The information below was originally written when we were at TLC, but the information is still very pertinent!
These are commonly asked questions by referring doctors. Check out this page for answers that might help you in your clinical practice.
If you think of a question that might be good for this section, please email us with your suggestions!
Should my patient take out their contact lenses prior to their consultation?
Either way is fine. Some patients do not like going without their contacts, so when they come in for a consultation, we can give them a rough idea of candidacy, and they can proceed from there. Some patients don’t mind removing their contacts for the specified period of time. If that’s the case, when they come in for their consultation, chances are that we will be able to accurately determine candidacy at that visit.
Time out of contacts varies by type of contact lens.
Soft spherical daily wear contact lenses : 2 days before final scans.
Extended wear and soft toric daily wear contact lenses: 1 week before final scans
RGP: discontinued for variable amounts of time. The usual rule of thumb with RGP wear is to discontinue use at 1 month for every decade of wear.
Note patients do not have to remove contacts for a specified period of time prior to your dilation/cyclo MR exam. However, they should not wear contacts to your exam.
Also, note: If your patient is really wanting to have sx ASAP, a huge time saver for them is to have you go ahead and do DFE/cyclo MR before they come in (you can send in the tx sheet then or later) AND to have your patient discontinue contacts according to the above schedule prior to their Holzman Laser Vision consultation. That will allow sx to happen ASAP.
Should I recommend LASIK to my presbyopic patients?
Just like you would not prejudge a patient when they are in your dispensary, you would not prejudge whether or not a patient would like to have refractive surgery. Depending on their individual lifestyles, patients may be willing to use readers in order to gain the freedom of having better distance vision. Additionally, some patients are candidates for monovision correction.
When should I dilate my patient and what drops are used?
Some doctors like to gather all of their patient information and data prior to sending the patient in for consultation. That’s helpful because we have a completed treatment sheet in the chart already. And, if the patient removes contacts ahead of the consultation per the schedule above, it can allow for all testing to be done in one visit. Surgery can be scheduled ASAP in this instance.
However, some doctors like to wait until the patient has been approved as a candidate before doing the dilation. Of course, what you do in what order also depends on the patient's schedule.
Tropicamide 1% is sufficient for most patients.
What is the pre-operative patient regimen for each procedure?
Please see the Documents Section.
Why does Dr. Holzman use Muro128 ointment on some patients?
Check out Dr. Holzman’s article about Muro 128 to find out more. Basically, Dr. Holzman wants to do whatever he can to ensure the best results possible for every patient.
Should I write prescriptions for my patient’s post-operative medications?
We'll write the rx's for the patient, and in most cases, we'll send them to Staywell Pharmacy. They readily stock all of our preferred medications, are knowledgeable regarding PA initiation and application of coupons for best pricing, and will mail all prescriptions to your patient promptly.
However, if you feel like your patient needs to start advanced dry eye therapy ahead of time, you can definitely initiate that therapy prior to their Holzman Laser Vision consultation.
What do I charge a patient for a monovision contact lenses trial?
You should charge whatever you would charge any other patient who wishes to be fit in monovision contact lenses. If we recommend that a patient sees you for a monovision demonstration, we will tell them to expect a contact lens fitting fee for this service.
Where can I get good copies of the Holzman Laser Vision pre-operative form?
Please see the Documents Section.
What kind of lasers does Dr. Holzman use?
The FS200 laser is used to create the flap on LASIK patients.
The EX500 laser is used to resurface the cornea. It can do wavefront-optimized or topography-guided treatments.
Can I observe Dr. Holzman performing actual cases?
Yes, you can! Once the new office is open, you're welcome to join us.
How many surgical procedures has Dr. Holzman performed?
Dr. Holzman has performed over 90,000 procedures.
What is Dr. Holzman’s enhancement rate?
Dr. Holzman’s enhancement rate is 1-2%.
Some patient demographics are more likely to need an enhancement: younger age, high myopia or astigmatism, any hyperopia, or a history of RGP wear.
Will my patient be able to meet directly with Dr. Holzman?
Yes, this can be accomplished in two different ways, depending on your patient preference.
If your patient prefers to meet with Dr. Holzman well ahead of the procedure, we can schedule what we call a “Meet and Greet” for sometime between their consultation visit and surgery date.
If your patient is OK with meeting Dr. Holzman right before their procedure, then no extra visits are required. Dr. Holzman actually meets personally with ALL of his surgical patients right before their procedure. He explains his expectations of the patient during the procedure in order to obtain optimal results.
Dr. Holzman likes to listen to music while performing surgery. May I send him a mixed tape?
Yes, Dr. Holzman will happily accept submissions on any medium such as vinyl, tape, CD, mp3, and other creative media. Dr. Holzman will be grateful for your musical contributions, even if he has his usual comment.
What if I'm not in the office for my patient's one-day post-op?
The Holzman Laser Vision Clinical Staff will be more than happy to see your patient for the one-day post-op then refer them back to you for all other post-operative care. Your co-management fee does not change because of this.
What is the post-operative patient regimen for each procedure?
Please see the Documents Section.
What does the typical patient experience after their procedure?
All patients will naturally experience some degree of dryness, glare/halos, and fluctuating vision while they are healing, regardless of their prescriptions.
Generally, low to moderate myopic and myopic astigmats will see quite well starting almost immediately after surgery. Hyperopic patients should be told that their vision will be blurry initially after surgery and then improve as their eyes heal. Presbyopes should expect to use readers for all intermediate and near vision tasks immediately following their procedure. Those with higher prescriptions will take longer to heal and reach stability.
What should I be monitoring for at each post-op visit?
At the one day visit, be on the lookout for appropriate visual acuities, flap striae, DLK, infection, epithelial defects, and epithelial ingrowth. VA should be pretty darn good, in the 20/20-25 range, especially if the patient had a low-moderate myopic rx with low cyl AND it's been almost 24 hours since the procedure. VA might be slightly blurry, in the 20/30-50 range, if: high myopic rx, moderate-high cyl, hyperopic rx OR if it hasn't been 24 hours of healing yet (example, had surgery at 4 PM the day before and being seen at 9 AM the next day). If VA not as expected, you need to r/o SPK, DLK, striae, infiltrate! Remember to document these pertinent negatives.
At the one week visit, be on the lookout for the same things. A pressure check should be done. VA should be a more solid 20/20-25 range for most everyone OR making forward progress compared to last week's VA.
For one month and onward, be sure to refract your patient and include that info in your post-op report. We use that info to track our numbers. Look for greater stability of vision and comfort. The patient should always be making progress.
At the one day visit, inquire about pain levels, check the cornea to make sure that there are no signs of infection, and make sure the BCL moves adequately. Remind them at their pain and vision are likely to get slightly worse over the next few days before getting better. Cycloplege if photosensitive. Remind patients to use cold compresses and drops to control discomfort. Avoid the comfort drop if at all possible because overuse can delay healing. VA should be blurry, in the 20/50-100 range, regardless of surgery time compared to one day post-op time.
At the 4- or 5-day visit, check for signs of infection and remove the BCL if the epithelium is healed appropriately. Your patient may still experience some discomfort that day. Educate them to HYPERLUBRICATE still! Remove BCL with forceps whenever possible because this is the most gentle on the epithelium. If you do not have forceps, then you should have your patient look up, touch inferior edge of BCL, slide down, and then pinch off the conjunctiva - NOT off the cornea! VA should be in the 20/30-50 range.
If the epithelium is not completely healed or you are unsure if it is completely healed, keep the BCL on and have your patient return in 1-2 days for re-check.
At the 11-14 day visit, ensure that the epithelium is stable and check pressures. VA should be 20/25-30 range.
At the one month visit, VA should be in the 20/20-25 range. You should refract your patient. Refracting any sooner will give you crazy results with lots of cyl which will cause unnecessary heartbreak. Make sure that there are no signs of developing corneal haze. Also, look for greater stability of vision and comfort. The patient should always be making progress.
If you have ANY questions at ANY time, feel free to contact us.
Where can I get good copies of the TLC post-operative form?
Please see the Documents Section.
Does anyone really look at the copies of my post-op forms that I fax in?
Yes, every form is reviewed. We use your information to better monitor our refractive goals. Beginning at one month, UCVA, refractions, and BCVA, combined with pre-operative data, go into data banks to build nomograms specific for our Center. Without this important information that only you can provide, we would not be able to ensure accurate results for future patients!
When you send in your post-op results, use the most current post-op form. Every blank on the form is "pertinent" so it would be ideal to have a completed post-op form for each visit.
Why wasn’t my patient immediately sent back to me after their procedure?
On the extremely rare occasion that surgical complications are encountered or if the patient requests to be seen at our center for a specified period of time, we will prefer that patients return to Holzman Laser Vision for post-operative care. We will do our best to notify you promptly if these unplanned changes occur. When they are released from our care, they will be promptly returned to your office for all further post-operative (without any changes to your co-mx fees) and comprehensive eye care.
How do I manage the post-op BCL?
Timing of removal depends on the procedure. If the flap looks clear on a LASIK patient, you can remove the BCL on the one-day post-op check. If you are unsure, it is OK to keep the BCL on for an additional day or two and have the patient return for recheck/removal. If the patient is having PRK, the BCL usually is not ready for removal until day 3-5 post-op. If you are unsure, it is OK to keep the BCL on for an additional day or two and have the patient return for recheck/removal.
Removal of the BCL might best accomplished using sterilized tweezers after instillation of one drop of artificial tear. The drop helps to float the BCL which minimizes epithelial damage upon removal. Tweezers ensure minimal disruption of the still delicate epithelium. Plus, it’s fun to break out your foreign body kit.
Some practitioners remove BCLs with their fingers like they would for any other patient. Dr. Holzman says that this OK, assuming you can slide the BCL inferior enough that it is sitting on the conjunctiva when you grasp it.
Recheck the epithelium AFTER removal. Throw in a drop of Celluvisc after removal, and start a short course of Muro128 ung qhs for PRK patients.
Tell your patients to expect some discomfort or FBS for the balance of the day when the BCL is removed.
How much does all laser LASIK cost at Holzman Laser Vision?
While costs differ based on the patient’s insurance and potential employer contributions, generally it is best to tell your patients that the all laser procedure will cost $5490. This global fee includes the patient's pre-operative, operative, and post-operative care for one year after the surgical date.
Quoting this fee for patients while they are in your office helps us out a lot. When patients know this fee coming into our office, they don't get "sticker shock" when our staff discusses financial aspects of refractive surgery.
Is there a cost difference between LASIK and PRK?
No, there is no cost difference between the two procedures.
Is the Lifetime Commitment available to all patients?
How much is my co-management fee?
You should discuss co-management fees directly with Holzman Laser Vision staff.
What happens to my co-mx fee if I don't manage the entire post-op period?
Your co-management fee is not affected should we keep your patient during their initial post-operative period or should you return your patient to us for consultation at any time during the post-operative period.
If you ever have a question about a patient’s post-operative status or progress, feel free to contact us about your concerns or send the patient back to us for consultation. Most patients will not mind returning to Holzman Laser Vision for consultation since they have already been here before.
How does using FSA funds benefit my patients?
Using FSA funds allows the patient to use pre-tax dollars to pay for their procedure. That is like a 20-30% cost savings to the patient!
As of 2013, the amount of maximum FSA allowed is $2500.
When is the best time for a consultation if my patient will be using FSA?
The usual last-minute FSA eligibility consultation rush is between October-December. It would be most ideal to have your patient come in August-October to ensure that they are able to discuss their case with us at a normal, non-rushed pace.
Can my patients get financing to help pay for their procedure?
Yes, this will be discussed at their initial visit.
What do I do when my patient wants to shop around for better pricing?
Your single recommendation means quite a bit to patients … and to us! When you express that you have consistently worked closely with Holzman Laser Vision and Dr. Holzman, patients feel secure. Also reference reasons why you have been referring to us for so many years.
Other places might offer lower fees, but as with all things, you get what you pay for. Comparing our service levels with that of other places is sometimes like comparing apples to oranges.
I have a question about ___. Should I contact Holzman Laser Vision for the answer?
Yes, always feel free to contact us about anything related to your patient.
How do I become a Holzman Laser Vision Partner?
It's easy! Contact Holzman Laser Vision staff.
How do I maintain my Holzman Laser Vision Partner status?
You must refer at least one patient that completes a surgical procedure during the year.
Do you provide a translator for my patients who do not speak English?
Some of your Holzman Laser Vision staff members speak other languages besides English. While we do not claim to be fluent, here is a list of who can speak what proficiently:
Dr. Weigel: Mandarin Chinese, Spanish (conversational)
Alina: Russian, Turkish
Melissa: Spanish (fluent)
If your patient is hearing impaired or deaf, we must know about this ahead of time. If given enough lead time, we might be able to arrange for an interpreter. If the patient can bring their own interpreter, the interpreter would ideally be able to communicate verbally with us.
Is yearly dilation required for Lifetime Commitment plan?
The Lifetime Commitment does not explicitly state that a patient must have a dilation at every annual examination. Holzman Laser Vision relies on your clinical judgment as to whether a dilation is necessary.