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"Superdoctors", marketing hype, or are they really better than average?
Are the doctors with world wide recognition really, somehow, 'better' at their specialty than those not world renowned? How much of their reputation is due to skillful marketing vs. actually being the best of the best?
I owned a small manufacturing business for 14 years, and was a manufacturing manager in the years after. I know the difference between marketing ploys and products that really are the best of the best. How do you tell that difference between eye surgeons? You basically get one chance to do it right. Everything after that is to fix something that didn't go right, or to fix something that wasn't diagnosed as bad at the time.
I've been waffling between (what I call) a superdoctor and a recommended local doctor. Did the research but don't really know which guy is "better". To be honest, I wouldn't even know what to look for - post surgery - to see if the surgery I end up with is "good" or "better" or "best".
What a pickle!
I owned a small manufacturing business for 14 years, and was a manufacturing manager in the years after. I know the difference between marketing ploys and products that really are the best of the best. How do you tell that difference between eye surgeons? You basically get one chance to do it right. Everything after that is to fix something that didn't go right, or to fix something that wasn't diagnosed as bad at the time.
I've been waffling between (what I call) a superdoctor and a recommended local doctor. Did the research but don't really know which guy is "better". To be honest, I wouldn't even know what to look for - post surgery - to see if the surgery I end up with is "good" or "better" or "best".
What a pickle!
Thank you Dr. Hagan. Very, very helpful post.
Is the "ORA intraoperative measurements to validate IOL power" that you mentioned the same thing as the "wave front technology" I posted about?
Is the "ORA intraoperative measurements to validate IOL power" that you mentioned the same thing as the "wave front technology" I posted about?
1 Comments
Wave front technology is imprecise and might be applied to a number of things including IOLs and a type of glasses. This is the link to the ORA tecnology https://www.myalcon.com/products/surgical/ora-system/ Research has not demonstrated this is "better" than regular surgery
Dr. Hagan;
The auto refraction test results by the CT surgeon was:
OS -0.75
OD -11.0
The OD retina has severe macula pucker at this time. A planned ILM peel after IOL implant will, it's hoped, reduce the macula pucker. When the pucker is reduced, the (OD) -11.0 may no longer be valid.
Considering I'll already have had an IOL implant using -11.0 as a baseline, how will the reduced macula pucker (resulting in better uncorrected VA for OD) affect my vision?
Won't, at that time, the IOL be overpowered, in that it was chosen based on auto refraction of -11.0?
And if the IOL is 'overpowered', will that make me far sighted or super farsighted?
The auto refraction test results by the CT surgeon was:
OS -0.75
OD -11.0
The OD retina has severe macula pucker at this time. A planned ILM peel after IOL implant will, it's hoped, reduce the macula pucker. When the pucker is reduced, the (OD) -11.0 may no longer be valid.
Considering I'll already have had an IOL implant using -11.0 as a baseline, how will the reduced macula pucker (resulting in better uncorrected VA for OD) affect my vision?
Won't, at that time, the IOL be overpowered, in that it was chosen based on auto refraction of -11.0?
And if the IOL is 'overpowered', will that make me far sighted or super farsighted?
1 Comments
An ERM (another name for macular pucker) does not affect cataract surgery or how its done. An Autorefraction does not affect your IOL power determination. The -11.0 just indicates the cataract has caused a lot of pseudo-myopia. Dr. MacKool is well known. I believe someone said that he does not accept medicare or insurance (you need to check that out) so for openers its going to be a lot more expensive. Second I mentioned that there is a lot of pressure to "upgrade" ORA intraoperative measurements to validate IOL power is one of those as is femtosecond laser. No studies have shown that femtosecond laser and ORA contribute to a better, safer surgery. More expensive for sure and does significantly improve the miniscule profit/case over what medicare pays. Medicare and insurance pay aboout 50% less now for cataract/IOL surgery than was paid in 1980's when you factor in inflation it's probably more like 1/3. Dentists are paid about 2-4 times for doing a crown than a delicate operation within the eye.
Plus you have the extra expense and travel of going into NYC for the surgery and some "super-surgeons" once the surgery is done don't want any more part of you and tell you to have all your subsequent care done at a local ophthalmologist or optometrist. If I were having cataract surgery on my eye (which I don't need) I would have one of the surgeon's in my group do it. If that wasn't possible there are 5-10 other surgeons in town I would let operate on my eye.
Plus you have the extra expense and travel of going into NYC for the surgery and some "super-surgeons" once the surgery is done don't want any more part of you and tell you to have all your subsequent care done at a local ophthalmologist or optometrist. If I were having cataract surgery on my eye (which I don't need) I would have one of the surgeon's in my group do it. If that wasn't possible there are 5-10 other surgeons in town I would let operate on my eye.
Thank you Dr. Hagan. Exactly what I was looking for. So, peer review contributes to a surgeon's reputation and elevation in status. At the other end of the spectrum are the public relations groups. They "sell the sizzle, not the steak".
I don't know if my condition requires a doctor from the first group, but I sure don't want a doctor from the second group.
Dr. Steve Charles (TN) told me I need an ILM peel, but he can't see through my level 3.0 cataract well enough to do the peel. He said to get the cataract fixed first, then get the ILM peel.
So.....following your previous advice to me on this forum to get two opinions, I got my first opinion from a CT cataract surgeon, Dr. Martin Edwards. He uses IOL Master to measure for IOL, which is what Dr. Charles said should be used due to my severe macula pucker.
Dr. Edwards was recommended by retina specialist Dr. Andrew Packer in CT. Dr. Packer, surprisingly, has at times invited Dr. Steve Charles to lecture here in CT to other retina specialists.
Dr. Edwards, the CT cataract surgeon, said he'd try to make my bad eye (RE) equal to my good eye (LE). My good eye has BCVA 20/20 (Snellen) using -0.50 contact lens. His target is plano to -1.0.
He answered all my questions but didn't really volunteer a whole lot of extra, or extraneous, information. I guess he's capable but without being a surgeon myself, who am I to decide that with only 5 to 10 minutes of conversation?
Now, per your advice, I need a second cataract opinion. Dr. Charles had told me about Dr. Richard J. Mackool in NY. Dr. Mackool uses wave front scanning during surgery. This is claimed to provide the most precise alignment of the IOL. I don't know if Dr. Mackool uses IOL Master.
CBCT on this forum posted that Dr. Mackool explanted two IOLs and gave her different IOLs. CBCT was pleased with the job.
Dr. Mackool is in the first group of surgeons you mentioned; peer reviewed and peer approved. He's your Dale Earnhardt, Jr. Even though I don't have the cataract conditions you mentioned, how does a guy like me know whether he's better off with Earnhardt or not?
As you've said, eye surgery is major surgery. You sorta get one chance only to do it right. I want to make the right choice for that one chance.
Thank you.
I don't know if my condition requires a doctor from the first group, but I sure don't want a doctor from the second group.
Dr. Steve Charles (TN) told me I need an ILM peel, but he can't see through my level 3.0 cataract well enough to do the peel. He said to get the cataract fixed first, then get the ILM peel.
So.....following your previous advice to me on this forum to get two opinions, I got my first opinion from a CT cataract surgeon, Dr. Martin Edwards. He uses IOL Master to measure for IOL, which is what Dr. Charles said should be used due to my severe macula pucker.
Dr. Edwards was recommended by retina specialist Dr. Andrew Packer in CT. Dr. Packer, surprisingly, has at times invited Dr. Steve Charles to lecture here in CT to other retina specialists.
Dr. Edwards, the CT cataract surgeon, said he'd try to make my bad eye (RE) equal to my good eye (LE). My good eye has BCVA 20/20 (Snellen) using -0.50 contact lens. His target is plano to -1.0.
He answered all my questions but didn't really volunteer a whole lot of extra, or extraneous, information. I guess he's capable but without being a surgeon myself, who am I to decide that with only 5 to 10 minutes of conversation?
Now, per your advice, I need a second cataract opinion. Dr. Charles had told me about Dr. Richard J. Mackool in NY. Dr. Mackool uses wave front scanning during surgery. This is claimed to provide the most precise alignment of the IOL. I don't know if Dr. Mackool uses IOL Master.
CBCT on this forum posted that Dr. Mackool explanted two IOLs and gave her different IOLs. CBCT was pleased with the job.
Dr. Mackool is in the first group of surgeons you mentioned; peer reviewed and peer approved. He's your Dale Earnhardt, Jr. Even though I don't have the cataract conditions you mentioned, how does a guy like me know whether he's better off with Earnhardt or not?
As you've said, eye surgery is major surgery. You sorta get one chance only to do it right. I want to make the right choice for that one chance.
Thank you.
Thank you Dr. Hagan, CBCT, and TallahassieLassie for your responses. It's encouraging to hear from you all.
There's something I still don't understand, though. Can anyone tell me why, if all cataract surgeons are equal and if no one needs a Dale Earnhardt Jr, some cataract surgeons are world renowned?
What exactly have they done that warrants them being world renowned?
Should they not be world renowned? Is their reputation the result of judicious advertising? Have they sold the sizzle instead of the steak?
Why is going to a world renowned cataract surgeon no better than going to a local surgeon?
I'm not trying to be flip, condescending, or rude. I'm trying to educate myself so I can make the best possible choice.
There's something I still don't understand, though. Can anyone tell me why, if all cataract surgeons are equal and if no one needs a Dale Earnhardt Jr, some cataract surgeons are world renowned?
What exactly have they done that warrants them being world renowned?
Should they not be world renowned? Is their reputation the result of judicious advertising? Have they sold the sizzle instead of the steak?
Why is going to a world renowned cataract surgeon no better than going to a local surgeon?
I'm not trying to be flip, condescending, or rude. I'm trying to educate myself so I can make the best possible choice.
1 Comments
What makes a surgeon a "supersurgeon" in the minds of his/her peers: brilliance and excellence in developing and teaching new techniques, developing new instruments, going all over the world lecturing to other surgeons, teaching courses for surgeons to learn how to do a new technique, being the surgeon that other surgeons refer difficult cases or difficult patients to for surgery. Current examples would be Robert Osher MD, Cincinnati; Sam Masket MD Los Angeles.
Now there are multi-million dollar publicity machines that gin up the reputation of so-so surgeons and other large practices that show no judgment on who needs surgery and whomever walks in the door they would operate on.
Most cataract cases don't need super surgeons. Some that might: subluxated lens, eye with previous anterior eye trauma, infants and children, posterior polar cataracts with capsule defect.
Now there are multi-million dollar publicity machines that gin up the reputation of so-so surgeons and other large practices that show no judgment on who needs surgery and whomever walks in the door they would operate on.
Most cataract cases don't need super surgeons. Some that might: subluxated lens, eye with previous anterior eye trauma, infants and children, posterior polar cataracts with capsule defect.
Hi, Eye,
I understand what Dr. Hagan means, and I agree that it is "overkill" to get a world-famous surgeon to do anyone's cataract surgery. Why? Because it won't do anything to improve your underlying retinal condition. (You have my sympathy, I'm currently in a similar dilemma, needing cataract surgery, with retinal tear history.) I'm planning to consult a vitreal retinal specialist for an unbiased opinion as to whether it would be safe for me to even have an IOL--they aren't "selling" anything anything, and would probably be the doctor specialist your surgeon ophthalmologist would turn you over to for complications caused by the IOL ( an operation not everyone is suitable for, unfortunately.) Hope this idea is helpful, and best of luck to you.
I understand what Dr. Hagan means, and I agree that it is "overkill" to get a world-famous surgeon to do anyone's cataract surgery. Why? Because it won't do anything to improve your underlying retinal condition. (You have my sympathy, I'm currently in a similar dilemma, needing cataract surgery, with retinal tear history.) I'm planning to consult a vitreal retinal specialist for an unbiased opinion as to whether it would be safe for me to even have an IOL--they aren't "selling" anything anything, and would probably be the doctor specialist your surgeon ophthalmologist would turn you over to for complications caused by the IOL ( an operation not everyone is suitable for, unfortunately.) Hope this idea is helpful, and best of luck to you.
1 Comments
I think you may've meant to say I'm overly complicating cataract surgery, no?
It may seem that way at first glance. However, I have serious, underlying retina issues that warrant my cautions and concerns in choosing a cataract surgeon. And to complicate matters, I received those underlying retina issues from a botched vitrectomy with ERM peel. My vision is forever ruined because the initial surgeon didn't remove all the ERM and then hid that fact from me before he left his solo practice for cancer treatments and died 8 months later...without ever returning to his practice.
These factors combine to make me suspicious, hesitant, and scared to choose the next person I let cut my eye open.
I need as much assurance as possible of my next surgeon's credentials and his or her plans for my eye. In this case, by hiring Earnhardt Jr. for my routine shopping trip, I know beyond all doubt he's more than qualified for the job. Everyone else is suspect.
It may seem that way at first glance. However, I have serious, underlying retina issues that warrant my cautions and concerns in choosing a cataract surgeon. And to complicate matters, I received those underlying retina issues from a botched vitrectomy with ERM peel. My vision is forever ruined because the initial surgeon didn't remove all the ERM and then hid that fact from me before he left his solo practice for cancer treatments and died 8 months later...without ever returning to his practice.
These factors combine to make me suspicious, hesitant, and scared to choose the next person I let cut my eye open.
I need as much assurance as possible of my next surgeon's credentials and his or her plans for my eye. In this case, by hiring Earnhardt Jr. for my routine shopping trip, I know beyond all doubt he's more than qualified for the job. Everyone else is suspect.
1 Comments
Do as you wish.
"Superdoctor" might be the wrong term. The doctor I'm thinking of is very well known. I don't think he advertises on airline magazines or in newspapers.
A more correct version of my question would be found by substituting "internationally regarded" for "superdoctor".
With that said, I repeat my question. How much better are said 'internationally regarded' physicians than the physician with 25 years experience who hasn't promoted himself or worked to gain international recognition?
I guess it's probably an over simplified question where specific questions would be yield better answers. But for the moment, whatever anyone could share would be appreciated.
A more correct version of my question would be found by substituting "internationally regarded" for "superdoctor".
With that said, I repeat my question. How much better are said 'internationally regarded' physicians than the physician with 25 years experience who hasn't promoted himself or worked to gain international recognition?
I guess it's probably an over simplified question where specific questions would be yield better answers. But for the moment, whatever anyone could share would be appreciated.
1 Comments
It is over-simplified especially with regard to cataract/IOL surgery. If you needed someone to drive you to the grocery store you would not need to pay Dale Earnhardt, Jr (top NASCAR driver) to drive your car.
CBCT;
So glad you chirped in! If you're in CT, you're just the person I was looking for. I'm in CT also and need right eye cataract surgery.
Wanted to ask about your experiences with your last cataract surgeon who's a few hours drive from here.
Would you mind contacting me via my private email so I can querry your experiences?
Thank you very much!
So glad you chirped in! If you're in CT, you're just the person I was looking for. I'm in CT also and need right eye cataract surgery.
Wanted to ask about your experiences with your last cataract surgeon who's a few hours drive from here.
Would you mind contacting me via my private email so I can querry your experiences?
Thank you very much!
2 Comments
I left you a message on your medhelp account
This brings to mind the "Super Doctor" ads I see in airline magazines -- lots of hype. Ask your friends and colleagues about their experience with surgeons in your area. If yours is a complex case, you may want to get a second opinion from doctors at a university opthamology department. If you need further consultation or need to correct a complication, you may want to look at Castle Connolly which is a peer nomination and review process. Best wishes.
4 Comments
Castle Connolly is probably the best if you wish a list based on other physicians opinions.
A "super doctor' listing like you find on commercial aircraft my cost over a quarter million dollars.
Make that "may" cost
Yikes!
If a physician's reputation is based on surgical skills, research, kindness and compassion and being invited to teach and lecture other doctors that's fine.
However many "super-doctor" lists are available for the purchase. Pretty much any doctor can pay $25,000 to $50,000 and can be listed in an "infomercial" as best doctor. All in all I think physician and hospital advertising has been detrimental to quality health care.
There are some operations that are so unusual or rare that it takes a very special type of surgeon. However cataract surgery is done almost 4.5 million times/year in the USA and most communities have several highly competent surgeons with complication rates of 1-2%.
Many high volume practices have huge pressure on every patient to "up-charge" by opting for femtosecond laser, premium lens, ORA technology.
However many "super-doctor" lists are available for the purchase. Pretty much any doctor can pay $25,000 to $50,000 and can be listed in an "infomercial" as best doctor. All in all I think physician and hospital advertising has been detrimental to quality health care.
There are some operations that are so unusual or rare that it takes a very special type of surgeon. However cataract surgery is done almost 4.5 million times/year in the USA and most communities have several highly competent surgeons with complication rates of 1-2%.
Many high volume practices have huge pressure on every patient to "up-charge" by opting for femtosecond laser, premium lens, ORA technology.
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