"USAEyes.org Certified Lasik Doctor Candidates – There are approximately 17,000 ophthalmologists in the US. Additionally, there are approximately 480 optometrists in states that allow optometrists to perform some types of refractive surgery."

           Source: www.usaeyes.org/lasik/faq/about.htm
 

The statement implies that USAEYES has many thousands of members. However, there are in fact about 30+ surgeons who are members of USAEYES.  The USAEYES.org web site is designed to obfuscate this fact, but if you click through every link on the site you can only find about 35 surgeons.
 

"It is the purpose of CRSQA to help patients identify the better refractive surgeons. There is no better way to accomplish this than for CRSQA Certified Lasik Surgeons to display the Quality Verified logo and announce that they have been evaluated by an independent patient/consumer organization and achieved its approval. Use of the Quality Verified logo is encouraged in all advertisements, brochures, and presentations."

           Source: www.usaeyes.org/faq/certification_request.htm

"You can be confident that a USAEyes.org Certified Lasik Doctor is one of the best refractive surgeons available."

           Source: www.usaeyes.org/faq/subjects/certified.htm
  

1. USAEYES certification standards are below the standard of care as evidenced by published FDA clinical trials. Therefore, no evidence exists that USAEYES surgeons are better than non-certified surgeons.
   
   Upon careful examination of the requirements for certification, it is evident that the efficacy requirements actually fall far below today’s standards and results achieved in FDA clinical trials completed in 2002 and 2003. Here is an example of surgical outcomes requirements from the USAEYES.org website:

   "Not less than 90% of applicant's refractive surgery patients must achieve Snellen 20/40 Uncorrected Visual Acuity (UCVA) or better in each surgical eye. Not less than 50% of applicant's refractive surgery patients must achieve Snellen 20/20 UCVA or better in each surgical eye."
   
              Source: http://www.usaeyes.org/faq/subjects/outcomes_requirements.htm

   In comparison, at 6 months post-op, 99.4% of eyes enrolled in the Bausch & Lomb Zyoptix clinical trials achieved UCVA of 20/40 or better and 91.5% achieved UCVA of 20/20 or better.
   
              Source: www.fda.gov/cdrh/pdf/P990027S006b.pdf
   
   Similarly, six month post-operative UCVA data from the VISX STAR S4 WaveFront System shows that 99.6% of eyes achieved 20/40 or better and 93.9% achieved 20/20 or better.
   
              Source: www.fda.gov/cdrh/pdf/P930016s016b.pdf
   
   The Alcon LADARVision 4000 wavefront-guided LASIK trials resulted in 98.6% of eyes with UCVA of 20/40 or better and 79.9% with 20/20 or better.
   
              Source: www.fda.gov/cdrh/pdf/P970043S010b.pdf
   
   These lasers represent the vast majority of lasers in use for refractive surgery in the United States today. USAEYES’ UCVA standards for certification are similar to outcomes seen with obsolete, first-generation laser technology from the late 1990s. Clearly the surgical outcome requirements are not superior, yet USAEYES issues a meritless "certification" to a surgeon who pays a fee for use of the logo, which is then used by the surgeon in the advertisement and promotion of LASIK surgery. This misleads patients into believing they are choosing one of the best when in reality the certification is nothing more than a gimmick for the promotion and marketing of LASIK.

2. Lack of adequate sampling to sustain claims
   
   USAEYES requires data from 125 patients for initial certification and again every other fiscal year for re-certification. This represents a very small percentage of patients in a busy refractive surgery practice. The audit procedures state that a surgeon;

   "may be requested to provide patient chart information when requested, not more than ten charts per fiscal year, and onsite audits are normally performed every 18 months, however may be performed more or less often at CRSQA's discretion."
   
              Source: http://www.usaeyes.org/faq/certification_request.htm

   These certification and audit procedures are too limited to represent the overall outcomes of even a small practice, and the standards are too loose to ensure that surgeons have demonstrated superior outcomes.

3. USAEYES makes claims made in the absence of consensual, scientific standards.
   
   Regarding complications and adverse events, the organization states the following requirements for certification:

   "Not more than 3% of applicant's monitored refractive surgery patients may report debilitating refractive surgery complications such as glare, haze, halo, etc."
   
              Source: http://www.usaeyes.org/faq/certification_request.htm

   These terms are vague and there is no consensus among refractive surgeons as to their meaning. It is known that reduced visual quality in dim light (starbursts, halos) occurs frequently after LASIK. The term "glare" is misused. Prior to laser eye surgery a prospective patient understands the word "glare" to mean "an intense, blinding light". Post-LASIK "glare" is not actually glare – it is a degraded retinal image induced by the laser treatment where the peripheral cornea refracts light differently than the central cornea. The word "debilitating" is also not defined and there is no distinction between a complication that is debilitating and one that is not. Until the industry can agree upon standardized terms and objective tests to quantify loss of visual quality and complications, USAEYES cannot demonstrate consistency with recording and reporting of these complications. Therefore, to state that a USAEYES certified surgeon’s complication rate is 3% or less is misleading and unsubstantiated.

4. USAEYES uses inadequate sampling methods to substantiate it’s claims
   
   Claims aimed at patients, such as "patient satisfaction surveys are evaluated every fiscal quarter" are internally inconsistent with other statements on the web site aimed at recruiting doctors such as, "we do not contact the patients directly" and "after initial certification, each quarter CRSQA will evaluate any patient complaints or patient satisfaction surveys as an indication if additional investigation is warranted."
   
              Source: http://www.usaeyes.org/faq/subjects/certified.htm and http://www.usaeyes.org/faq/certification_request.htm
   
   The statement aimed at patients is deliberately misleading as there are apparently no tight controls or procedures to ensure the gathering and submission of satisfaction surveys. Essentially it appears the doctors are monitoring themselves.