1. How long have you been performing
refractive surgery? Not less than three
years.
Dr. Siems has been performing refractive
surgery for over 10 years.
2. How many refractive procedures
have you performed total, excluding
mechanical surgeries like RK, ALK, and
AK? Not less than 500.
Dr. Siems has performed over 46,000
refractive surgical procedures.
3. How many refractive procedures
have you performed in the last 12 months?
Not less than 250.
Dr. Siems has preformed over 5000
Lasik procedures in this past year.
4. How many refractive procedures
of the exact type you intend to use
for me, with the same equipment, and
the same refractive error, have you
performed? Not less than 100.
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Using the most advanced technology
available, Dr. Siems performs
over 400 procedures each month. |
5. Approximately what percent of
your refractive surgery patients receive
Snellen Uncorrected Visual Acuity (UCVA)
of 20/40 or better? According to our
Quality Standards Advisory Committee
(QSAC), about 90% is the norm.
99% of Dr. Siems' patients have
20/40 or better.
6. Approximately what percent of
your refractive surgery patients receive
UCVA of 20/20 or better? About 50% is
the norm according to QSAC. If you have
high myopia, high hyperopia, and/or
high astigmatism expect the probability
of achieving uncorrected 20/20 to be
lower.
96-97% of Dr. Siems'patients have
20/20 or better.
7. What percent of your refractive
surgery patients report unresolved complications
six months after surgery? Less than
3% is the norm according to QSAC.
Less than 1% of Dr. Siems' patients have
unresolved complications after 6 months.
8. What percentage of refractive
surgery candidates do you decline? Don't
be surprised if a solid number isn't
readily available. The only wrong answer
would be "none".
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Dr. Siems has safely performed
Lasik surgery on hundreds of patients
who had been deemed non-lasik
candidates at other lasik centers. |
This is made possible because all the
Siems Advanced Lasik & Eye Centers
use the most advanced technology available
today. Siems Centers also offer a variety
of solutions for patients who are not
lasik candidates such as, Lensectomy,
Intacts, ICL, and Corneal Transplants.
As a direct result of these additional
services, very few patients are unable
to benefit from type of surgery.
9. Have you had a successful refractive
surgery malpractice claim of greater
than $30,000? Not more than one for
every 500 refractive surgeries. That's
a 99.5% success rate. Not more than
five in the last five years, even if
the doctor has performed tens of thousands
of surgeries. Discuss with the doctor
the circumstances of any malpractice
case. Consider how they were handled
and how the circumstances may apply
to you.
While at Siems Advanced Lasik Centers,
Dr. Siems has never had a claim brought
against him for refractive surgery.
10. Will you perform a wavefront
technology diagnostic (not wavefront
guided ablation) of my higher order
aberrations prior to recommending refractive
surgery? The answer should be yes as
this is a very important evaluation,
however not every doctor has the equipment
to perform this test. Remember that
this question is about a wavefront diagnostic
evaluation preoperatively, not about
wavefront guided laser ablation.
Not only does Dr. Siems perform Wavefront
diagnostics on every lasik patient,
he has three separate wavescans available
to measure each patient.
11. What percentage of your pervious
patients has had enhancement surgery?
Less than ten percent is a ballpark
number but the "why" is much
more important than the percent. The
doctor should explain his/her philosophy
on enhancement.
Several factors influence the need for
enhancements; the level of prescription,
age, and the type of treatment performed
(hyperopic vs myopic).
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Enhancement rates vary to as
low as 3% for young myopes with
moderate correction, to over 50%
for older patients who have high
levels of hyperopia. |
In general, patients are monitored
for 3 - 6 months prior to performing
any supplemental procedure. Monitoring
includes noting any visual changes,
performing diagnostic testing, and
reviewing the risks and benefits of
an enhancement procedure with each
individual patient.
12. What is the worst refractive
surgery outcome experienced by your
own patient? How was it handled? You
want a doctor who knows how to get you
out of harms way if something unusual
occurs. You want a doctor that is cool
under fire and is willing to work with
other ophthalmologists who may have
specific expertise outside of your doctor's
realm of experience. All doctors with
enough surgical experience have had
a poor outcome. You need to feel comfortable
that this particular doctor can handle
problems appropriately. If your doctor
says s/he has never had a poor outcome
or a problem, politely excuse yourself
to the nearest exit.
Adverse outcomes are possible. We
use the most advanced technology available
to minimize the incidence of adverse
outcomes. No patient from the Siems
Advanced Lasik Center has required a
referral to another center for additional
care.
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13. If you intend to use an excimer
laser, is it broadbeam, variable spot,
or flying spot? The type of laser beam
may be very important or may mean very
little, depending upon your individual
circumstances. All good doctors understand
the limitations of their tools and techniques
and will not perform surgery (no matter
what the laser) if there is not a high
probability of you receiving a good
outcome.
Dr. Siems uses the following flying
spot lasers: B&L Technolas, Alcon
Ladarvision, and the variable spot laser
Visx Star4.
14. Have you ever had malpractice
insurance coverage denied? Answer should
be no.
Dr. Siems has never had a denial in his
malpractice coverage.
15. Are you currently under investigation
by the agency that provides the license
that allows you to perform refractive
surgery? Has this license ever been
revoked, suspended, or otherwise restricted?
Are you on any sort of license probation.
Generally, the answer should be no,
but if there are any licensing concerns,
consider the circumstances. Discuss
any licensure issues with the doctor
and come to your own conclusion about
disqualification as a potential doctor.
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Dr. Siems has never been under
investigation by the agency that
provides the license that allows
him to perform refractive surgery. |
16. Have you ever had hospital or
surgical facility privileges revoked?
Answer should be no.
Dr. Siems has never had hospital or surgical
facility privileges revoked.
17. Have you ever had your Drug Enforcement
Agency (DEA) certification revoked,
suspended, or otherwise restricted?
Answer should be no.
Dr. Siems has never had his Drug Enforcement
Agency (DEA) certification revoked,
suspended, or otherwise restricted.
18. Have you ever been convicted
of a felony? Generally, the answer should
be no, but discuss the circumstances
and come to your own conclusion about
disqualification as a potential doctor.
A problem 20 years ago when a college
student may not be germane to today.
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Dr. Siems has never been convicted
of a felony. |
19. Have you ever been arrested for
being under the influence of, or in
the possession of, any controlled substance?
Generally, the answer should be no,
but discuss the circumstances and come
to your own conclusion about disqualification
as a potential doctor. A problem 20
years ago when a college student may
not be germane to today.
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Dr. Siems has never been arrested
for being under the influence
of, or in the possession of, any
controlled substance. |
20. Have you ever been treated for
substance abuse or mental illness as
an adult? Generally, the answer should
be no, but discuss the circumstances
and come to your own conclusion about
disqualification as a potential doctor.
A problem 20 years ago when a college
student may not be germane to today.
Dr. Siems has never been treated for
substance abuse or mental illness.
21. Have your ever been refused participation
as a provider in a health insurance
plan? Answer should be no, except in
the case of managed care, which excludes
doctors for reasons other than medical
competency.
Dr. Siems has never been refused participation
as a provider in a health insurance
plan
22. Is the laser and equipment you
will use specifically approved by the
Food and Drug Administration (FDA) for
the recommended procedure and intended
parameters? If no, explain why it is
not FDA approved and/or off-label use.
The equipment should be FDA approved
(hardware and software). The parameters
may not be FDA approved. Surgeons are
legally able to use FDA approved tools
beyond FDA approved parameters in some
circumstances. This is called off-label
use and should be discussed with your
doctor if applicable to your circumstances.
All of Dr. Siems' lasers and equipment
are FDA approved. A separate consent
is obtained from patients if an off-label
use of FDA approved technology is contemplated.
23. If an enhancement surgery is
required, what will you charge for the
additional procedure? Answer should
be no charge for an enhancement within
a specified period of time, usually
about a year after surgery.
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Within the first year, there
are no fee's charged by Dr. Siems.
There is a small operational fee
that is charged by the laser manufacturer. |
24. If another doctor will be co
managing pre- and/or postoperative care,
can I see you at any time without my
co managing doctor's authorization?
The answer should be yes. You should
be able to go directly to the doctor
at any time you feel it is appropriate.
Dr. Siems' office is always happy to
schedule an appointment for you regardless
of who is treating or caring for you
postoperatively.
25. What should I expect my vision
to be like for the first few weeks after
surgery? The answer should include an
explanation of minor fluctuations, regression,
minor halos, minor star bursting, etc.
Most patients notice a substantial improvement
in their vision within the first few
days following surgery. Normally vision
will fluctuate for the first 4 to 6
weeks. Healing time varies, but generally
it takes a little longer for higher
prescriptions. Glares and Halos may
be present for short period of time;
however, generally these diminish as
the eye(s) continue to heal.
26. Will you perform a complete refractive
examination including evaluating the
medical health of my eyes both before
and after surgery? The answer should
be an unqualified yes.
Yes, All Dr. Siems' patients receive
a comprehensive exam.
27. Will my vision fluctuate after
surgery? How long is the healing period?
If the doctor says, "Twenty minutes
and all will be fine" you may want
to move on. Refractive surgery is more
of a six-month process than a 20-Minute
Miracle even though it is possible you
will have perfect vision immediately
after surgery.
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Your vision will fluctuate for
the first 4 to 6 weeks. Healing
time will depend on your prescription
before surgery. |
28. Will you perform a contrast sensitivity
test before and after the surgery? The
answer will probably be no, but should
be yes.
Dr. Siems does not perform contrast
sensitivity testing on all patients.
Dr. Siems does not agree with the protocol
of testing all patients.
29. Will you perform a glare sensitivity
test before and after the surgery? The
answer will probably be no, but should
be yes.
Dr. Siems does perform glare sensitivity
testing on patients he deems to be at
risk.
30. Will you perform corneal topography
before and after the surgery? The answer
should be yes.
Dr. Siems performs a corneal topography
on every patient before and several
times post-operatively.
31. If you recommend Lasik, will
you use a laser to create the flap or
a mechanical microkeratome? The femtosecond
laser (Intralase) may be a better alternative
than a flap created with a blade, however
not many doctors have this equipment
and it is not always be required.
Dr. Siems uses the Intralase laser exclusively
on all Lasik patients. He is one of
the first refractive surgeons in the
US to integrate this technology into
his practice. He remains one of the
most experienced Intralase surgeons
in the world.
32. Will you perform a test to determine
tear volume (Schirmer) and tear breakup
test (TBUT) prior to making a recommendation
about surgery? Answer should be yes.
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Dr. Siems only performs a Schirmer
test on those patients that he
suspects have a significant dry
eye problem. |
33. Will you measure the size of
my pupils when naturally dilated in
a dimly lit room prior to making a recommendation
about surgery? The answer must be yes.
Dr. Siems measures pupil size in a dimly
lit room and under bright light conditions.
34. Will you use a different microkeratome
blade (Lasik only) for each eye? The
answer may be yes, but many doctors
use one blade for both patients' eyes.
Dr. Siems uses Intralase to create the
flap, there is no blade that ever touches
the eye.
35. Will you require me to be without
contacts for a period of time before
the examination that will determine
final calculations for surgery? What
is this period of time? The answer must
be yes and for a significant period
of time.
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Dr. Siems generally requires
a minimum of 4 days for soft contact
lenses to 6 weeks for hard contact
lenses. |
36. Will my treatment prescription
be based on cyclopegic refractive error
as well as manifest refractive error?
The answer must be yes.
Dr. Siems has equipment that provides
both a manifest and cycloplegic refraction.
Generally, if the refraction is done
properly, the results are very similar.
37. Will you measure the thickness
of my cornea prior to making a recommendation
about surgery? The answer should be
yes.
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Dr. Siems measures the corneal
thickness of every patient. |
38. If an excimer laser is to be
used, what size will be the optical
ablation zone not including the transition
zone? Is this larger or smaller than
my naturally dilated pupil? If the answer
is less than 6.0mm or less than the
size of your naturally dilated pupils
(whichever is greater), ask for a clarification
and discuss additional risks for low
light aberrations such as halos, starbursts,
glare, etc.
Dr. Siems bases each ablation zone on
the pupil size, correction, and corneal
thickness of each patient.
39. Is a patient with more than ten
diopters myopia, more than three diopters
hyperopia, or more than two diopters
astigmatism a good candidate for refractive
surgery? The answer must not be ideal,
excellent, or anything of the like.
Dr. Siems feels that although these
patients may not be "ideal"
candidates, they may still benefit considerably
from the surgery. The chance of needing
an enhancement is considerably higher
with these patients. A thorough evaluation
will outline the possibilities and options
for each patient.
40. How often and when will you perform
postoperative examinations? The answer
should be not less than the day after
surgery, one week, 30 days, 90 days,
and six months - or more if required.
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Dr. Siems follows this same standard
for his patients follow up care. |
41. When will you provide me with
a copy of your written informed consent?
The doctor should offer to provide a
copy immediately upon asking this question.
All patients are provided with a copy
of informed consent and are instructed
to take it home to thoroughly review
it before surgery.
42. Will you provide contacts for
me to wear to simulate monovision prior
to surgery? How long will you want me
to wear these contacts before I make
my decision about monovision? Contacts
should be provided free with at least
four weeks wearing time before monovision
decision must be made.
Dr. Siems will provide contacts upon
request.
43. Will you provide me the names
and contact information of at least
ten previous patients who have had the
exact same surgery with similar refractive
error? Answer should be yes.
Our facility has been constructed with
a viewing. Anyone wishing to view a
surgery is more than welcome.
44. Will you allow me to observe
a surgery? Answer should be yes.
All the surgeries in our practice can
be viewed at any time. We constructed
our facility with this in mind.
45. Do my occupation, leisure activities,
and hobbies have any bearing on my candidacy
for refractive surgery? Answer should
be yes.
Dr. Siems evaluates each patient occupation,
hobbies, and lifestyle to calculate
the best treatment for each patient.
46. Does my general medical and medication
history have any bearing on my candidacy
for refractive surgery? Answer should
be yes.
Dr. Siems takes a complete medical history
on all patients.
47. Does being pregnant or contemplating
pregnancy have any bearing on my candidacy
for refractive surgery? Okay guys, you
don't get asked this one but all women
of child bearing age should be asked.
Fluctuations in refractive error are
often related to pregnancy and lactation.
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In some instances, pregnancy can
have an effect on refractive error. |
48. Who will pay for multiple corrective
lenses if I experience fluctuation in
visual acuity while healing? Whatever
the answer, consider this as a part
of the cost of the surgery.
Dr. Siems generally prefers to use contact
lenses for patients who are fluctuating
after surgery. However, an eyeglass
prescription will be provided upon request.
49. Are there any reasons why I would
not have excellent refractive surgery
results? A blanket question to provide
you and your doctor an opportunity to
discuss in more detail what you can
reasonably expect from the proposed
surgery. If you cannot reasonably expect
to receive what you consider to be a
successful result, don't have surgery.
Prior to surgery, Dr. Siems will review
surgery options and possible outcomes
with each patient.
50. What certification do you hold,
if any, from the American Board of Ophthalmology,
American Board of Eye Surgery, and/or
the Council for Refractive Surgery Quality
Assurance? If not all, why? It may be
important for you to know if the doctor
desires the additional oversight of
these organizations. Some are more valuable
than others
The American Board of Ophthalmology
(ABO) does not provide any evaluation
specific to refractive surgery. Certification
is valid for a lifetime, or 10 years
if recently certified. ABO certification
would be conspicuous by its absence,
but not terribly important by its
presence.
The American Board of Eye Surgery
(ABES) is an ophthalmic group that
provides procedure specific certification.
They do have peer-reviewed certification
for Lasik, and RK, but not PRK, LASEK,
CK, LTK or any other refractive procedure.
ABES Lasik certification is valid
for seven years.
The Council for Refractive Surgery
Quality Assurance (CRSQA) is a nonprofit
consumer/patient organization that
evaluates a doctor based upon actual
patient outcomes. The doctor is reevaluated
every three months.
Consider the relevance and value
of these and other certifications
the doctor may have achieved.
Dr. Siems is a board certified ophthalmologist.
He studied and trained at the highly
regarded Kellogg Eye Center at the
University of Michigan. Dr. Siems is
not a member of a professional organization;
he feels that the skills and training
of a surgeon are far more important
than being a member of a nebulous
group.
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