Next-generation excimer lasers pose some challenging practice management questions. If you have a broad beam laser, can you compete with practices offering flying spot technology? What if your laser lacks an eye tracker? Do you have to upgrade to maintain or grow your refractive practice? As the marketing of the latest technology heats up, the need to make sound decisions regarding acquisition of a newer-generation excimer will become even more pressing.

Add to that the growing number of discount LASIK shops and how the escalating price wars will make it more difficult to maintain current co-management arrangements, and it's easy to feel the weight of these decisions.

To help you decide what's right for your practice, we focused this month's cover story on eye tracking during the LASIK procedure -- one of the tools and technologies key to next-generation lasers and their ability to make custom ablation a reality. There are plenty of issues to think about, from how the technology works to how dependent you want to be on automation to whether or not you even have a choice if you plan to remain a cutting-edge refractive surgeon. Our report (which begins on page 38) contains the insights of several surgeons who use one of the currently available trackers or have had experience with one of the several in development.

We shouldn't be threatened by these advances, but rather challenged and encouraged. Once understood, they'll enable us to enhance the safety of our procedures and the visual outcomes for our patients.

This, of course, goes hand-in-hand with having extremely satisfied patients -- the kind who love to refer friends for the same excellent care.

So read well, get the facts, and as my Latin teacher used to say, "caveat emptor!"