. I don't know, but I trusted him and I'm happy with my eyes.

Let me tell you, for the first three weeks or so after I had the procedure done I was sure I had made a horrible mistake. I was in pain, and I couldn't see very well at all. My doctor had explained to me that the recovery took time, but I didn't think it would be that difficult. I had a tough time going back to work after 5 days off. My vision slowly improved, but it was not an instant solution by any means. Full results took about six months, just like the doctor promised. I'll need reading glasses in a few years (he warned me about that, too) but that's ok since I'm getting older.

Good luck!
posted by notaninja at 4:46 PM on February 16 [1 favorite]


Oops, I paid $2200 total. That included all the testing before and all the meds and followup appointments.
posted by notaninja at 4:47 PM on February 16


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