Why should I come here when people have had LASIK done cheaper in Canada?

    Subjective vs. Objective:  A patient with a simple prescription and small pupils could probably get good results even on an older laser with a novice surgeon.  Under the same conditions, a person with a more complex prescription and larger pupils would likely obtain less than optimal results.  Since eyes are as unique as fingerprints, it would be misleading to compare your prescription or ocular anatomy with a neighbor or friend, since that would be like comparing apples to oranges.  Happiness after laser surgery can vary dramatically, and often has more to do with expectations than actual visual outcome.  It is not uncommon to find that one patient will be ecstatic with 20/40 acuity, while another can be unhappy with 20/20 vision.  The choice of your laser surgeon must be based on quite a bit more information in order to understand the differences between surgeons and surgery centers.

    Price, Quality, and Value:  Anyone who has comparison-shopped knows that similar products can vary dramatically in price.  The variation in price typically corresponds with a variation in quality.  Consumers sacrifice quality for two main reasons: 1) they are a less discriminating shopper who is willing to put up with lower quality or higher risk in order to save a few dollars or 2) they are simply unable to afford the higher quality product.  In medicine, using price as the primary guideline places the patient in the position of having to weigh price versus quality while considering the risk for undesirable side effects and complications.

    Profits versus Patients:  You should thoroughly evaluate the core values of the surgeon and the organization.  Essentially, which is more important – profits or patients?  The answer to this question is critical to determine an organization’s level of commitment to excellent outcomes and patient satisfaction.  In the business of medicine, there must be a balance between quality/service and “the bottom line”.  One should not be sacrificed for the other. 

    Corporate LASIK centers that promise bargain basement fees must often compromise technology, attention to detail, and level of service to offset financial considerations.  Because these companies have a financial obligation to their shareholders, their survival is often based on profit rather than the quality of their surgical outcomes.  No patient should be satisfied with below average medical care. 

    High quality medical organizations have learned that the only way to be successful is to prioritize medical decisions over business decisions.  With that perspective in mind, the financial success of the organization is virtually guaranteed.

    Patient Abandonment:  Many corporate LASIK discount chains claim that the main reason they cost less is due to the elimination of “co-management”.  Co-management involves arranging all pre- and post-operative care with a doctor who lives near you so you only need to travel to the surgeon’s office for the actual surgery itself.  This scenario costs more but maximizes quality of care and is by far more convenient for the patient.  Corporate laser centers avoid this cost by requiring the patient to return to the surgery center for all follow up appointments.  Since traveling long distances inside or outside the USA for follow up visits after surgery is neither convenient nor cost effective for the patient, many get lost in the follow up care shuffle. 

    The responsibility to see that the patient receives all postoperative care belongs to the surgeon.  Failure to do so constitutes “patient abandonment” and is considered very serious by both medical and legal communities.  Another way discount LASIK centers save money is when an enhancement of the original surgery is necessary to improve vision further, the patient is forced to choose whether or not the expense of returning to the distant center is worth the chance for better vision.  These corporate centers exploit the fact that many people will opt to live with their vision as it is, which saves the corporation the expense of doing an enhancement.

    Lack of Malpractice Protection:  In the US , patients are protected from malpractice two ways.  Strict medical school and residency training guidelines, board certifications, credentialing, and licensure all lend assurance to the public that the provider is qualified and competent.  In the rare circumstances where delivery of care is below standard, a patient can pursue a malpractice judgment against the provider.  Choosing care outside the US negates both of these protections.  The standards of care in medical communities in other countries are not nearly as demanding as in the US .  As a result, the patient protection from malpractice can be vastly different or absent altogether. 

    In addition, there is increasing legal debate as to whether foreign surgeons who advertise their services in the US are liable for their malpractice actions in the US .  Currently, it appears that the act of advertising a medical service constitutes a legal basis to assert a malpractice claim against the surgeon in the state in which the advertising occurred.  If this is correct, then foreign surgeons are essentially practicing medicine without any malpractice insurance for US patients.  Even if a lawsuit were successful, the foreign surgeon would not realistically have ability to pay for damages without insurance.

    No Guarantees:  A “selling point” of several of the discount LASIK centers is the guarantee of lifetime LASIK enhancements.  Unfortunately, unless the details of the enhancement guarantee are fully disclosed this guarantee constitutes fraudulent representation.  Although it is often true that LASIK can be enhanced months or years after the original procedure, the circumstances under which such enhancements can be performed is markedly restricted.  

    Most serious is the illusion created in the patients mind that LASIK can be done repeatedly throughout a person’s lifetime.  The laser removes a certain amount of corneal tissue with each treatment.  The cornea has a certain amount of tissue, which can be thinned only so much before another enhancement would have adverse results.  Furthermore, medical and surgical advances may, in the future, significantly decrease both the advisability and appropriateness of LASIK enhancement surgery for refractive corrections in the future.  Organizations that offer such “guarantees” without fully informing the patient about these restrictions will ultimately suffer the medical and legal consequences of these errors.

    Surgeon Expertise:  It is important to recognize that LASIK is not magic.  It is a surgical procedure performed in a medical setting using highly sophisticated laser technology.  To attain consistently successful results, the surgeon performing the LASIK procedure must be trained and experienced in the art of refractive surgery.  Unfortunately, despite having a degree in medicine, not all surgeons are born with the same surgical ability.  Some surgeons are clearly more able to provide consistent results than others.  This is a consequence of excellent hand eye coordination as well as a superior understanding of specialized techniques for avoiding potential surgical complications, astute complication management when required and advanced insight into the healing process to consistently achieve the desired refractive endpoint.  These skill sets are the product of a gifted innate ability enhanced by years of systematic scientific observation, a discerning intellect, methodical data analysis and introspection and unparallel clinical judgment.  Beyond mere technical skill, the physician must exhibit a professional, caring, compassionate, and personalized bedside manner that ensures that the patient’s individual needs and concerns are addressed and met throughout the healing process.  Unfortunately, you cannot purchase a new set of corneas for the amount you save by going to a corporate discount LASIK center with a "no name" surgeon. 

    In addition to performing flawless surgical technique, your surgeon must understand that your eyes are unique and the surgical approach taken must be customized for each patient including the surgical protocols, surgical plan as well as the follow up management plan.  LASIK is not a "cookie cutter" or "carbon copy" commodity that can be marketed as a "LASIK in a Box" and sold to the lowest bidder like a burger and fries value meal.  Maximized outcomes can only come through customized care and service.  Customization and planning requires time, experience and direct patient-surgeon interaction. 

    Laser Technology:  A laser’s FDA approval status does not necessarily give an indication of its level of technology and effectiveness under various circumstances.  A good analogy is the comparison of a Hyundai versus a Lexus.  Both are deemed safe and effective by industry standards.  However, these vehicles differ dramatically in comfort, handling, safety, acceleration, braking, and overall maneuverability.  Although a Hyundai clearly qualifies as an automobile that serves its purpose for many people, it is not equivalent to a Lexus on any level. 

    Similarly, there are lasers that can perform an adequate surgery for most people but fall short for more complex prescriptions.  To improve outcomes for these people, there are now more sophisticated laser technologies that allow for rapid eye tracking, smoother and wider blending of the treatment area to reduce risk of glare and haloes, and other software enhancements that allow more precision in complex prescriptions.  It is imperative to research the laser that your surgeon is going to use on your eyes.  

    Post-operative Examinations: Ideally your post-surgical care is provided by the surgeon or the surgeon’s team of physicians.  They are the most knowledgeable about any difficulties that may have occurred during the procedure as well as any unique findings during the main exam.  Follow up care is essential to ensure that the healing process is proceeding normally and that no complications go undetected.  These examinations typically performed at one day, one week, and one month after surgery, actually account for over 50% of “face to face” physician time.  Corporate centers that provide LASIK at reduced fees often attempt to reduce the cost in providing follow up care in order to increase their profit margin.  This is easily accomplished when the patient has traveled a great distance for surgery.  This geographic barrier reduces the chance of the patient returning for both follow up care and for an enhancement when necessary.  In most cases, patients are left to “fend for themselves”.  This cost savings is anticipated by surgery chains and passed on as a discount.  Unfortunately inadequate or inappropriate medical care can ultimately cost a patient visual function or performance, which was far more costly than the amount “saved” on the surgery itself.  A final consideration is the level of convenience in receiving the follow up care and the accessibility of the surgeon or surgical staff in the event of an ocular emergency.

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