20 Questions to Consider While Researching LASIK: We have provided important questions below, along with answers from our surgeons, should you contact other laser vision correction providers while researching the procedure.
- Is LASIK Right for Me?
- Are You Qualified to Be My Surgeon?
- Do You Use State-of-the-Art LASIK Technology?
- How Safe Is LASIK?
- What Results and Follow-Up Can I Expect?
Is LASIK Right for Me?
1. Am I a good candidate for laser vision correction and how does your evaluation differ from other evaluations?
To answer the first part of that question adequately, we start with a free, initial consultation here in our office, with the surgeon of your choice. At this appointment, we perform a series of diagnostic tests to assess your candidacy for laser vision correction. We will also see you for additional preoperative appointments before surgery. Over the course of these visits, your eyes will be scanned by several diagnostic instruments and our doctors will perform a dilated retinal examination to assess your ocular health.
We will also perform our exclusive Pentacam scan (detailed in question 11) and your surgeon will review the results with you. Consideration will be given to how you use your eyes in the course of a typical workday, what your visual needs are in your leisure time and most importantly, what you hope to gain from laser vision correction. A responsible and conscientious recommendation must take into consideration your individual situation and your unique needs.
Evaluations at other centers can differ substantially from the procedures just described. Evaluations at other centers are typically done by a technician or staff member and sometimes by an optometrist. At most high-volume centers, you don’t meet your surgeon until minutes before your actual surgery (as discussed in some detail in question 5). Many patients report they have been told they are good candidates for surgery at some other center. Often that candidacy is based on their ability to pay for the surgery, rather than their suitability for the procedure.
Our comprehensive consultation and preoperative appointments will include some familiar tests: refraction, pupil exam, eye motility exam, confrontational visual field, slit lamp exam, intraocular pressure and dilation.
In addition to these familiar tests, we routinely provide other examinations for potential laser vision correction patients. These examinations include the Pentacam scan, corneal thickness measurements, corneal curvature measurements using sophisticated corneal and eye mapping devices, and analysis of any unique abnormalities in vision.
All these data are gathered and analyzed during your preoperative visits. The data are then carefully correlated with a comprehensive history of how you use your eyes during a typical day. We also determine what your visual needs are during relaxation and recreational times, as well as your expectations regarding laser vision correction. All that information is then evaluated in a personal consultation with your surgeon, who together with your input uses their expertise to advise you whether laser vision correction represents an appropriate choice for your eyes and your needs.
The collection of data usually requires a surgery patient to return to our office for more than one visit. In this way, we can compare data from various tests, until the most accurate repeatable data have been collected. Then and only then can an accurate calculation be performed and an individual program be designed to correct your vision. Anything less is nothing more than generic laser vision correction surgery, also known as "plug and play" laser vision correction.
Your consultation represents an important step in determining the suitability of laser vision surgery for you. The consultation also serves the purpose of helping you feel comfortable with the particular surgeon you designate. We have seen a number of laser vision correction surgeons, surgery mills and corporate chains come and go. We have no doubt that we will see more come and go. Often these chains will even hire the surgeon from a corporate chain that previously failed in the same geographic area. There will be more bait-and-switch pricing schemes, more tier pricing, where every little thing costs more. There will be more "closers," trying to find a trusting patient's "price point" for laser vision correction surgery. There will be more phony lifetime guarantees and cleverly disguised disclaimers, also known as 20/40 or 20/30 waivers (see question 4). There will be more people trying to commoditize laser vision correction surgery. It’s important to bear in mind that you are not buying a television. If you don't like the picture, you can't return your eyes.
For all these reasons, we don’t take your consultation lightly — and neither should you.
2. What qualifies a patient for Custom LASIK?
Custom LASIK is one of the latest advances in laser vision correction. Aside from being nearsighted, farsighted and astigmatic in various combinations, we all have some unique imperfections with regard to the way our eyes bend light. No two eyes or patients have the same identical set of imperfections. We use the latest technology from Alcon (WaveLight EX500) and only offer Custom LASIK for every patient. In other LASIK centers (many using different laser platforms like Visx/AMO) custom treatments are optional.
3. I’ve seen the ads with the low prices. Will I get that price?
We suggest you read the fine print. There is a reason that the print is so small. Many of the advertised prices at these centers are only available to patients with very low prescriptions and no astigmatism. Question every asterisk: What are they hiding? The average price at these centers that advertise an initial low fee is usually around $2,000 per eye. Don’t just take our word for it. Check out what the Sacramento Business Journal had to say in a feature article.
Some surgeons claim they are able to offer a reduced price because they own their own laser. Whether a surgeon owns their own laser has very little to do with the pricing structure if proper maintenance is performed on the laser and corners aren’t being cut. In order for a laser to perform predictably, regular maintenance is required — and excimer lasers are very expensive to maintain. For example, the mirrors inside the laser have to be replaced after a specific amount of use or outcome variations can occur. These specialized mirrors cost up to tens of thousands of dollars. Upgrades from the manufacturer for software and hardware are expensive. Gas levels used by the laser must be maintained, in order to produce a consistent beam. Ignoring regular maintenance and gas levels used by the laser may save a surgeon money but potentially risk patients’ visual outcomes.
We meticulously follow maintenance guidelines with all of our equipment. Improper maintenance increases risks to which we are not willing to expose our patients, for any reason. Our surgeons control every aspect of our LASIK centers. Those who charge less for laser vision correction surgery know what their services are worth. If you pay a low price but don't achieve the outcome you desire, you have still paid too much. We believe that the bitterness of poor quality remains long after the sweetness of a lower price is forgotten.
Are You Qualified to Be My Surgeon?
4. Why should I choose to have laser vision correction with your practice?
There are several reasons people choose to have their surgery done with us:
- They want to have a safe surgical experience. Our doctors and surgeons are all board certified, which can be verified with The Medical Board of California. We encourage you to make sure that the surgeon you select is board certified. We don’t cut corners. We use the latest technology. We don’t skimp on maintenance of our equipment. We won’t perform surgery on you unless we would lay there in your place under the same circumstances.
- Our visual outcomes are outstanding because we insist that data gathering on each of our patients be consistent and must meet a very high standard before it is considered accurate enough to use in designing a treatment plan. We further insist on providing our patients with follow-up care ourselves, to ensure that the desired outcomes are being achieved. We give each patient an accurate assessment of a projected visual outcome, based on our extensive previous patient experience. Each individual can then decide whether the anticipated results justify proceeding with surgery.
- We take extra steps to earn and maintain the trust of those who honor us by allowing us to do their surgery. We believe the relationship between a patient and doctor is completely different from one between a consumer and a provider. We are blessed to be able to perform surgery for those people we feel are good candidates. We feel no compulsion to push anyone to have laser surgery. We honestly tell patients whether we think they are good candidates for surgery after we get to know them better. We are committed to always putting the patient’s interests first.
- We are so confident in our ability to deliver the results our patients desire that we are the first and only practice in the area to offer 20/20 vision from your LASIK surgery or your money back to qualified patients. We decided it was time to put our money where our mouth is and set a new standard. We were tired of the hype and claims of many in our industry and decided to do something about it.
For additional information, please visit contact us online or call (916) 485-2020.
5. When will I meet with the surgeon?
The laser vision correction surgeons at our practice sit down with each patient and examine them, as well as get to know them before surgery. It is important to understand how a patient spends their day visually and their individual visual needs (such as what various focal distances they work at). We find out how patients spend their leisure time and address those specific visual needs, as well. It is very important to explore each patient’s expectations for laser vision correction surgery. If expectations are unrealistic or unreasonable, the patient deserves honest feedback. The process of caring for patients and educating people takes time and effort, as well as skill.
We believe that long before you lay down and look up at the blinking red target light of the laser prior to surgery, you should know that your surgeon’s primary motivation for performing your surgery is a desire to help you see well and live a better life, with the benefit of laser vision correction surgery. How can you trust that the surgeon really has your best interests at heart if you meet him or her for the first time while preparing to lay under the laser? How can that surgeon know you adequately or really know your specific, individual needs?
6. Will I get the same LASIK results regardless of the surgeon I select?
How the laser is programmed makes all the difference in terms of outcome. Results do vary by surgeon, even if the same model laser is used. Our proprietary programming method increases the probability from about 65% to 98% that you will get the outcome you desire after one treatment (see question 12 below). In addition, there are differences in laser technology that can also affect results and potential complications.
Please realize that one of the biggest risks in having LASIK is when the flap is made, prior to the actual laser treatment. Even if the surgeon uses the same laser but doesn’t use the Ziemer Z4 femtosecond laser to make the corneal flap, then you only have part of the equation solved. Please see question 13 below for further explanation of why we choose to only use the Ziemer Z4 femtosecond laser.
7. How many surgeries do you perform?
We only perform as many as we can do safely, including providing personal care before and after surgery. We usually perform laser vision correction surgery two days a week and devote the remainder of our time to seeing patients for evaluations for laser vision correction or follow-up after surgery. On a busy surgery day, we average approximately 20 patient surgeries. The efficiency and care of our surgery team is superb. Once you arrive for surgery, all the preparatory work will have been completed and we follow a specific process to make sure everything is perfect for your surgery. In a typical month, we will perform an average of about 150-200 laser vision correction procedures on new patients. We insist on seeing and caring for our patients both pre- and post-operatively, so we only do as many patient surgeries as can be reasonably accommodated.
As previously mentioned, a surgeon may claim to have performed tens of thousands of procedures but the most important question is, “What are the visual outcomes of those tens of thousands of patients?” The number of eyes a surgeon has treated means very little if the visual outcomes of most of those are “20/mediocre” vision.
8. How many years of experience do you have and how many procedures have you performed?
We have been performing laser surgery for vision correction since 1994. Prior to U.S. FDA approval, we took groups of patients monthly to Canada for treatment. Since that time, we have completed tens of thousands of surgeries. However, we invest more of our time and resources tracking our outcomes and providing pre and post-operative care, as opposed to simply focusing on surgery. How well our patients actually see after surgery is much more important to us than maximizing the number of patients run through surgery.
9. Are you currently involved in any litigation?
“If you don’t want to deal with litigation,” it has been said, “then don’t practice medicine.” Though we are not currently involved in any litigation, there have been lawsuits filed against us in the past, and this may again happen in the future. The right to bring a civil suit against a doctor does not require any reasonable justification and with the large number of people we see and the wide variety of personalities, it is to be expected. However, no legal judgment has ever been entered against us.
Do You Use State-of-the-Art LASIK Technology?
10. What brand of laser do you use for the LASIK treatment and why do you use that brand?
We use the Alcon WaveLight EX500 laser, which is permanently installed in our Sacramento and Roseville offices. This is the most advanced, state-of-the-art LASIK laser technology currently available. We do not cut corners by using cheaper lasers or skimping on maintenance, in order to pad a profit margin at the potential expense of our trusting patients.
The reason we prefer the Alcon WaveLight EX500 is that when Visx (the manufacturer of what was formerly the top-of-the-line system) ceased to innovate after being purchased several times by other companies, Alcon developed a superior delivery system. The WaveLight EX500 performs its treatments in approximately one fourth the amount of time as other lasers. This translates into predictable results for the patient because of less corneal dehydration during treatment. Proper corneal thickness is imperative for patient safety with laser vision correction. The EX500 is also the first and only laser in the U.S. to measure corneal thickness in a non-contact method while the patient is under the laser. Having this option during surgery adds yet another layer of safety for the patient. Another advantage of the EX500 is the speed of its eye tracker during treatment. Visx’s eye tracker operates at 60 Hz (tracks the eye at 60 times a second), while the EX500 operates at 1050 Hz, thereby dramatically increasing precision.
Many of the other lasers on the market can actually cause night vision issues and halos, due to poor technology. The bottom line is this: If we ourselves were lying under a laser or doing vision correction for a family member, we would want to use an Alcon WaveLight EX500. (Please also see question 11 below.)
11. What technology do you use for surgery?
During the initial evaluation, you are scanned on our Pentacam. In order to proceed to surgery, the Pentacam must confirm our measurements and findings during the evaluation. This assures absolute safety.
Your safety is our first priority. Not only must your overall health and the health of the eyes be considered, some additional standards of eligibility must be met. We test your eyes with scans and devices not normally used in routine eye exams.
Since laser vision correction is done on the cornea, the health and integrity of that part of the eye is critical for safe and predictable outcomes. Previously, doctors only used scans such as corneal topography as a method of measuring elevations, irregularities and the curvature of the cornea. These topography scans are capable of showing possible problem areas but are limited to a view of the front surface of the cornea only. Subtle abnormalities of the back or posterior surface of the cornea are impossible to measure with conventional instruments. Subtle abnormalities of the back side of the cornea are often responsible for unpredictable and sometimes very poor visual outcomes after laser eye surgery.
Devices such as the Orbscan I and II, which have been available for many years, give some indication of the posterior corneal surface. But such devices often underestimate or overestimate true corneal contours and curvatures that are critical to the surgeon’s assessment of patient suitability for laser eye surgery. The lack of measurements that are repeatable and absolute has in the past been a source of frustration to many laser eye surgeons. At times, based on incorrect information, patients were told they were not candidates for the surgery. At other times, patients that probably should not have had surgery due to unreliable measurements did actually undergo LASIK surgery. Then the Oculus Company, in Germany, developed the Pentacam.
The Pentacam is a critical diagnostic tool for laser eye surgeons. It utilizes a sophisticated Scheipmflug camera system that scans the anterior eye (cornea, anterior chamber, iris and lens), taking up to 25,000 measured data points in a scan time of two seconds per eye. These data generate a 3D model of the eye that can be viewed and analyzed by the doctor.
The data collected allow us to view the eye from 25 different angles with a three-dimensional analysis of all the structures mentioned above. Most importantly for potential laser vision correction patients, this provides us with a precise elevation map of the back surface of the cornea, unparalleled by any previous technology. This information helps to ensure that the recommendations made for laser vision correction will be as safe as possible. The 3D capability of the image allows us to see whether lens implants for very near or farsighted patients might be a better option than laser surgery. We can also grade the level of cataract development in the lens of the eye and follow its progress with serial scans. For patients who have undergone previous laser vision correction who are now or may at some time in the future be in need of cataract surgery, we are able to more accurately calculate the lens implant replacement power with the true corneal curvature measurements (keratometry readings), which are provided by the Pentacam.
In addition, some corneal conditions (including keratoconus, pellucid degeneration and corneal ectasia) can be monitored for stability or progression with the Pentacam. This allows us to help these patients with the best contact lens or other vision correction option for their particular needs.
Every patient we see who is contemplating laser eye surgery or lens replacement surgery is scanned with the Pentacam. This enables us to recommend the safest and most appropriate treatment option for those who place their trust in us. In our opinion, there is no more accurate and helpful a diagnostic device in determining a patient’s candidacy for laser vision correction as the Pentacam. Our office was the first in the greater Sacramento area to offer our patients the benefits of this device.
The technology we use for the actual laser procedure consists of the Alcon WaveLight EX500 excimer laser and the Ziemer Z4 femtosecond laser for flap creation, as mentioned in questions 6, 10 and 13. Although more expensive than other available technology, our doctors feel that this equipment affords our patients the absolute safest possible treatment.
12. How does your doctor determine how to program the laser for my laser vision correction?
The way the laser is programmed has a tremendous impact on your outcome. Many laser vision correction surgeons in the United States use what has been termed the "plug and play" method. The "plug and play" method involves the surgeon entering a patient’s prescription into the excimer laser's computer, letting the laser do the calculations. When a surgeon uses this method to treat patients with a prescription between +4.00 to –6.00 (the majority of patients fall into this range), there is usually a 65% to 75% chance that the patient will achieve 20/25 or better vision.
At Griffin & Reed Eye Care, we have been tracking our surgical outcome data meticulously and incorporating it into our treatment since becoming the first to offer laser vision correction to our patients on the West coast. As a result, our surgeons developed the nomogram (a kind of formula) we use to program our Alcon WaveLight EX500 laser, yielding superior surgical outcomes. By constantly tracking our post-operative data and using that information to continually evaluate our nomogram, we can offer the best possible outcomes.
The use of our extensive data and nomogram offers a 98% chance that you will achieve 20/20 vision — or no worse than 20/25 vision — with a single treatment. You have a higher probability of getting the result you desire at our practice because of our comprehensive data evaluation and proprietary laser programming.
A surgeon may claim to have performed tens of thousands of procedures but the most important question is, "What are the visual outcomes of those tens of thousands of patients?" The number of eyes a surgeon has treated means very little if the visual outcomes of most or even many of those are mediocre. Most doctors probably won't be able to tell you their visual outcomes or they may quote national statistics, as the majority do not track their individual post-operative data.
13. How do you make the flap for LASIK and why?
For flap creation, we use the Ziemer Z4 femtosecond laser. We have tested other femtosecond lasers and believe the Ziemer Z4 to be the best option available. If we used less expensive equipment such as a mechanical microkeratome, which uses a blade to create the flap on the cornea, we could save many tens of thousands of dollars per year. By using the next-best instrument, however, we would be placing our patients at risk. This is because the failure rate is significantly higher, which for us would be unacceptable. Poor design and poor engineering will lead to malfunction, even in the hands of experienced surgeons. We continually evaluate new technology options and have yet to find anything as good or better than the Ziemer Z4 femtosecond laser. We only offer the safest option available – Blade-free, All-laser LASIK.
How Safe Is LASIK?
14. What safety precautions do you take?
We use the absolute best diagnostic equipment available to ensure your candidacy for laser vision correction, as detailed in question 15. For surgery, we use only what we feel is the safest equipment available, the Ziemer Z4 femtosecond laser for LASIK flap creation, and the Alcon WaveLight EX500 for the actual laser treatment.
Patient safety is our top priority. If the procedure is not safe for you, we don’t want you to have it. That is why we do our pre-operative measurements so carefully. We check and double-check everything. Our surgery involves a series of procedural steps, which we conscientiously follow to assure that the calculations we use are the very best for your eyes. We test run the Alcon WaveLight EX500 laser, and Ziemer Z4 femtosecond laser used for flap creation, calibrating them individually before each eye we treat. The EX500 laser is unique from a safety perspective, in that it measures corneal thickness (utilizing a non-contact method) while the patient is under the laser. Proper corneal thickness is imperative for patient safety with laser vision correction. Although we measure corneal thickness at multiple points prior to the procedure, incorporating this extra safety step into the laser itself adds a valuable, additional layer of patient safety.
In case of any fluctuations in electricity, we also maintain a reliable back-up power supply. Everything we do is done to ensure safe, predictable outcomes for our patients.
15. What steps do you take to minimize risk?
Everything we do is designed to minimize risk and enhance the benefit and outcome. We insist on treating the laser vision correction surgery area as a sterile operating facility. All staff members wear masks and gloves, as well as surgical scrubs. Since infection and inflammation are much less likely to occur under sterile conditions, we observe sterile protocol in surgery.
In some facilities, the surgeon and staff dress in street clothes or do not use gloves and masks. Prospective patients are even given tours of the surgery suite. This only increases the risk of contamination and exposure to patients of things to which they would be best not exposed.
Our approach is based on making laser vision correction surgery as risk-free as possible.
16. What are possible complications involved with laser vision correction?
Our consent form lists every complication from laser vision correction surgery that we have ever read about in the international literature. Reading this list can, understandably, feel intimidating. Documents such as these are necessary for obtaining malpractice insurance coverage in California. Experts are aware that the risks and outcomes of any particular surgery may vary significantly, depending on who does the surgery and how it is done.
One of our greatest concerns with regard to LASIK patients is the patient "tweaking" the flap during the first 18 hours following surgery. A slight wrinkle in the flap can cause a decrease in vision. This is repairable in most cases, but delays recovery. After surgery, we also look closely for any signs of inflammation or infection. In our experience, these issues show up very rarely (once in 2-3,000 cases), but are much easier to treat when caught early. That is why we insist on seeing you personally the day after surgery. Patients are prescribed special eye drops to control any possible issues. In those rare cases when inflammation or infection presents itself, it is observed very early. The one-day and one-week follow-up visits ensure that you will be monitored for and promptly treated for any such condition.
What Results and Follow-Up Can I Expect?
17. How good are your LASIK results?
Our laser surgery results are among the very best in the industry. An impressive 98% of our patients see 20/20 — or no worse than 20/25 — after their first treatment. We attribute this to comprehensive collection of patient data (see questions 3 and 18), in combination with the use and proper maintenance of the most advanced technology.
18. Do you collect and track data from your laser vision correction patients?
Yes. In fact, this is one of the main reasons we are able to provide such predictable outcomes and is what distinguishes our practice from most other LASIK providers.
The expertise utilized to program the excimer laser with such a high degree of accuracy is derived from extensive testing, interviewing and counseling. This expertise is based on years of data collection that Griffin & Reed Eye Care has compiled from the thousands of patients we have treated. From the outset, we have been tracking all our patients' post-operative results. The need to carefully track patient results was evident after watching the evolution of laser vision correction outcomes. In the late 1980s and early 1990s, the surgery outcomes in Europe, Great Britain and Canada were generally quite poor. As visual outcomes improved, it was apparent that surgeons who achieved outstanding visual results for their patients were gathering data methodically and then combining this with careful follow-up and correlation of their patients' visual outcomes, one by one. If you wanted to help your patients achieve the best possible visual outcomes, it was evident that you had to see them in follow-up and, most importantly, continue to refine the programming of the laser based on ongoing data and experience.
Patients mistakenly think that all laser vision correction surgeons track their data, which unfortunately is not the case, as most practices are unwilling to make the substantial investment that this involves.
19. Who performs the follow-up exams?
Unlike many other centers, our surgeons insist on doing the follow-up exams on our patients at the one-day and one-week post-operative visits. The exception is for patients from outside the area. In some cases, we work with out-of-area doctors who we know are well trained for early post-op visits. The remainder of the follow-up visits are mostly done to monitor your healing progress and for purposes of data collection. Some of these visits are with other doctors on staff here at Griffin & Reed Eye Care.
20. What is your retreatment policy — and will I have to sign a 20/40 or 20/30 waiver?
It is interesting that most surgeons try to find ways to cover themselves if the patient does not achieve 20/20 vision. They lack confidence in their outcomes and therefore resort to waivers. We take the exact opposite approach and offer 20/20 vision from your LASIK surgery or your money back to qualified patients.
We consider retreatment with the same level of care as we do primary treatment, asking these two key questions:
- Is it safe to retreat?
- Are we unreasonably risking what we have gained in the original treatment?
If we can safely achieve even a slightly better result for our patients, then why wouldn’t we retreat them? They came to us in the first place because they trusted us to do our best for them. We do not have a 20/40 or 20/30 waiver in our practice. Most of the patients that undergo a retreatment in our office have better than 20/40 vision.
In most high-volume laser vision correction centers, patients are asked to sign a 20/40 or 20/30 waiver with their other paperwork. Most patients don't realize they are signing this type of waiver, so please be careful. A 20/40 or 20/30 waiver stipulates that even if you are best corrected with glasses or contacts to 20/20 before surgery — and the best you achieve after surgery is 20/40 or 20/30 without glasses or contact lenses — then you will not be eligible for enhancement or touchup. You will be told that 20/40 or 20/30 is an acceptable outcome and the risk of retreatment is too great with 20/40 or 20/30 vision. However, these same centers would be willing to treat a patient with 20/40 or 20/30 vision if they were new, paying patients. This same 20/40 or 20/30 vision is apparently bad enough to treat if you are paying for the treatment, but not bad enough to treat if the surgeon is not getting paid to retreat you.
The difference in approach about eligibility for retreatment can cause confusion for patients when they are comparing retreatment rates between laser vision correction surgeons. Surgeons may appear to have an artificially low retreat rate if their requirements for a retreatment are so limited that few patients qualify. At the same time, they may have a large number of treated patients who are visually challenged by 20/30-20/40 vision.
On the other hand, if you compare the retreatments at Griffin & Reed Eye Care for those who are 20/30 or worse, our retreatment rate would be less than 1% of all our patients. Our overall retreatment rate is between 1% and 10%, depending on the level of the patient's preoperative correction. Very high corrections tend to show more regression after surgery and therefore have a slightly higher rate of retreatment than the majority of patients with moderate corrections.
Also, when surgeons boast of the number of surgeries performed, they often include the retreatments as "eyes treated.” Having a high retreat rate pads their statistics, while speaking poorly of visual outcomes. Most reputable laser vision correction surgeons don't charge patients for retreatments. The justifiable exception to this is the minimal royalty fee enforced by the laser manufacturers for encrypted key cards to operate the laser (usually about $150.00 per card, with one card used to treat one eye).
For additional information on our 20/20 vision from your LASIK surgery or your money back program — as well as any other questions you might have — we invite you to contact our LASIK department at (916) 485-2020. Additional information with regard to various financing options is available at our website. You can even apply for financing online. We also welcome you to view one of our informative seminars online.
Our medical practice is well-established in the community. We have been around for decades and will continue to be serving patients for many years to come. We understand your concerns and will treat you like family.