LASIK rates highly among physician-patients

Take home:

Physicians expressed high rates of satisfaction with laser vision correction up to 10 years following surgery.

San Francisco-LASIK results are good. Studies using current LASIK platforms routinely show 20/20 in excess of 80% of eyes and a high degree of satisfaction in 95% of patients. With about one million eyes treated annually, LASIK results are so good the U.S. military has accepted the procedure for combat pilots.

But what about physicians?

Dr. Krueger

“Physicians are skeptical, they are cautious and they have an extraordinarily high demand for visual function,” said Ronald R. Krueger, MD, MSE, medical director, Department of Refractive Surgery, Cole Eye Institute, and professor of ophthalmology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland. “So, how well do they do with LASIK? And how satisfied are they with surgery?”

The answer, it turns out, is very well and very highly satisfied.

Dr. Krueger presented the results of long-term patient satisfaction of laser vision correction among physicians at the annual meeting of the American Society of Cataract and Refractive Surgery. He surveyed all physicians he treated using laser vision correction at The Cleveland Clinic from 2000 to 2011. This was not a study of a particular platform or technique, but a broad survey that included a variety of platforms, profiles, and keratomes over more than a decade of real-world surgery in a highly demanding population.

Dr. Krueger and his research team were able to identify retrospectively 226 physicians he had treated over that time. He said that while the Cleveland Clinic employs more than 3,000 physicians and the Cole Eye Institute is not the sole venue in which these physicians seek out their treatment, the Cleveland Clinic health plan offers benefits and incentives for employees using in-house facilities, such as the Cole Eye Institute.

Physicians become patients

The 226 patients represented 429 eyes. A chart review showed that a majority of the patients, 63%, were male, and the median age was 38 years. There were nine eyes with hyperopia in the group, with a mean refractive error before surgery of +1.25 D. The 420 eyes with myopia had a mean spherical equivalent refractive error of –4.5 D, with a range from 0 to –11.50 D. Most of the eyes, 89%, had LASIK and 11% had PRK. The mean follow-up period was 20 months.

The visual outcomes were good, Dr. Krueger said, with 78% having uncorrected visual acuity of 20/20 or better after surgery and 97% 20/40 or better. Eighty percent of eyes were within 0.5 D of target and 96% were within 1 D of target.

A majority of patients, 86%, had no change in best-corrected visual acuity (BCVA) following surgery. Just 1% of eyes lost two lines of BCVA and 13% lost one line of BCVA.

“[Compiled] over 10 years, these results are not with a single platform or today’s latest platform,” Dr. Krueger said. “These results include the older lasers we used in 2000 as well as our newer modifications. It is across all platforms, and hence gives a good idea of how well we did with laser vision correction overall.”

Patient satisfaction

Beyond these results, he also wanted to assess physician satisfaction over this time. His researchers mailed a physician-specific survey to all 226 physician-patients and received 132 responses, about 58%. Nearly all of the respondents, 97%, completed the full survey. Of the respondents, 28% were surgeons, 43% were non-surgeons who performed procedures, and 29% did not perform either procedures or surgeries. Respondents included cardiac surgeons, neurosurgeons, ophthalmologists, and a variety of other specialties, as well as generalist practitioners.

Physician satisfaction largely mirrored satisfaction in the general population. More than two-thirds of physicians, 70.3%, reported being very satisfied with their surgery and another 25% were satisfied. That agrees with general population satisfaction rates. Nearly all physicians, 96%, said they would repeat the surgery based on their experience and knowledge of their outcomes.

Physicians’ assessment of their own visual outcomes was equally positive. Most respondents, 84.3%, said the quality of their corrected vision was better or much better than their BCVA before surgery. None said the postsurgical vision was notably worse, 3.1% said it was slightly worse, and 12.5% said it was about the same after surgery as it was before surgery.

A total of 21% of physicians said they needed spectacle correction after surgery. Of this group, 67.9% said they needed correction for reading and near work, 39.3% while driving at night, and 25% while driving during rain. Smaller percentages reported needing correction doing their job (21.4%), working on a computer (14.3%), watching television or movies (17.9%), and for social life or while driving with glare from oncoming headlights (10.7% each).

Most physicians, 90.6%, said the quality of their vision post surgery has not limited their work as a physician, while 3.9% said only a little bit, 1.6% said a moderate amount, and 3.9% said they didn’t know.  Overall, 39% said improved vision quality has made performing procedures much easier or better. Another 59.4% reported no difference in performing procedures after surgery.

“Overall, refractive surgery in physicians seems to be successful,” Dr. Krueger said. “That is what I thought we would see subjectively. But it is good to know that this demanding physician audience is generally satisfied with their laser vision correction.”

Ronald R. Krueger, MD, MSE

E: Krueger@ccf.org

Dr. Krueger reported no financial conflicts of interest that could affect this study, except for his employment at the Cleveland Clinic as an ophthalmologist and refractive surgeon.

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