Wednesday, August 30, 2000

Shopping the LASIK market

Watch for eye surgeon's qualifications not come-on ads about low prices, experts say

By Peggy O'Farrell
The Cincinnati Enquirer

        The ads are everywhere — on TV, on the radio, in the Sunday paper — and they're all touting low, low prices.

        They're not pitching cars or computers or hardware or groceries. They're selling LASIK, laser surgery to correct nearsightedness, and competition has pushed some surgery centers to offer the procedure for under $1,000 per eye.

    Experts offer the following advice for would-be LASIK patients:
    • Know the surgeon. Check the surgeon's qualifications — training, board certification and so on, says Dr. Adam H. Kaufman. Find out if they can perform any other corneal procedures. If they're only trained in LASIK and a complication means you need corneal sutures — LASIK is a “stitchless” surgery — there could be problems.
    • Ask about outcomes: How many patients need enhancements? How many patients end up with 20/40 vision — or better — after the surgery? Is the surgeon based locally, or does the doctor only come in on the days surgery is done? If there are complications after the surgery, who will handle the after-care?
    And is the surgeon the center advertises as its “star” the same practitioner who will be performing your surgery, or will a less-experienced or less-qualified physician be doing it?
    • Know what you're paying for. Does the “low, low price” cover the kind of surgery you need? People with poorer vision or extreme astigmatism might need more extensive — and more expensive — work. And some lasers cost more than others, even though there's no evidence that one works better than another, says Dr. Kaufman.
    Does the price you're quoted include consultations, initial exams, adjustments and after-care, or are those billed separately? Are adjustments included in the initial charge? Dr. Kaufman suggests patients think of the after-care issues as a kind of “warranty.”
    • Know the risks. LASIK surgery can have side effects, including glare; a corneal haze; over- or under-correction of vision; the inability to wear contact lenses; loss of the corneal cap requiring a corneal graft; and corneal scarring, infection or loss of vision.
   Sources: The Federal Trade Commission, the American Academy of Ophthalmology, Dr. Adam H. Kaufman.
        LASIK centers have mushroomed around greater Cincinnati, says Jeff Dowdle, vice president of marketing for LCA Vision, which operates the Lasik Plus Vision Centers in Northern Kentucky and Kenwood.

        “A year and a half ago, there were just two of them, and now there're six or seven of us,” Mr. Dowdle says.

        Competition among LASIK providers is fierce in the Cincinnati area, and some clinics are advertising pricing up front — a rarity in the medical marketplace.

        But cost shouldn't be the first consideration for consumers shopping around for LASIK, experts say. And consumers should ask plenty of questions before choosing a provider for the surgery.

Scope out the surgeon

        Consumers need to get past the marketing and look at who's performing the surgery, Dr. Adam H. Kaufman, director of the corneal and refractive surgery service and an associate professor of clinical ophthalmology at the University of Cincinnati Medical Center, says. Most of the advertising now being pushed at consumers focuses on the center itself and the number of LASIK procedures being performed there.

        “They're putting the emphasis on the center and the de-emphasis on the surgeon so they can they can say their center is great, their company is doing more than anybody else,” says Dr. Kaufman, who has performed LASIK procedures since undergoing training at Harvard in 1991. He has also led several symposiums training physicians in how to perform the procedure. “Most people choose their doctor because of their local reputation. This is a totally new way to choose your doctor.”

"Remarkable' growth

        Dr. Kaufman calls the growth of the LASIK industry in Cincinnati “remarkable.” But he doesn't mean it as a compliment. He also says he's “personally disgusted and disappointed with the evolution” of the procedure.

        “Some of those guys out there are doing 60 eyes a day,” he says. “How careful can they be?”

        A surgeon's qualifications, not the number of procedures he or she has performed, are most important, Dr. Kaufman says. They include board certification and breadth of surgeries performed.

        “The whole number thing is a marketing gimmick,” he says. “The numbers don't mean you're going to get a careful surgeon who's going to program a careful refraction into the laser.”

        Cost is certainly a factor in deciding to have the surgery, providers say, but it shouldn't be the only factor.

        Marsha Wyler, marketing director at Cincinnati Eye Institute in Montgomery, says patients need to consider what they're getting for their money. Does the price quoted include only the surgery, or does it include follow-up visits and enhancements — subsequent procedures to “fine-tune” a patient's post-LASIK vision. And who's going to provide the follow-up care?

        “Should price be a factor in my mind?” she asks. “No.”

Glad without glasses

        Dave Lingler, 37, confesses he was “definitely” nervous when he opted for LASIK surgery.

        What scared him most about the procedure, in which doctors use a laser to slice a thin layer from a patient's cornea, was “going blind, frankly,” Mr. Lingler, an accountant, says. “I'm a CPA and I don't know how I'd do my job without being able to see. That was pretty much the biggest thing.”

        But the West Chester man, who went under the laser March 30, had worn glasses since sixth grade and was tired of them. “I couldn't see my clock radio that sits inches from the edge of my bed. I couldn't see it without leaning all the way up to it,” he says.

        When he decided to have the surgery, he did some research, talking to friends who'd had the surgery and acquaintances in the health-care field.

        “I was looking for someone who had been doing it for a while and who did it himself, not just his office or his company. I wanted the actual person behind the laser,” Mr. Lingler says.

        He says he's “thrilled” by the results, even though he's already been warned he might need reading glasses a little sooner than he might have without the surgery. Changes in the shape of the cornea as people age lead to changes in vision, and LASIK surgery can aggravate those natural changes since it involves removing a section of the cornea.

        “I'll worry about that when the time comes,” he says. “I'm glad to see now and for the next 20 years, since I was going to be wearing glasses anyway.”

Developments lower costs

        LASIK surgery is becoming more and more popular, Mr. Dowdle says, and he expects that to continue. Competition among providers and cheaper laser technology contribute to low costs. And the majority of LASIK patients end up with at least 20/40 vision — the level needed to drive without glasses — or better, he says.

        The procedure itself is safe and more employers are making it available to their employees, either through contracted discounts or actual insurance coverage, providers say.

        Mr. Dowdle says he hopes to see more employers offer coverage or discounts on LASIK as prices continue to drop and consumers become more comfortable with the procedure.


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