If you're interested in refractive eye surgery, be a smart consumer.  Do the research you need to make an informed choice for yourself – and avoid ads that sound too good to be true.

First of all, it's important to distinguish between the three kinds of specialists who provide different levels of eye care. 

• Ophthalmologists are M.D.s (doctors of medicine) with advanced training in eye conditions (just as, for example, a cardiologist has advanced training in heart conditions).  As medical doctors, ophthalmologists are legally allowed to diagnose eye conditions and diseases, prescribe medications, and do eye surgery. 
• Optometrists have an O.D. (doctor of optometry) degree, but they have not gone to traditional medical school and are not MDs.   Normally, they test and evaluate vision, diagnose some eye conditions, prescribe glasses and contact lenses, and make referrals to ophthalmologists for more serious conditions.  Some states may allow them to prescribe some medicines, but they do not do surgeries. 
• Opticians are essentially eyeglass makers.  They fill prescriptions for eyeglasses, making the lenses and assembling and fitting the glasses.  Some states allow them also to sell and fit contact lenses. But they do not provide direct patient care; they do not do eye exams nor prescribe glasses.

Your primary care physician is not an eye specialist, but you should discuss your interest in refractive surgery with her or him.  Your doctor knows your medical and eye history, has information about whether you're a good candidate for the surgery, and can suggest questions you should ask an eye surgeon.  Your doctor can also recommend eye surgeons.  When requesting a recommendation, always ask "If you or your children were having this procedure, who would you want to do it?" 

Many ophthalmologic practices offer open houses and patient education seminars to prospective eye surgery candidates.  They can be a good source of information and allow you to hear questions asked by others, avoid possible feelings of intimidation that can arise when you speak to a doctor individually, and leave without making any commitments.  Of course they can also be full of hype and both high pressure – and very subtle – marketing techniques.  Go to several so you get can compare them.

When you do go to an eye surgeon individually, be prepared with lots of questions, including: 

• Are you a board-certified ophthalmologist?
• You can find biographies of board-certified doctors at the American Society of Cataract & Refractive Surgery  and the International Society of Refractive Surgery
• Where did you get your training in refractive surgery? 
• Why did you decide to do this kind of surgery?
• How long have you been doing it and how many have you done? 
• Do you specialize in refractive surgery?  Some doctors include all laser eye procedures, including cataract surgery, in their numbers, so be sure to ask about the specific surgery you want.
• How many complications or problems have there been?  What percent of the total number of procedures is this?  Be wary of doctors with problem rates above 1 percent – or who do not know their rate or refuse to discuss it.
• Will you do the surgery yourself, or will you be directing an assistant?
• How often will I need to see you after my surgery? Will I see you or an assistant or technician?  One reason why prices for LASIK surgery vary is that the surgeon may not be available for follow-up care or the follow-up care is abbreviated leaving the patient with suboptimal care.
• What will the recovery period be like?
• What are the long and short term side effects?
• What happens if I need an enhancement, a further procedure, a second surgery?  Under what conditions will you do it?  Who pays for it?
• Get these answers in writing, to protect yourself. 
• One reason why prices vary is the number of follow-up procedures included in the original cost. 
• What type of laser do you use, and why?  Do most other ophthalmologists use it?
• Are your lasers inspected and maintained weekly?
• Do you do studies testing new technologies for the companies?
• Have you published articles or presented papers at national/international meetings on refractive surgery?  Check the doctor's website to see if his or her CV is available.
• Do you have pupil-tracking or computerized eye-tracking systems to target the laser over the center of the cornea?
• Can I wear my contacts before my surgery?
• Can you work with my regular eye doctor?
• Do you offer financing?
• Have you been sued or have litigation pending?

For more questions to ask about refractive surgery, go to Ask Your Doctor.

If any of the answers feel rushed or evasive, if the doctor seems impatient or insulted that you presume to ask them, then think seriously about choosing another.  Remember, you are deciding who will operate on your eyes, and you have every right to learn as much as you can about that person.  You should also be wary of anyone who spends less time collecting your medical history and more time trying to "up sell" you, that is, convince you to buy more than you intended. 

The doctor should spend time establishing a true doctor/patient relationship.  That means the doctor should get your complete medical history, ask about your lifestyle and other pertinent information, and do a complete eye exam. Of course it's your responsibility to give full, honest answers.  Only then can you and the doctor decide if you really need the surgery, will benefit from it, and if you're a good candidate for it.  (For more information about what makes a good candidate for refractive surgery, go to Vision Correction Key Point 3.)

Your other responsibility is to be sure you have realistic expectations for the outcome of the surgery – and discuss them with the doctor.  If you expect "perfect vision," and don't get it, you won't be happy, even though your vision has improved enormously.