SEEING CLEARLY; BEFORE DECIDING ON LASER EYE SURGERY, PUT YOUR FOCUS ON DOCTOR, EQUIPMENT.

Byline: Carol Bidwell Daily News Staff Writer

Four eyes. The class geek. The nerd behind Coke-bottle lenses.

Ian Williams, 31, of Hollywood has felt that way since the third grade - when he got his first pair of glasses.

In college, he tried to chuck that poor self image by trading his glasses for contact lenses. But they were such a bother.

So five years ago, when Williams first heard about laser eye surgery, he began doing research in hopes of tossing his thick specs for good.

Follow Williams' lead, say medical experts. If you're tempted to try new eye-surgery procedures, do your homework first, because it can be a scary and dangerous proposition to pick just any surgeon to operate on your eyes.

Too busy to do the research? The Better Business Bureau and the American Academy of Ophthalmologists will eliminate that excuse.

The BBB recruited Dr. Peter McDonnell, medical director of the USC/Doheny Refractive Laser Medical Center in Los Angeles and one of the top ophthalmological surgeons in the United States, to help make a video explaining refractive eye surgery and telling potential patients what they need to know before having the procedure done.

The tape should be available in most libraries by late May or early June.

``Refractive surgery by laser is a huge emerging market, and we decided that, to prevent any problems, we needed to change people from just being patients to being good consumers,'' said Donald Burkholder, head of BBB Video Productions. The organization has produced how-to videos on a number of subjects, from how to buy a recreational vehicle to how to choose a mechanic to work on your car.

``We found that a lot of people feel like they're insulting doctors by asking them questions,'' Burkholder said. ``They have the God complex: `Whatever the doctor says, I'll do.' ''

But McDonnell says patients who question a doctor about anything - from the price of a procedure to his training to his equipment to his success rate - should get fast, straight answers. If not, he said, they should find another doctor - especially when considering a delicate operation on their eyes.

``You wouldn't leave a car for someone to fix unless you thought the guy you left it with knew what he was doing,'' McDonnell said. ``And I think your eyes are certainly more important than your car.''

Choosing a surgeon wasn't something Williams wanted to do on a whim.

``I wanted to find the right doctor,'' Williams said. ``I wasn't going to have somebody slice open my eyes without checking him out.''

Satisfied with the track record of the USC/Doheny center, which does 300 to 400 of the surgeries per month, Williams chose Dr. William May, the institute's president, to do the procedure he hoped would change his life.

The procedure he used is called LASIK (laser assisted in situ keratomileusis) surgery, where an instrument called a microkeratome is used to cut a thin flap on the cornea's surface so a laser can reshape the cornea.

The surgery would be bloodless, because there are no blood vessels in the cornea, and painless, although he'd feel pressure from several instruments, May told him. Williams knew there were no guarantees, no way to assure he'd have perfect vision after the surgery. He might still have to wear reading glasses, and he was told the surgery might have to be repeated as his eyes change with age. But he was assured that his eyesight - so poor without that he could only see clearly less than 6 inches without his glasses - would improve drastically.

Last week, Williams stretched out in a tiny operating room, ready for surgery at last. After anesthetizing Williams' eyes with drops, May cut two tiny flaps from the surface of each eyeball, then the rat-tat-tat sound of the laser filled the room as a pinpoint beam of light reshaped Williams' corneas.

Forty seconds for the right eye; 40 seconds for the left eye.

Then the flaps were smoothed back into place.

Within five minutes, Williams was reading the tiny letters on an eye chart - without glasses. His vision was a little blurry, but improving by the minute.

``Congratulations!'' May told him. ``You've just seen well enough to pass the California driver's license test. And your vision will only get better for the next two weeks or so.''

``Awesome!'' was all an emotionally exhausted Williams could say. ``Awesome.''

The result of all his homework was finally paying off. Over the years, Williams had checked out a variety of doctors and hospitals, read a virtual library of articles about the surgery and picked one of the most respected hospitals in the country to do the procedure. (Insurance usually doesn't cover the surgery, so Williams' dad offered to help pay the $4,400 bill - $2,200 for each eye.)

Not everybody who's had laser eye surgery has been as lucky as Williams. Based on ads promising perfect vision, many have believed fraudulent or overblown claims, made by doctors who perhaps have not been properly trained to perform the delicate surgery.

A few patients who've trusted the wrong doctors - perhaps well-meaning but using cheap lasers of doubtful accuracy - have gone blind after the surgery. Others have suffered infections and corneal burns that have required cornea transplants.

So blatant were some doctors' claims that the Federal Trade Commission has warned eye surgeons to tone down their advertising (``Throw away your eyeglasses'' and ``Have perfect vision'' are almost always false claims, says the FTC), and the U.S. Food and Drug Administration has cautioned that any lasers operated without FDA approval, or without being part of an FDA-approved clinical trial, will be seized.

Especially dangerous are the unregulated, unapproved ``black box'' lasers, purchased cheaply and imported from overseas, says the FDA. The lasers earned the derogatory term because their strength and precision, both untested, is a mystery.

Although the FDA can regulate the laser equipment itself, it's up to state and national medical boards to crack down on untrained doctors who use lasers improperly, said Michelle Stevens, spokeswoman for the American Academy of Ophthalmologists. And policing all those doctors is becoming a harder job, she said.

``As managed care is cutting into doctors' earnings, (laser surgery) is a way for doctors to make more money,'' she said.

The approved laser USC/Doheny and most other eye centers use costs $550,000, but a ``black box'' laser can be purchased overseas for $80,000, McDonnell said.

And because there's no standard for training for the relatively new surgery, any eye surgeon can buy a laser and start operating on patients' eyes, he said.

``The prospects are scary,'' McDonnell said. ``And if it doesn't seem scary to you, I don't think you're taking this surgery seriously. You have to be careful about self-proclaimed experts. Some of them aren't experts at all.''

Questions to ask about eye surgery

Farsighted? Nearsighted? Have an astigmatism?

You may be a candidate for laser eye surgery.

But before stepping into the operating room, a wise patient who is also a good consumer should ask a prospective surgeon several questions, said Dr. Peter McDonnell, medical director for USC/Doheny Refractive Laser Medical Center in Los Angeles.

How do I find a surgeon?

Ask friends who have had the surgery; ask your family doctor; call the local medical society. Or check out the American Academy of Ophthalmology, at www.eyenet.org, for a list of surgeons in your area. Call the Better Business Bureau at [phone] to find out about a doctor's business history. Call the American Board of Ophthalmology's Board Certification Line at [phone], or check out its Web site at www.certifieddoctor.org to see if he or she is board-certified.

What should I ask a doctor before agreeing to surgery?

Get an eye exam and ask how much your vision would be corrected by surgery. Ask whether you would still have to wear glasses after surgery. Ask him to describe the surgery and any side effects. Ask about fees.

What should I know about the doctor's equipment and training?

Ask if his laser is FDA approved (it should be), how many similar surgeries he has done, what sort of training he has, and whether he participates in ongoing training. Ask what his success rate is (a good success rate would include vastly improved vision in virtually all patients, no cases of blindness and virtually no cases of infection) and how he calculates that success rate.

What about after surgery?

Ask whether there will be follow-up exams and when, what treatments will be given if there are complications, any medication needed afterward, and how long the healing process takes.

- Carol Bidwell

CAPTION(S):

5 Photos

Photo: (1--2--Cover--Color) 20/20 FORESIGHT

Choose laser eye surgeon with care

(3) Ian Williams undergoes the LASIK procedure at the USC/Doheny Refractive Laser Medical Center with surgical technician Tony Perez, left, Dr. William May and surgical technician John Gil-Flamer.

(4) May works on Williams - it takes about 40 seconds to operate on each eye.

(5) His eyes still closed after the surgery, Williams, with May and Perez, knew his vision dramatically improved within the next five minutes. It was expected to get even clearer in the following weeks.

David R. Crane/Daily News

Box: Questions to ask about eye surgery (See text)