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• Discount centers pose extra dangers for some patients.
   

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• Better LASIK in sight-- seeing beyond 20/20.

 Discount LASIK Dangers:

While searching for the best value, some have discovered first hand that cheaper sometimes isn't better...

Dayton, Ohio

   Lisa M. thought she had found a good deal when she had found a discount center offering LASIK for $999 per eye.  "They said all the right things; they claimed they had lots of experience, and great success," she notes.  But soon after her surgery, she noted that something had gone wrong with her left eye.  She and others have learned the hard way the importance of finding a good surgeon for laser eye surgery.  Her doctor had left her flap wrinkled.  "I just couldn't see clearly out of one eye, and the lenses they showed me didn't help.  My vision was smudged and ghosted pretty much all the time", she recalls.  "The doctor there at the center told me they would need to relift and resmooth the flap."  So Lisa had a resmoothing done, not just once, but twice over a couple of months.  "It just didn't get any better, the vision was still blurred and smudged.  They said the wrinkles were gone, but I still couldn't see right.  I just didn't trust them anymore."

    That's when she decided to see another doctor for a second opinion.  According to Dr. Brian Stahl, the refractive surgery specialist she choose to see that fixed her problem, "Getting a second opinion is always a good idea if your not improving or you are starting to loose confidence in your doctor."  Lisa was the second patient that month he had seen from a center that emphasizes low price with the same problem, a wrinkled flap after unsuccessful attempts to fix the problem.  According to Dr. Stahl, this problem is fairly easy to fix if it is done right and early on.  "I sat Lisa down and as a physician explained the problem and what we could do to fix it.  I find that many patients have had little information given to them in these circumstances.  After the wrinkles have been left in place for several months, it is much harder to resolve the problem.  I explained to Lisa that I expected her to have a fairly long recovery with temporarily worse vision before  improvement," notes Dr. Stahl. 

    Now Lisa is seeing well again, her vision has returned to 20/20, but she wonders what would have happened if she hadn't seen Dr. Stahl when she did.  She is not alone in wondering that, patients from all over the country are starting to speak up about similar experiences (CNN Article 2003, Imagine Your Health Article 2002).  She admits that she had misgivings about going to the first center, "I realize now that I didn't chose well, they were not nearly as thorough or professional as Dr. Stahl.  I just hope this helps others not make the same mistake."

     Jay B. narrowly avoided problems when he walked out of the center just before his surgery.  He had visited a discount center in Cincinnati, and a doctor that examined him told him he was a great candidate for LASIK surgery.  Then he met with the refractive councilor and the $299 advertised price quickly escalated has he found out that he would pay extra for a higher prescription, eye exam, drops, follow-up visits, and any enhancements he needed.  "It is really deceptive, they are not really any cheaper than other places when you add it all up," he found.  High pressure sales tactics and bait and switch advertising has drawn criticism from the Washington Post and others.   Jay was in for more surprises the day of his surgery.  "When I arrived at the center for my surgery, the surgeon walked in and said that my corneas were a little thin and that he wanted to do PRK instead of LASIK.  I had never met or spoken to this guy before, and now he was telling me he wanted to change the surgery at the last moment," Jay remembers.  "So I walked out, that was the last straw.  I wanted to see someone reputable before I did anything." 

    As it turns out, Jay had more than just thin corneas.  His corneas were showing signs of irregularity that sometimes can turn into a disease called keratoconus.  "I remember meeting Jay on a Thursday evening, I looked over his test results and examined his eyes.  Jay had several signs that can be precursors to keratoconus.  We  call it forme fruste or pre-keratoconus at this stage.  I explained to Jay that he was a poor candidate for refractive surgery and was at high risk for losing vision with laser vision correction," Dr Stahl said.  Some cases of pre-keratoconus can be subtle and hard to detect, but Jay's was pretty clear-cut according to Dr. Stahl.  Jay's corneas were thin, the surface was irregular, and Jay's vision was poor even with glasses.  When you put the picture all together, Jay is very glad he didn't proceed with surgery.  "It just isn't fair, I had already paid for my surgery, and now they will only give me a partial refund," Jay complains.  Jay's case points out several of the weaknesses of the discount LASIK surgery model: patients don't get examined by the doctor who will do the surgery, contra-indications to surgery sometimes get missed, price pressure has made centers eager to do surgery on almost anyone, and many patients feel cheated when the price is often 3 or 4 times more than advertised and they only get partial refunds if they are not a good candidate.  Critics point out that this is bad medicine for everyone, doctors and patients.

    Jeff C. tells a similar story.  "I was all set for surgery, they told me I was a good candidate.  The only thing that stopped me from having surgery was that the surgeon was out for medical reasons the day I was to have surgery," Jeff told us.  But when Jeff went to see Dr. Stahl he got a very different response.  "Jeff is extremely farsighted, as much as +7 diopters.  LASIK for his level of farsightedness is not recommended for treatment by the FDA or any reasonable surgeon," Dr. Stahl told us.  If Jeff had proceeded with surgery he is very likely to have lost some vision and it might be very hard to correct afterwards.  "I think the best way to handle complications is to prevent them in the first place.  A part of that is turning 5 to 10% of people away from surgery if they are not going to be a good candidate," opinions Dr. Stahl.  Jeff like Jay is now unhappy with the discount center he first chose because they won't refund his money for his eye exam, eye drops, and medicines-- even though he was not really a candidate to have the surgery.  

      When Debbi W. suffered a cut on her cornea a couple of years after her LASIK surgery she called the center where she had her surgery.  "They told me they couldn't see me, that I would have to find some other doctor to look at my eye.  I felt angry and abandoned," she notes.  So she saw another doctor who started her on some antibiotics and noted that her corneas looked a little irregular.  "My vision hasn't been right and my night vision is very bad since they did my surgery.  When I finally insisted that they see me, the doctor told me there was nothing wrong.  He told me that I was the only patient in 12,000 that had any problems.  I looked right at him and told him he should publish that, because that surely would be a record.  They are so dishonest there.  After this, the other doctor I saw recommended I get a second opinion and recommended Dr. Stahl in Dayton."  When Dr. Stahl saw Debbi, he noted two problems, some corneal irregularities from her prior laser treatment and an infection of her lid glands that was disturbing her tear film.  "A recently approved technology known as wavefront offers hope and help for irregular corneas, and is now becoming available at select centers," says Dr. Stahl.  "But Debbi's more immediate problems needs nothing so elaborate.  She has a fairly common lid infection known as meibomianitis, and it is fairly easy to fix.  But you have to know to look for it, and with Debbi it had been overlooked for some time." Debbi echoes a familiar sentiment, and wishes she had never chosen a discount center.  "They weren't honest, they didn't do a good job on my eyes, and they wouldn't see me when I had problems."

     This year, more than a million Americans will have refractive surgery.  Complication rates are low in the right hands, but a recent Wall Street Journal article points out that as many as 15% of patients seeking surgery at discount centers end up unhappy. If you are choosing to have laser eye surgery this year, do your research and use good judgment in who you chose for your surgery.  Your eyes are worth it.