Patients eye costs of laser surgery

Sunday, April 30, 2000 | 10:28 a.m.

Armed with billboards and newspaper advertisements, laser eye surgeons are waging war across Southern Nevada in a fight that's pitting independent physicians against flashy corporate-run eye centers.

The battle turf is LASIK, a state-of-the art procedure that can restore perfect vision to less-than-perfect eyes in a matter of minutes.

LASIK stands for "laser in-situ keratomileusis." It's a three-step procedure in which tissue around the cornea is removed to correct vision. The surgeon lifts a flap of lens off the cornea, removes the tissue with the laser and replaces the flap.

The procedure takes about 15 minutes for each eye, and the flap re-attaches itself in minutes.

It's popular, expensive and not covered by most insurance plans. And at costs of $1,500 to $2,500 an eye, the procedure typically has been out of reach for many people.

Until now.

A handful of national and international corporate-owned chains of LASIK surgery centers are infiltrating the Las Vegas Valley marketplace offering the procedure at half the historical costs.

Full-page newspaper advertisements run nearly every Sunday, offering deals of $1,000 LASIK procedures to a center's first 1,000 customers or $750 discounts to patients who bring the newspaper ad to their first appointment.

The ads and their claims rankle independent ophthalmologists who have incorporated LASIK into their private practices as an option for their patients. They accuse the centers of making an assembly line out of serious surgery.

"I think it's unethical that LASIK surgery is being presented like a haircut. It's not a haircut," said Kurt Buzard, a refractive surgeon who opened his Las Vegas practice 15 years ago.

"The patient becomes a customer instead of a patient," Buzard said.

A patient who has to pay for an entire procedure out of his own pocket is a customer, and he deserves quality at a fair price, said James Watson, executive vice president of LASIK Vision Corp.

Watson's Canada-based company has opened six of the nine centers they plan to build in the United States. The company's lower prices were drawing many U.S. patients to Canada for eye surgery, so they crossed the border to offer those patients the follow-up care they need, he said.

LASIK Vision is opening a 10,000-square-foot surgery center in Summerlin May 1. They've been advertising in local newspapers for almost a month, offering $1,000 procedures to the first 1,000 patients.

"Sacramento and Anchorage just blew us away," Watson said. "We're the laser vision correction company of the masses because of our price point."

At least 500 people already have made appointments, Watson said. He expects 1,000 people will be booked by opening day, based on the openings in other U.S. cities.

Las Vegas resident Bonnie Chen had LASIK to correct nearsightedness April 6.

"I've been waiting for this for years. It was terrific. I had surgery at 2 p.m., and I laid there and kept my eyes closed for two hours," she said. "I went out to dinner that evening where they had the menu mounted on the wall, and I read the menu."

She said her eyes felt a little scratchy for a few hours, but she has had no other discomfort. The typical follow-up period lasts three months.

Patients also may need "enhancements" every few years as their eyes change -- just as eyeglass or contact lens wearers need new prescriptions, but not as often.

Still, not all people are good candidates for LASIK surgery. Some problems can't be adequately corrected. Other variables, such as the thickness of the cornea after surgery, also come into play.

And there can be complications, such as dry eyes, a wrinkle in the lens flap or debris that slipped under the lens flap, that may need additional attention.

It's these pre- and post-operative examinations and complications that make independent surgeons like Buzard skeptical of the cheaper centers and their advertising claims.

Some people may schedule an appointment for the $995 special only to find out they have an astigmatism that costs $1,400 to fix, he said.

"The problem is not the low price. The problem is unethical conduct," Buzard said. "There's bait-and-switch (advertising) and 'lifetime guarantees.' What does that mean? What if the guy gets cataracts?"

He likened the cheaper, quick-fix claims to fast food.

"The more unrealistic the offer, the less likely it's an offer at all. It's more of a deception," Buzard said. "I think I would be very wary of going to Burger King to get my eyes fixed."

Jon Siems is an ophthalmologist who left California to open the Laser Vision Institute in Las Vegas about two months ago. The center, owned by Laser Vision Institute of Lake Worth, Fla., has been offering LASIK to its first 500 customers for $995.

"It's a fairly competitive market right now," Siems said. "It's pretty fierce."

That market is what lured Siems from Southern California, where he says "there's a dedicated laser center every six blocks." He has performed about 400 surgeries since opening the center in Las Vegas.

"There really weren't any centers dedicated to it here," said Siems, who has been doing the procedure since 1996. "People should be treated at centers where that's all they do, and they have lasers running every day."

There are a lot of choices out there -- more every few months, it seems. And people need to be careful about the choices they make. Not all surgeons are the same.

Chen, an optometrist, said she chose her surgeon by his credentials. He is an independent ophthalmologist to whom she refers her own patients, and he is a corneal specialist.

"There are a lot of people to choose from, but not every one is a corneal specialist," Chen said. "Once you get your medical license you can pretty much practice whatever you feel comfortable practicing."

Larry Lessly, spokesman for the Nevada Medical Examiner's Board in Carson City, said the board licenses physicians but not their specialties. It doesn't track or regulate the lasers ophthalmologists add to their practices.

"A lot of these lasers are leased and are brought to the surgical centers on the days they are used. There are all kinds of combinations on that," Lessly said.

Price does not determine quality. Even a high-priced surgeon can make mistakes or lack experience, said Kent Wellish, a corneal specialist and refractive surgeon who incorporates LASIK into his independent Las Vegas practice.

Patients have a right to ask how much training a surgeon has had and where it took place, Wellish said. And they should be wary of doctors who claim proficiency after only a few days of training.

"They take a weekend training course, and suddenly they're a world expert," Wellish said. "Be very, very wary of exotic claims."

Wellish sees the outcomes of those claims. An increasing number of people who chose their surgeons solely on price have come to him to fix the complications they had after the procedure.

"A year ago I saw about one patient a month like that. Now I'm seeing three to four people a week," he said. "They're drawn in by very sexy advertising, but the problems aren't being addressed."

Patients should look for a center or physician's office where all pre- and post-operative examinations are done by a doctor, not a technician or office assistant, he said.

The complications he sees vary with every patient, but there is one recurring theme among them.

"A lot of these people didn't meet their surgeons until the day of surgery," Wellish said. "You need to know your doctor. In some of these places everybody wears a white lab coat. Everybody looks like a doctor."

Buzard doesn't want to treat people who come to him with complications they received from one of the less-expensive LASIK centers. He doubles his fee for such work and refuses to do enhancements later.

"We're not terribly interested in seeing other people's complications," he said. "It's much more complicated fixing someone else's problems."

Buzard said the cost-cutting measures some centers take can result in complications. For instance, he recommends drying the lens flap for 3 1/2 minutes before replacing it to make sure there's no debris underneath.

Debris under the flap can cause distortion later. But waiting 3 1/2 minutes per eye can put physicians behind schedule, if they have to do several LASIK procedures a day, Buzard said.

Another cost-cutting measure is not changing the laser blades between each patient because the blades cost $50 to $80 each, Buzard said. Some surgeons reuse them.

"There are a lot of ways to cut costs, but I don't want to do that," Buzard said. "It comes down to quality of care. You get what you pay for."

But many people are paying too much, said Watson, of LASIK Vision. The Canadian company was able to cut its prices because they pay no referral fees to optometrists and no fees to laser manufacturers.

Independent surgeons often have referral fee agreements with optometrists, who are basically losing a patient each time they make a referral for LASIK, Watson said.

"We changed the business model," he said. "Our number of procedures doubled."

No matter how popular LASIK has become, many large health insurers aren't likely to add extensive coverage of the procedure in the near future.

"It falls into the category of plastic surgery. It's not medically necessary," said Jenny DeVaux-Oaks, spokeswoman for Sierra Health & Life, Nevada's largest health plan provider.

Vision Service Plan, a California-based eye care insurer with 3 million members nationwide, began offering 20 to 25 percent discounts for LASIK in January, company spokesman Jim Caster said.

"We knew this was an up-and-coming trend, and we've also had some members request it," Caster said.

For the foreseeable future most people who choose LASIK will be paying for all of it themselves. And Wellish cautions people to look at more than the price tag when they're choosing a surgeon and clinic.

"You have to ask, 'Is this the person I want to trust my eyesight with?' " Wellish said. "You have to ask, 'Am I being educated or am I being sold?' "

Susan Snyder is a staff writer for the Sun. She can be reached at (702) 259-4082 or by e-mail at snyder@lasvegassun.com.

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