Lasik - meeting only the optometrist at the consult

[gobruins]

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Hi all,

I'm a physician but not an ophthalmologist. I accompanied by wife for her eye consult for vision correction. I sat outside watching our kids while she went in. Afterwards, we met with the business manager to consider surgery dates. I noticed my wife spoke to an optometrist and that she would only meet the ophthalmologist the day of surgery.

Is this the norm? I figured for most medical procedures, consults are done with the operating physician who makes the call, operate or not, and what kind of procedure.

This was at a TLC center.

Thanks.

 

[OPPforlife]

We will let you decide whether you guys should seek care at a clinic with that model of practice.


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[jsh1986]

No. Your instinct is correct. I would see someone else.

Hi all,

I'm a physician but not an ophthalmologist. I accompanied by wife for her eye consult for vision correction. I sat outside watching our kids while she went in. Afterwards, we met with the business manager to consider surgery dates. I noticed my wife spoke to an optometrist and that she would only meet the ophthalmologist the day of surgery.

Is this the norm? I figured for most medical procedures, consults are done with the operating physician who makes the call, operate or not, and what kind of procedure.

This was at a TLC center.

Thanks.

 

[LightBox]

This is actually a pretty common model for reasonably high-volume refractive surgery practices. i.e. an Optometrist who is highly-experienced in working up / refracting / screening refractive sx patients first sees the patients and determines who is a reasonable candidate. Then a refractive surgery counselor/coordinator goes over more of the logistics and finances of the chosen procedure. This is what we do in our practice and we have had no problems at all. Any questionable topographies, thin corneas, etc are shown to the surgeon for review far in advance. We also sit down with the patient before the procedure to make sure they understand exactly what is going to happen, and to answer any last-minute questions.

Our optometrists have been doing this for >10 years (i.e. refractive workups) so we trust their manifest and cycloplegic refractions and assessment of risk for ectasia. Trust me -- theirs are better than any Ophthalmologist's!

Of course, you want to make sure that the surgeon reviews your pre-op data and errs on the side of safety. But more importantly, I would make sure the surgeon has done a reasonable volume of procedures and has some of the better equipment on the market.

 

[Apollyon]

I had my LASIK done at Duke 9 years ago, as a senior resident (one month before the end of residency, so I got the discount), and, as part of the workup, I didn't see the ophtho until the day of surgery. They also charged me for the workup, and that didn't even bother me. Then again, when I've been re-examined, the docs can't believe that the ophtho did the flap, because, it is so good, it looks it was automated.

edit: and, if that doesn't make sense, it's because I'm a dumb ER doc!

 

[OphthoApp]

I would consider seeing another doctor. I think there is nothing wrong with wanting to meet the surgeon before spending thousands of dollars. Also make sure it is a high quality place. High volume doesn't always equal high quality. I do believe though that high volume is important. Many good places look at their outcomes. You can ask how many procedures are done and what percentage end at what refractive error. Also they look at how many patients require enhancement, ect.

 

[gobruins]

Thanks for the opinions. Ironically we went to this location based on recommendations from two ophthalmologists we know. Unfortunately both practice too far away for us to go to them. I was not completely turned off by this set up but it did strike me as odd.

We'll just find a second opinion and explore. Thanks again.

 

[Visionary]

As LightBox said, this is not uncommon, particularly in high volume refractive practices. It makes for a very efficient model, actually. The optometrists in these groups tend to be very good. The surgeons need them to be, after all. There are optometry residency programs that focus specifically on refractive co-management. I've had quite a bit of pathology caught and sent my way from optometrists in practices just like this. As with any elective surgery, you really need to do your research, though. There are good groups and bad groups. Talk to folks you trust and assess their satisfaction with the process, care, and results.

 

[Dusn]

The refractive surgeons in our practice may have the optom do the initial measurements but they will always see the patients and review the case, consent, and measurements with the patient prior to the day of surgery. Often times they will have the patient return later to double check the measurements and see if they're changing over time.

Unfortunately, as you know, assembly line medicine like this is probably the future. But I would go elsewhere.