LASIK Discussion Continued
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NOTE: Last week we initiated an in-depth discussion of LASIK refractive surgery. This week we'll pick up where we left off.
Pre- and post- operative care:
A LASIK procedure not meant to be a one-visit experience. Several post-operative visits are necessary to monitor healing of the eyes and the return of best-corrected vision. Typical scheduled visits include 1 day, 1 week, 1 month, 3 months, and 6 months after the procedure, as well as yearly examinations thereafter.
Usually, all the post-operative visits are included in the surgical fee up to and including the 6-month visit. (This means if you have a concern or problem between visits, your care is included at no extra fee). At these visits, your eye doctor will be looking at the front part of the eye including the flap, gauging the healing process, checking for any dryness, inflammation, and/or residual correction. Immediate post-operative vision and comfort with LASIK is quite good - but we still expect vision and comfort to improve over the ensuing weeks.
Variations on LASIK- depending on your individual eyes and your unique visual needs, the procedure may be varied slightly.
LASEK is a variation involving removing the epithelium (outer corneal layer) then replacing it after laser ablation, avoiding creation of a flap. This is helpful if your corneas are not thick enough to have total correction of your vision with creation of a flap. The postoperative course is quite similar, but involves slightly more initial discomfort.
Epi-LASIK is a procedure whereby a very thin flap is created.
Intralase involves the creation of a flap by a laser - instead of a tiny microkeratome blade. Initially, surgeons felt that this variation would lead to better outcomes, but results are mixed. The results have not been proven to be statistically better, and this procedure costs about $1,000 more, so I am somewhat guarded with this recommendation. It has been advertised as better - but as the saying goes, if you want to know what you are talking about, don't talk to people, read the literature.
Custom LASIK is a variation on the laser application itself and may be performed with any of the above procedures. This is the way I explain it - just like no two snowflakes are the same and no two fingers have the same fingerprint, your eye has a unique shape that is different from everyone else's.
Standard LASIK (or LASEK as the case may be) applies your correction to your eye. Custom LASIK takes into account the exact topographical shape of your eyes, so if someone else has the exact same prescription as you, they will receive a different treatment with Custom LASIK. Statistically (overall) there is a higher chance of 20/20. Many patients do just fine with Standard LASIK - I make a point to recommend a Custom treatment if certain characteristics are true, such as moderate astigmatism and/or larger pupil sizes. Custom usually costs about $500 more than standard (total for both eyes).
There are certainly other refractive procedures, but they are not as commonly employed and are beyond the scope of this discussion.
A laundry list of all possible corrective procedures may look impressive in an advertisement, but remember it is the doctor who needs to recommend which procedure(s) is/are right for you and why. The latest and greatest isn't so great if it doesn't apply to you, and typically you (the consumer) are not in a position to know.
Prices
Including both eyes and all pre- and post-operative care, I believe a typical fee for this part of the country would be around $3,000 for standard LASIK, $3,500 for custom LASIK, and $4,300 or more for Intralase. Of course, fees may vary.
$299 per eye?!?
You've certainly heard the saying "you get what you pay for". I would say that's usually true - but there are always exceptions. Certainly one can't stretch it to imply that the higher cost is always better. Another saying that has meaning to me is "you have to be comparable on the comparables."
I have seen, while driving on the interstate (as I'm sure you've seen as well) billboards and propaganda in other places advertising rock bottom prices for LASIK. The lowest I saw was $299 per eye in late 2004.
How is this possible? Depends on your business model. You may choose to brew your own coffee at home for pennies a cup, or grab a cup of gourmet coffee for several dollars a cup. With that mindset, it is important to understand that eye care is a business.
The most common way to offer a procedure at a lower fee is to attempt to do a huge number of procedures. Some firms purchase their own laser, and by the time it is paid for, their only costs for the procedure are the time for the surgeon and facility and some consumable elements.
The problem with this approach, as most rational thinkers would agree, is that technology changes. I never want to purchase a laser regardless of the number of procedures performed at my office because when technology changes, advances, and improves, I don't want to be stuck with something obsolete. So we choose to pay per use, and let the owner of the laser shoulder the risk of having to update equipment when technology warrants. If they do not offer the most advanced instrument, I will not use their instrument. Simple as that.
Another common way to offer a low-ball price is to not include any post-operative care in the fee. This care is necessary, so be careful.
A well known news program did a segment a few years ago at one of these low fee/high volume places and found that not one patient actually paid the lowest advertised fee over the preceeding few years. That's amazing. The firm would tack on extra fees to consult with the surgeon before the procedure, more extra fees if your prescription was higher. This is all ridiculous. The difficulty and skill, and for the most part, time involved are all pretty much the same regardless of your prescription. So now you can see through this hype.
The funny thing is that most of these LASIK "mills" are now out of business. I guess that's not so funny to patients who received surgical care, paid their fee, and returned for follow up care (heaven forbid with a vision-threatening problem) to find closed doors.
Complications
The biggest potential complication is the loss of best-corrected vision. That means that there is a chance that even after the procedure, your vision with correction would be worse than it was before. This is infrequent. There can be problems with creating the flap, problems with the flap post-operatively, inflammation within the cornea, debris under the flap, epithelial ingrowth, and over or under treatment. These conditions are treatable.
From the perspective of side effects or normal post-operative symptoms, there can be (and usually is) some degree of dry eye sensation. This usually subsides, but judicious use of lubricating agents is prudent. There is also more notice of glare and/or halos around lights, especially at night. This too usually subsides, but depending on your pupils size may always be present to some degree.
The total complication rate is very low considering LASIK is a surgical procedure - just a few per 1,000 cases - if anyone wants hard data just ask, I'll be glad to research it.
My favorite discussion - the "real value" of LASIK
I had this discussion with a friend recently. It is said that value can be defined as "the extent to which people perceive what we do as good." Makes enough sense. Another pertinent definition may be the relative worth of something, measured in dollars or compared to something else tangible.
That said, at $3,000 to $4,000 for both eyes, LASIK is a steal. To pay a few thousand dollars for something that can improve your visual status potentially for the rest of your life - isn't that priceless? I dislike commoditization and competing on price alone - that cheapens the value of everything and I feel has diminished the image of the eye care industry to some extent. Taken to the extreme, maybe you could actually get paid to undergo LASIK someday. Low profit means cheap prices to consumers, but profit means ability to keep doors open.
Comparing LASIK to other procedures may be comparing apples to oranges. I realize that. Here's a good analogy - someone who wears glasses/contact lenses or both may "break even" in 5-7 years after LASIK, more or less.
In the big scheme of things, LASIK is pennies - taken in context.
Please understand that I am not implying that you should rush out and have LASIK done - you may be a poor candidate. I've talked many a patient out of it, because their expectations didn't match reality. I've also told patients NOT to have it done just to save money after the break even period, they'd probably do better investing the difference now.
Undergo LASIK only if you wish to experience some degree of visual freedom from glasses and contact lenses, only if you fully understand the procedure and the healing process, only if you're a good candidate and have had all your concerns addressed, and only under the care of someone you know and trust.
Dr. Lee Newton
I invite your questions and feedback
Or Contact Dr. Lee Newton at:
3720 E. Wilder Road, Bay City, MI
(989) 667-9393
3720 E. Wilder Road, Bay City, MI
(989) 667-9393
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