In my experience, finding a LASIK surgeon was a lot like buying a car: it combined a little excitement, a bit of confusion, a fast-talking salesman, and some not-so-subtle pushes toward the shiny and new automatic version versus the older, manual model.
Did I want extra safety features for an additional $350? What about a lifetime warranty? I desperately wanted to trade in my eyes, but, with so many options, I felt that it was in my best interest to shop around.
I have worn eyeglasses for most of my life, but, until this point, I had not given LASIK much consideration. In fact, before these consultations, I was not even sure if I were a candidate. Luckily, I found that my age, family history, refraction (approximately -4.75 D), and desire for spectacle independence made me a perfect fit for LASIK. It should be noted, however, that I am probably not a typical patient. As an editor for Cataract & Refractive Surgery Today, I have read my share of complicated cases, practice-management columns, and equipment reviews. At best, this background should have made me a well-educated consumer. Instead, I wondered if my knowledge about LASIK gave me a slightly unrealistic fear of endophthalmitis and torn flaps or a mistrust of having my surgery performed by anyone other than Stephen Slade, MD, CRSToday's chief medical editor. Whatever the case, I admit that I went into the consultations with extremely high expectations for every aspect of the process. Then again, from what I have read about exceedingly demanding patients, perhaps I am typical.
TLC VISION
My first stop was at a TLC Vision Center. One day after making an appointment online, I received a follow-up phone call from a woman at the center. She gave me a code to access the patient information area on the Web site and congratulated me for "taking the first step toward perfect vision." The surgery cost between $1,800 and $3,100 per eye, she said, and financing was available. Additionally, the surgeons were "some of the most experienced in the region, having performed more than 18,000 surgeries combined."
Several days later, I showed up for my first consultation with a slight sense of nervousness. As I walked into a typical-looking waiting room, I recalled stories from doctors who turned their waiting rooms into something resembling a high-end hotel lobby to help project the value of their product. The idea is that people want elective medical procedures to feel like a trip to the spa. This was obviously not that kind of place.
As I hung up my coat and sat down in the nondescript lobby, I felt more like I was waiting for the dentist. Several posters of Tiger Woods hung on the walls as a celebrity endorsement for the center, and stacks of educational material were placed near the chairs. After several minutes, a woman offered me refreshments from a corner of the room. My guess is that this was the center's attempt at pampering.
Although four patients had signed in before me, I was the only person in the waiting room. Once I received and filled out the appropriate paperwork, a technician took me to a small room to begin a series of eligibility tests. First was a topography test, which took several tries due to my dry eyes. Then came the keratometer and refractometer to read the prescription on my old glasses. Next, I was ushered into another dark, crowded room where I underwent a second topography and a wavefront scan. Lastly, the technician measured my corneal thickness, as we chatted vaguely about my work for an ophthalmic publication. Throughout the process, she explained what the test was and why it was necessary in determining my eligibility for LASIK.
I was then escorted down a long hallway lined with photographs of what appeared to be basketball players who had found great success at this particular center. Inside the examination room, the technician went over financing again: 1.99 for 18 months or 0 interest for 12 months. This would be the second of four similar conversations that occurred throughout my hour-long consultation.
We were then joined by a young, personable optometrist who performed a few more vision tests. Using a model of an eyeball, he began to explain the causes and treatments for myopia, astigmatism, and presbyopia. I was also informed of the pros and cons of having my corneal flaps created with the IntraLase femtosecond laser (Advanced Medial Optics, Inc., Santa Ana, CA) versus a bladed microkeratome. LASIK very rarely caused complications, the optometrist assured me, but, when problems occurred, they were associated with the use of microkeratomes. The microkeratome had been the standard for many years, however, and complications were extremely rare. Adding customized LASIK to my surgical package could ensure fewer postoperative aberrations no matter how the flap was created, he said.
Obviously, adding these two technologies to my surgery would cost more, but it would also guarantee me better visual outcomes. "How can you put a price on something you use every day of your life?" the optometrist asked. Furthermore, if I upgraded to customized wavefront-guided LASIK with the FS IntraLase laser, touchups would be covered in the original cost of my surgery. He reassured me that I would not pay all of that money only to have mediocre vision in 5 years. (According to the staff, more than 95 of patients choose the customized LASIK procedure.)
My meeting with the optometrist lasted almost 30 minutes. I appreciated not feeling rushed, and he gave me the impression that he valued me as a patient. The lackluster lobby was easily forgiven, as I was filled with a sense that this man cared about my vision and my desire to wake up in the morning and read an alarm clock. The personalized attention and detailed answers to my questions built a trust for the product and the center.
At the end of my consultation, I was directed to the financing and payment department. My counselor handed me a sheet that clearly broke the costs down by the various procedures (Figure 1). Because I have eye insurance, I was offered a 15 discount, cutting the $2,700 price tag to $2,300 per eye for customized wavefront-guided LASIK, or from $2,125 to $1,800 for traditional LASIK (ie, microkeratome, no IntraLase). Meanwhile, the optometrist stayed in the room to answer questions. I would like to think that this was because the staff was dedicated to thorough patient education and complete customer satisfaction, but instead I got the feeling that maybe it was just a slow day.
When I discussed a concern over the cost, the optometrist even offered a cost-cutting solution. If I had to decide between adding the IntraLase or customized LASIK to my package, I should go with the latter, he said. As soon as the optometrist left, however, the counselor told me he had traditional LASIK with great results. "Your existing aberrations were low (0.13 for the left eye, and 0.9 for the right), so you could probably get away with traditional LASIK," he told me. If I did not like the results, I could always come back in for a second, customized procedure and pay the difference, he added.
Although I appreciated the flexibility of having several choices, I was a little concerned that the financial counselor, who probably had a business degree, was giving me medical advice.
Postoperative care included visits at day 1, week 1, and months 1, 3, 6, and 12 as well as any touchups. If I moved, I could visit any TLC center in the US for this service, which requires a yearly eye examination to remain valid.
After all of my questions were addressed, I told the counselor I could not commit until I had a second opinion at the local LasikPlus. He seemed disappointed that he had not closed the sale, so I tried to give him the last word. "Is there a reason I should not go to the other facility, that perhaps their technology, customer service, or pricing was not as good?" I asked.
I was surprised to see that this line of questioning threw him off. John admitted he was not familiar with the chain's technology, but, by this point, he seemed unfazed at the suggestion of a second opinion. "Get comfortable about your decision," he said, before shaking my hand and showing me the door.
LasikPlus
Several days later, I ventured a trip to the local LasikPlus. As with my initial contact with TLC, I had made an appointment online and had received a follow-up phone call. I almost laughed out loud when I walked into the waiting room and saw a swank lobby filled with fresh flowers, shelves of awards, and a huge coffee bar. Staff mingled with the dozen or so patients scattered throughout the various sitting areas. There was a sense of excitement in the air, and I realized I had come in on surgery day. Compared with the bland environment at TLC, the atmosphere in the lobby made me feel like this was the place to be!
As I browsed through a book of handwritten thank you notes from satisfied patients, I eavesdropped on the conversations of patients sitting nearby. "I'm really afraid I'm going to blink during surgery," one man said to his mother and sister. Both assured him that this was not possible and teased him about his nervousness. "You're going to love it!" they gushed. It seemed that LASIK was a family affair for this group. "It's easy and quick. You won't even have time to worry," the his sister told him. Meanwhile, the staff began congratulating a man who had just undergone PRK. Unlike the women beside me, he definitely had not experienced the "wow" factor.
"Congratulations!" said one technician. "How did it go?"
"Eh, OK, I guess," he replied as he walked out the door while complaining of burning eyes.
A nervous and grinning technician who had been watching the scene quickly approached me and escorted me into various examination rooms for the same tests I had undergone earlier that week at TLC. It all felt very familiar, so I was not surprised when I was again proclaimed a perfect candidate. Next, I was given drops to dilate my eyes and sent back out to the bustling waiting room to give them time to work. This test had not been performed at TLC, and it was supposed to help determine my pupils' size, the technician explained. Another smiling technician handed me a portable DVD player with a 10-minute educational video covering every detail of the process. Once again, I was impressed with the streamlined efficiency that the center maintained during the consultation process. Still, there was a lack of personal attention in the place that made me a bit wary. The sense of value—perhaps instilled by the fancy lobby and high-tech gadgets—was mixed with a feeling that I was merely a cog in the wheel.
Soon, I was shuttled to the final examination room where an overly perky optometrist greeted me. "Great news!" she said. "I've looked over your test results, and you are one of the lucky patients who qualifies for IntraLase—the best procedure in the industry!" I could sense the up-sell from a mile away. Without missing a beat, she asked me how soon I could schedule my surgery, handed me a prescription for an antibiotic I was to use pre- and postoperatively, and bounced back out the door. Unlike my consultation at TLC, there was no discussion of my alternatives, no time for my questions.
I approached another technician at the front desk who began to discuss pricing. My planned treatment would include a customized wavefront-guided IntraLase procedure, she told me, as if reading an official prescription from a doctor. I was surprised that, although I was given a chart of available laser treatments including IntraLase or traditional, I was not given any option to make an educated choice for myself (Figure 2). I pressed the issued with the woman.
"Do I have to have IntraLase, or could I just get customized LASIK with a microkeratome?" I asked.
She was unsure of how to answer.
"Um. Hold on one second," she said as she scurried away for several minutes before returning with a scribbled drawing on a piece of paper and explained something convoluted about the shape of my cornea and visual disturbances. I did not really understand what she was saying, but I am pretty sure she did not either. I think that the gist was that I could have IntraLase at an additional cost of $300 per eye or nothing at all. "Unfortunately, the optometrist was too busy to explain it herself, but she thought this drawing might help," the technician said.
Now, I completely understand the benefits of the IntraLase technology. In fact, if I were to have LASIK performed, I would probably fork over the extra cash to have all-laser LASIK. I did not, however, appreciate feeling forced into the decision, especially because only 4 days earlier I had been told that, although it was the best, the IntraLase was only one of several good options available to me.
Despite the small setback with the technician and optometrist, I was excited to see that the total price for customized LASIK with the IntraLase was $3,908—about $1,400 less than the same treatment would cost at TLC.
I thanked the woman, and I assured her I would consider the information that was presented to me and would be in touch if I chose to have the surgery.
