Is "Cheap LASIK" really cheaper?

Surgeon Expertise:  It is important to recognize that LASIK is not magic. Submitting LASIK to the “lowest bid” in the marketplace generally describes a selection strategy that is highly likely to reward patients with a high rate of complications and the use of outdated technology platforms.  Highly experienced surgeons who exhibit a passion for excellence and whose name and reputation are “on the line” generally deliver the best outcomes.  You need a surgeon who is personally responsible to you and who will ensure that only the most advanced technology is used for your specific surgery and that the care program is ideally customized to your visual needs.  Unfortunately, you cannot purchase a new set of corneas for the amount you save by going to a discount LASIK center where the surgeon is “there today and gone tomorrow” and only has limited personal accountability for your outcome.

LASIK is also not a procedure stamped out on an assembly line by a robot. You have unique visual needs and, like you, your eyes are “one-of-a-kind”.  To attain consistently successful results, the surgeon performing the LASIK surgery must be trained and highly experienced in the art of refractive surgery.  The surgeon must have a superior understanding of all aspects of the procedure, unparalleled clinical judgment and specific expertise in how to avoid potential surgical complications in your eyes.  Beyond mere technical skill, the physician must also demonstrate a professional, caring, compassionate, and personalized bedside manner in order to ensure that your unique individual needs and concerns are addressed and met throughout the healing process.  The consistent delivery of excellent results demands a broad set of skills that are frequently difficult to find in discount centers where the surgeon often is detached from individual patient needs and their vision requirements and, most often, whose first encounter with you is in the operating room. 

Laser Technology:  The quality of a patient’s final visual outcome in laser vision correction is highly dependent upon the laser technology used to that perform surgery.  Early forms of laser technology certainly provided patients with freedom from glasses and contact lenses.  However, that freedom often came at the cost of poorer quality of vision, night glare and unwanted optical effects. 

In order to address these problems, new technologies were developed that markedly reduced the incidence of these issues.  Although the scope of these improvements is vast, the most critical improvements to laser technology have been in the arena of measuring and treating optical aberrations.  Using wavefront adaptive optics, a complex technology borrowed from astrophysics, state-of-the-art laser vision correction now utilizes “wavefront guided” treatments.  These new wavefront driven procedures routinely deliver superior quality of vision, much better night vision and many fewer complications compared to older methodology.  As a result, the US Military only uses wavefront-guided procedures on their aviators and NASA only allows wavefront-guided procedures within their astronaut corps. 

Unfortunately, even today, many laser surgeons or centers fail to provide wavefront-guided treatments for their patients, often citing cost of acquisition of these sophisticated devices as an impediment.  Others will attempt to confuse the patient by using similar terminology such as “wavefront optimized” in order to deceive and lure patients.  A “wavefront optimized” treatment is NOT a wavefront-guided correction.  As a result, many patients may unwittingly subject their vision correction to older technology.  Tragically for the consumer, simply knowing that the laser used in your case is FDA approved does not necessarily give an indication as to how modern the technology is or its consistency or effectiveness in providing excellent clear vision.

Another common error amongst patients is to believe that because their friend “Sally” had a good result with Brand X laser that it will produce excellent results in their own eyes.  Unfortunately, the optical characteristics of each person’s eyes are as unique as their fingerprints and DNA.  In that context, a laser that can perform an adequate surgery for “Sally” may fall far short of that for more complex prescriptions. 

Happiness after laser surgery can also vary quite dramatically and often has more to do with expectations and personality 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.

What is clear however, is that to consistently provide excellent visual outcomes over a broad spectrum of patients, the ideal is to undergo LASIK on sophisticated modern technology that uses wavefront guidance, eye tracking, compensation for eye cyclorotation and pupil centroid shift, provides smoother and wider blending of the treatment area to reduce risk of glare and haloes, and other camera hardware and software enhancements that allow more precision in complex prescriptions.  Irrespective of your friend “Sally’s” great results, it is imperative to research the laser that your surgeon is going to use on your unique set of eyes.

Price, Quality, Value:  Anyone who has comparison-shopped knows that similar products can vary dramatically in price.  With few exceptions, the variation in price amongst items in most product categories typically corresponds with a variation in quality. 

Consumers are often willing to 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.  This is dangerous as the effects of an incorrect decision are generally “glaringly” permanent.  In our opinion, if someone cannot afford modern LASIK on state-of-the-art laser technology under the care of an experienced surgeon, they are better off to wait until that can either finance the best surgery or they have saved sufficient funds to proceed.

Profits versus Patients:  You should thoroughly evaluate the core values of the surgeon and the organization.  The essential question is; 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 the very existence of these companies demands that they have a financial obligation to make money for their shareholders, their survival is based on profit rather than the quality of their surgical outcomes. 

No patient should be satisfied with average or below average medical care or care where the profitability of your procedure is the highest priority driving the process.  High quality medical organizations have learned that the only way to be successful is to prioritize medical decisions over business decisions.  With the latter perspective in mind, the patient’s excellent surgical outcome and the financial success of the organization is virtually guaranteed.

No Guarantees:  A “selling point” of several of the discount LASIK centers is the guarantee of lifetime LASIK enhancements.  Unfortunately, this represents an unethical pattern of deliberate fraud and ultimately constitutes an inducement to undergo a surgical procedure.   Lifetime guarantees and “commitments” directly imply that LASIK can be done repeatedly throughout a person’s lifetime.  In point of fact, 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.  In addition, it is well known that certain complications such as epithelial ingrowth become increasingly frequent the longer the time interval between initial surgery and enhancement procedure.  It is more likely than not, at some time in the future, it will no longer be possible to perform a laser enhancement on your eyes.  In that setting, the “lifetime guarantee” or “commitment” will predictably be worthless.  The discount LASIK center certainly knows that future enhancements will very likely be medically contraindicated in your case, yet attempts to deliberately mislead you to the contrary.

The idea of a lifetime warranty for a surgical procedure must also appropriately assess the probability that the surgeon and / or the company that extends such a contract possesses the fiscal wherewithal to be in business many years into the future.  Such warranties and commitments are unlikely to survive the practice life of the surgeon and the company for which he or she works.  We suggest that a review of the performance of many similar corporations will determine that many of these companies have either vanished, gone bankrupt or otherwise abandoned patients.  The history of LASIK Vision Institute, Luna, Lexington, LASIK Vision and a litany of others suggest that the lifespan of most corporate LASIK centers is best measured in months rather than decades.

Postoperative Care: Ideally the surgeon or the surgeon’s team of physicians provides your post-surgical care.  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. 

At many discount LASIK centers the surgeon and his or her team frequently fly from center to center.  If you develop an ocular emergency postoperatively, it will be difficult if not impossible to obtain timely care from your “out of town discount surgeon”.  Many times in medicine, appropriate therapy delivered in a timely fashion can make the difference between solving a problem or allowing a serious problem to spin out of control unchecked.  Having a skilled and experienced surgeon that remains local may prove to be invaluable in such a setting.