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By Lauren Paris
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After receiving post-operative instructions and having his eyes checked one final time, Paul Groer goes under the laser. It's 9:13 a.m.
A doctor and two assistants hover over Groer, whose eyelids are held back to keep him from blinking. A thin cloth covers his face, except for his left eye, which has been numbed with eye drops, and a surgical hat covers his hair. Lying flat, his hands are crossed at his belt. He looks fairly relaxed.
The computer-aided laser looks like an oversized copier with an arm extending over Groer's head. A close-up of his left eye occupies all of 19-inch TV screen on top of the machine. But before the laser goes to work, a metal instrument fitting over the eye cuts a circular, thinner-than-paper layer of Groer's cornea leaving a hinge so it can be put back into place.
Then the laser -- firing rapidly and emitting a clicking noise -- vaporizes some of his cornea, changing its shape and therefore improving Groer's limited ability to see distances. It takes less than one minute per eye as Groer is careful to stare directly at the intermittent red beam.
By 9:23, it's all over.
Afterwards, Groer, 49, sits with his eyes closed in a brown recliner outside the surgical room. The Florence resident and owner of four McDonald's franchises, with two more to come, had been thinking about getting laser eye surgery for a few months. After 30 years of wearing contact lenses, he was fed up with their maintenance and hassle.
So, after driving by Dr. David Schneider's sign on U.S. 42 in Florence a few times and hearing about the Lasik procedure from a few friends who received it, he made an appointment with the Midwest Eye Center in Tri-County, almost on an impulse. He did worry that something might go wrong with his one-and-only set of eyes, but he got over it.
"I guess you can say it went pretty well as expected," says the tall, dark-haired Groer, impressed at how pain-free the operation was and how well the staff prepared him for it.
Within a few minutes, he receives wraparound sunglasses and a fanny pack with anti-inflammatory eye drops, among other items, to aid him in healing. His vision is a bit blurry, but he can already tell it has improved significantly.
Then Groer walks out the door, heading for a few-hour nap to help his eyes begin healing. If all goes well, he'll play golf a few days later at a Terrace Park country club.
A Changing Operation
Hundreds of thousands of the 120 million American contact lens and glasses wearers have received the Lasik eye surgery in recent years. Decreasing prices and an expansion in the number of doctors who perform it have increased demand for the procedure, often promoted as a miracle-like operation.
Lasik surgery has its roots in RK (radial keratotomy), an operation involving several spoke-like incisions in the cornea's edge to reshape the eye's surface and improve vision -- but without a laser. Begun in the U.S. in the early 1980s, RK required months of healing, isn't very comfortable and isn't as precise at correcting vision as later operations.
PRK (photorefractive keratectomy) introduced the use of a laser on the eye in the late 1980s and became more widely used in the mid-1990s. It vaporizes a thin layer of the cornea's surface, but this procedure takes longer to heal than the Lasik method because it affects the cornea's surface. PRK is an increasingly rare operation, although it's still used.
Clinical trials on the Lasik method began in 1991 and widespread use began in 1997.
Although the operation is often compared to a miracle, it's not foolproof, nor is it for everyone. According to the Food and Drug Administration, previous eye surgery recipients, people under the age of 18 and people taking sumatriptan for migraines are some of those who aren't recommended for Lasik.
Plus, laser eye surgery can't eliminate a patient's need for glasses forever. For example, even if a 30-year-old has his farsightedness corrected, he might still need reading glasses after the age of 40, when many people begin to have difficulty focusing on close objects.
On average, fewer than 3 percent of Lasik patients experience some sort of complication from the surgery, such as halos around lights or multiple images. Sometimes they go away after a few weeks or months, but sometimes they don't.
"This is an extremely successful procedure, but expectations have to be tempered as well," said Glenn Hagele, founder of the nonprofit Council for Refractive Surgery Quality Assurance, a fledging organization that certifies doctors who perform Lasik and other vision-correcting operations. "It's not a 20-minute miracle. The most that refractive surgery can do is to reduce your need for glasses."
In other words, it isn't likely to improve your vision beyond what your glasses provide. It's a new operation with unknown long-term effects. And it's a permanent change to your cornea.
Where to Turn?
Increased competition for patients is leading more surgeons and clinics to advertise laser eye surgery. But people should use more than ads to choose a doctor -- it's not like buying a Chevy, Hagele said.
For one thing, he said, each model of a car is the same from dealer to dealer. And if you don't know much about the car, "you can go to Consumer Reports," but so far there's no such source for comparing laser eye surgeons.
Hagele suggested first checking with the state medical boards and county court records to see if the doctor had trouble in the past. But keep in mind the doctor could have migrated from another state.
After that, ask your optometrist for a recommendation and visit the doctor's office and get to know the staff.
The Council for Refractive Surgery's Web site (www.usaeyes.com) also offers a list of 40 questions to ask a doctor who performs refractive surgery. They include (with good answers in parentheses):
· How many procedures has the doctor performed in the last 12 months/total? (Not fewer than 250/500.)
· What percentage of patients has needed a follow-up operation? (Ten percent is a ball park figure, but the why is much more important than the number. The doctor should explain his/her philosophy of surgery.)
· Will the doctor measure the thickness of you cornea? (Yes, especially if you need more correction.)
Hagele also noted the doctor's price might or might not reflect their experience and technical skill, though it might reflect how much individualized attention and hand-holding patients receive.
Other groups to contact include:
· The American Society of Cataract and Refractive Surgery (www.ascrs.org).
· The American Board of Eye Surgeons (915-335-0077) offers certification for refractive surgeons.
· The non-profit Lasik Institute (www.lasikinstitute.org) is dedicated to promoting and educating people about the Lasik method of laser eye surgery.
· The American Board of Ophthalmologists (www.abop.org) is the lead certification board for Ophthalmologists, though it isn't tailored to those performing laser eye surgeries.
Jockeying for Position
A couple of years ago, the Lasik operation cost $5,000 to $6,000 for both eyes. And while independent doctors still charge an average of $3,000, two national chain clinics are charging as little as $2,000: LCA Vision and Lasik Vision, both located on Montgomery Road in Kenwood, the local Mecca for laser eye surgery.
The competition has spurred print and radio ads either promoting or de-emphasizing the procedure's price, depending on who's buying the ads, and attracting the scorn of independent doctors, who question how the chains can keep quality high and prices low.
LCA Vision's lone doctor, Vince Marino, charges from $995 to $1,495 per eye, depending on lens prescription and the level of service. About half of his patients pay the cheaper rate, which is up to $1,000 less than some other local doctors.
How do Marino and LCA do it? A high number of surgeries and cooperation with the 30 other LCA locations across the U.S. LCA's buying power nets the company discounts on lasers and other equipment, plus a better rate on advertising, said Tom Watson, LCA's president. Local specialists have a hard time competing with that.
But can LCA keep its prices low indefinitely? Schneider believes their goal is to drive down the local price of laser eye surgery so some surgeons stop performing it and then raise prices when the competition is thinned. If that doesn't work out, don't expect to see them stay in business, he said.
Watson said the price can stay low as long as enough people keep coming in the door.
"At (our current) price, we're not doing it at a loss," Watson said. "You certainly wouldn't expect them to be able to compete with us."
But what about the lifetime guarantee? With the number of patients LCA is treating, how can they keep both that promise and low prices?
That shouldn't be a problem, Watson said, because only about 8.5 percent of LCA's patients need retreatment.
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Photo By Jymi Bolden
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Dr. David Schneider (left, sitting) operates on Paul
Groer
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"The burden of giving these folks a lifetime guarantee is really minimal," he said.
Just down Montgomery Road is LCA's main competition, Lasik Vision, offering even less expensive laser eye surgeries. Based in Vancouver, Canada, it has 34 locations in the U.S. and Canada, according to Anthony DiPenti, the company's local director.
Lasik Vision stormed the local market a few months ago by offering operations for $995 (for both eyes)to the first 1,000 patients. The clinic received 10,000 calls in the first three days and opened June 26. Now Lasik Vision's standard rate is $1,998.
"We're very, very busy and pleased with the response," DiPenti said.
Local doctors who were used to renting a laser and charging $5,000 per operation obviously are going to find fault with LCA and the other chains who offer less expensive eye operations, he said.
"There are a lot of private (doctors) who are threatened by that," DiPenti said.
Improving by the Month
Anyone considering the operation should know the lasers and the surgeons are improving quickly and the lasers are becoming more specialized, Hagele said. Comparing first-generation lasers to recent models is like comparing a Chevette to a Mercedes.
The surgeon, however, is still the most important factor in the operation's success, according to Hagele.
"Our official position is the best laser is the one in the hands of the best surgeon," he said.
Schneider agreed, saying that only about 20 percent of the operation's success depends on the equipment. The rest is up to the skill of the surgeon. But there's always room for error, no matter the quality of the surgeon.
"You're using mechanical equipment here and nothing is perfect mechanically," Schneider said. "It's a life changing experience. ... It should be a very considered purchase for people."
Schneider recommends people go to the surgeon's office, get to know the staff there and ask questions.
"Let the buyer beware," he said. ©
