2. THE LASER VISION CORRECTION MARKET



2-1. Who is a candidate for laser vision correction?

Most people who wear glasses or contact lenses are potential candidates for laser vision correction. But many of these people are perfectly happy wearing their contact lenses or glasses. Those people should continue to wear their glasses or contact lenses, rather than having an operation. Laser vision correction should be reserved for those who cannot tolerate their glasses or contact lenses, or find them inconvenient.

2-2. What if I don’t like to use glasses or contact lenses when I am playing sports?

Sports are among the most common reasons people have for choosing laser vision correction. Many amateur and professional athletes have had LASIK or PRK, and most are extremely happy with the results.

2-3. How many people in the United States are candidates for laser vision correction?

Of the 275 million people in the U.S., about 151 million use corrective lenses; 110 million use glasses and 41 million use contact lenses. Most of these people are candidates for laser vision correction, although less than 10% have had laser vision correction at this time.

2-4. How many are nearsighted, farsighted, or presbyopic?

Figures may vary, but of the 151 million people who use corrective lenses, roughly 80% are nearsighted and 20% are farsighted. Many of these people are also presbyopic. That is, they need glasses in order to read. Over the age of 43, nearly everyone, whether or not they have used corrective lenses in the past, starts to develop presbyopia.

2-5. Among people who have laser vision correction, what percent is nearsighted, farsighted or presbyopic?

About 80% of people who have laser vision correction are nearsighted, or myopic. Most are in the -2.00 to -6.00 diopter range. Of course, laser vision works well for smaller or larger amounts of myopia. About 20% of people who have laser vision correction are farsightedness. Most are in the +1.00 to + 4.00 diopter range. Very few people have laser vision correction for presbyopia. But about 5 or 10% of people over age 43 elect to have monovision, that is, one eye corrected for distance and the other for near.

2-6. Are men or women more likely to have laser vision correction?

Sixty percent (60%) of people who have laser vision correction are female, and 40% are male.

2-7. What is the average age for laser vision correction?

The average age is about 40 years old.

2-8. What is the average income?

The average income is $88,000 a year.

2-9. Which procedure do people choose to correct their vision?

Ninety percent (90%) choose LASIK, 5% choose PRK or LASEK, 4% choose intraocular lens implants, and less than 1% choose IntacsŪ. Conductive keratoplasty, or CK, a thermal procedure for presbyopia, is gaining in popularity, but it is too new to quote actual figures.

2-10. How many lasers and laser centers are there in the U.S.?

There are about 2,000 excimer lasers in about 1,500 laser centers across the U.S. About 1,200 of these centers are owned by doctors or other individuals, and about 300 are owned by corporations.

2-11. How many LASIKs are performed in the U.S. every year?

About 1.5 million eyes have laser surgery each year.

2-12. Is LASIK gaining in popularity?

Yes. More and more people know someone, often more than one person, who has had successful LASIK. This diminishes the “fear factor,” and convinces more people of the benefits of LASIK.

2-13. Is it better to have laser vision correction at a private or corporate center?

Both have advantages and disadvantages. Doctors usually have more control over how things are done in a private laser center. Business people usually determine the policy in a corporate center. Corporate centers may be able to offer greater discounts, but, usually, private centers are competitively priced. Corporate laser centers tend to do more high profile and sophisticated advertising. However, corporate centers are more likely to employ a variety of ophthalmologists and optometrists, and pay them a fee for each case. Thus, the relationship between the doctor and patient may not be as strong in a corporate laser center as it would be in a private center.

2-14. What about the doctors in corporate versus private laser centers?

You may find good doctors in both corporate and private laser centers. Some corporate centers employ doctors who have recently finished their training, or have not built up their own practice. Others employ highly experienced doctors. Some corporate centers use optometrists to screen patients and deliver pre and postoperative care. Private offices are more likely to have the surgeon provide pre and postoperative care.

2-15. Where will I receive the best operation, a corporate or a private laser center?

The results of laser vision correction usually reflect the skill of the surgeon and the quality of the staff at the doctor’s office and at the laser center.

2-16. Which type of laser center is more likely to be available if I have a problem after surgery?

The individual laser center tends to have more longevity. Some corporate laser centers have gone out of business after a short time. Others have closed their centers in some cities and retained their centers in other cities. Corporate laser centers are more likely to employ multiple doctors who may or may not stay for many years. Individual laser centers have more stability. If your ophthalmologist is expected to be in practice during the foreseeable future, he or she will most likely be available to handle any problems after laser vision correction.

2-17. What about laser centers that advertise?

Most surgeons who perform laser vision correction advertise. That is the way they let people know about the services they offer. But as with other services, be wary of advertising claims. Some advertisements are misleading. Some promise things they cannot deliver. We may not be used to seeing misleading advertising in medicine, but as with other commodities, advertisements are meant to promote sales.

2-18. What kinds of advertising claims are usually exaggerated?

One of the most common is price. Do not be fooled by the low price advertised in big print. Be sure to read the fine print. Extra charges may, and usually do, apply for astigmatism, unusual corrections, preoperative visits, followup care, and medication. 

2-19. What are co-management fees?

These are fees for followup care charged by the optometrist who referred a person for laser vision correction to a surgeon. The average co-management fee is about $300 per eye, or 20% of the entire surgical fee. The co-management fee covers pre- and post-operative management by an optometrist.

2-20. Can the followup care be done by the surgeon who performed the procedure?

Yes. Co-management is a somewhat unusual arrangement. It may be justified by the fact that the optometrist referred the person for surgery. Some people may be more comfortable with followup by their optometrist than by the surgeon. Most prefer followup by the person who actually did the surgery. Co-management implies that the surgeon and optometrist have a relationship, and the nature of that relationship is financial. There may be nothing wrong with co-management of laser vision correction, but it is important for the person having surgery to understand co-management.

2-21. Is the ophthalmologist or the optometrist better qualified to perform the followup care after laser vision correction?

Most ophthalmologists and optometrists would probably agree that an ophthalmologist trained in laser vision correction would be better qualified to do followup care. On the other hand, optometrists who have been trained in followup care may also do an excellent job. Under ideal circumstances, any surgeon should do their own followup care. However, if convenience or availability makes it more practical for a well-trained optometrist to do followup care, it is a reasonable alternative.

2-22. Is it true that Tiger Woods, and other celebrities, have had laser vision correction?

Many celebrities, including numerous professional athletes, have had laser vision correction. The celebrities who promote laser vision correction, and those who give testimonials, frequently have financial arrangements with the doctor who performed the surgery, or the laser center where the procedure was performed. These financial arrangements include discounted surgical fees, free surgery, or, in the case of very prominent celebrities, millions of dollars in endorsement fees paid by the corporate laser centers. Testimonials for laser vision correction are similar to testimonials for other products. No matter how sincerely your local radio talk show host praises the doctor who did his or her laser vision correction, remember that they are getting paid handsomely for their endorsement, and they probably had their LASIK done at no charge.

2-23. What do you think of infomercials?

Infomercials may contain some useful information that can help you become better informed about LASIK and other vision correction procedures. Many infomercials contain testimonials from satisfied patients. You are unlikely to see testimonials from unsatisfied patients. Some patients who appear in infomercials may have received discounted or free surgery. Some may be paid for their endorsement. Keep in mind that infomercials are a form of advertising. It is helpful for us to be as skeptical about this form of advertising as we are of other forms of advertising.

2-24. How do most consumers learn about LASIK?

A Harris poll showed that 68% of people learn about LASIK from an ophthalmologist or optometrist, 53% from a family member or friend, 34% from the media, 31% from advertising, and 18% from a medical or health association.

2-25. What is the best way to evaluate an advertisement for LASIK?

All advertisements, including LASIK advertisements, are supposed to be truthful and not misleading. Yet many ads, intentionally or unintentionally, contain false or misleading information. One should be cautious about ads that make exaggerated claims or promise too much. Such ads may indicate that the surgeon is more interested in performing LASIK than in having a well-informed and satisfied patient.

2-26. What are some misleading words or statements that might be found in LASIK advertisements?

Terms such as “proven safe and effective, “permanent,” “throw away your glasses,” “stable,” “perfect,” “normal,” and “painless,” are considered misleading. Any “guarantee” of a visual outcome, such as 20/20, should be treated with great skepticism. Although the results of LASIK are usually very good or excellent, no one can guarantee a particular outcome.

2-27. Are there any specific claims in LASIK advertisements that are unlikely to be met?

The following claims should send up a red flag:

• “…quick and pain-free way to eliminate your need for corrective lenses.”
• “The world’s most advanced ophthalmic lasers.”
• “The only 3D Eye Tracker to treat a lifetime of nearsightedness, farsightedness, and astigmatism.”
• “…opinion leader…pioneer…wrote the book on LASIK…International expert.”
• “Can virtually eliminate potential complications.”
• “Ask about our ‘no glare, no halo’ technology.”
• “CK is a noninvasive procedure…No hassles. Just crisp, clear vision.”
• “We guarantee 20/20 vision.”
• “Most of our patients see better than 20/20 after LASIK.”

2-28. What if the advertisement mentions a high percentage of success with LASIK?

If a high success rate is mentioned in an ad, the doctor who placed the ad must be able to back up the statement with data. Keep in mind, that success can be defined in different ways. For example, the doctor may consider a visual result of 20/30 successful, but if the patient is not happy with 20/30 vision, the procedure can hardly be called a success.

2-29. How can some doctors and laser centers advertise LASIK at a deeply discounted price?

Usually, the deeply discounted price is an advertising ploy. The true price is often much higher than the “teaser rate.” The deeply discounted rate may not include the initial consultation, topography, followup visits, co-management fees, laser facility fees, retreatments, and so forth. The low rate may only apply to a narrow range of corrections. If someone has even the tiniest bit of astigmatism, and almost everyone has some astigmatism, the discounted rate may not apply.

2-30. Is financing available for LASIK?

Most LASIK centers offer financing. A monthly fee is paid, usually over 6 to 24 months. Interest charges vary. Some centers have 0% financing.
2-31. Is “flex spending” available for LASIK?

Flex spending is offered by many employers. It allows pre-tax earnings to be placed in a special account, and used to pay for LASIK, and other medical benefits. Sometimes, the cost of LASIK can be spread over two years of flex spending by having LASIK in one eye in December, and the other eye, in January.

2-32. What about money back guarantees and lifetime guarantees?

These terms are not considered appropriate for LASIK advertising. LASIK is not something that can be returned, or exchanged, like a watch or a sweater. It is unlikely that the LASIK fee will be refunded, and of course, the surgeon may not be in practice when the refund is requested.

2-33. Can one believe the claim that the doctor has done several thousands of surgeries?

It is common for surgeons to exaggerate the number of cases they have done. Sometimes, a surgeon claiming to have performed thousands of cases will include all eye surgeries performed, whether or not they were LASIK cases. Some advertisements mention the number of procedures performed by the laser center, or the chain of laser centers, rather than the individual doctor. Sometimes, a surgeon who has performed thousands of cases will turn cases over to a less experienced surgeon who has done far fewer.

2-34. How does one evaluate claims that the doctor “pioneered,” “invented,” or “wrote the book” on LASIK?

Such claims should be taken with a grain of salt. Many surgeons have an exaggerated opinion of their contributions to laser vision correction.

2-35. How does one evaluate claims that a certain doctor has a unique LASIK technique that is superior to other techniques?

Most laser vision correction techniques are available to all ophthalmologists. While surgical techniques may vary from one doctor to another, most surgeons use a very similar technique. Surgeons often evaluate a number of slight variations in technique and put a great deal of thought and preparation into the technique that works best for them.

2-36. How can one best protect oneself against false advertising in the LASIK marketplace?

The best way to protect oneself against false advertising is to become educated about LASIK. Having LASIK should be a carefully thought out decision. One can become educated by speaking with friends who have had LASIK, reading about LASIK in articles and on the Internet, and talking extensively with qualified health care professionals who are familiar with LASIK.