In 1998, when I decided to start performing laser-assisted in situ keratomileusis (LASIK), I knew it would be a natural addition to my practice because I had more than 20 years' experience in ophthalmology and refractive surgery. With such an established practice and a history of patient trust, I was determined to obtain the best training and equipment available.

While credible LASIK programs exist in the United States, I wanted to learn more. Who could teach me? The European LASIK pioneers, of course, because of their long history with the procedure. Luckily, I soon had an opportunity to pursue this idea.

A few months before my family and I planned to vacation in Europe, I started contacting several well-regarded ophthalmologists and asked if any of them would be willing to allow me to visit their practice. I received some very nice responses, but eventually decided on Lucio Buratto, M.D., and Julian Stevens, M.D., two respected LASIK pioneers. Both had re-searched and practiced the procedure for almost 10 years, before it was readily available in the United States.

My first stop was Milan, Italy, where I met Dr. Buratto and learned about his experiences as one of the first doctors in the world to perform LASIK back in 1989.

Dr. Buratto also had extensive experience with earlier procedures similar to LASIK, which go back to the 1970s. A highly efficient man, Dr. Buratto showed me more than 20 years of data on the results of automated lamellar keratoplasty (ALK), an earlier elective refractive surgical procedure similar to LASIK. He reviewed with me the excellent long-term results of his ALK patients. This information was valuable to me because I knew that when I went back to America I could tell my patients about the safety and stability that they could expect from LASIK over an extended period.

After leaving Italy, my next stop was London, where I met Dr. Stevens, who is the head of the excimer laser unit at Moorfields Eye Hospital. Moorfields is the main referral center in the U.K. and is well-known for treating celebrities, such as actress Nicole Kidman and author Frederick Forsyth.

Dr. Stevens is an especially tall gentleman who's very gregarious and freely gives out information. He was one of the developers of the VISX algorithm revisions used to program excimer lasers. Dr. Stevens showed me in detail how the excimer programming he helped to develop maximizes the way corneal tissue is removed in order to achieve the ideal curvature for each patient.

This tied in perfectly with what Dr. Buratto had showed me. If you combine the 20-plus years of success of ALK procedures with the technological advantages of LASIK, any ophthalmologist would be enthusiastic about urging his patients to undergo LASIK.

I encourage you to correspond with other ophthalmologists around the world, especially in Europe and South America, where the latest research is being conducted. While speaking with international doctors at meetings and conferences can be useful, seeing specialists in their own environment is more productive. There's no substitute for firsthand experience.

At the next opportunity, step out of your familiar surroundings to develop your practice. Not only will you benefit from increased expertise, but you'll broaden your professional and personal horizons.

I visited Dr. Buratto and Dr. Stevens again in 1999. But that's a different story, to be told at another time.

CALL John Osborn at (215) 643-8055, E-MAIL to osbornjs@boucher1.com, FAX to 215-643-3902, or WRITE to 1300 Virginia Drive, Suite 400, Ft. Washington, Pa. 19034. Offer a few thoughts, and we'll take care of the rest.