Your Guide to LASIK Eye Surgery
Introduction - What influences the cost of LASIK?
As discussed earlier, most LASIK patients have never shopped for medical services, so comparison to the more familiar process of purchasing a new car can provide perspective.
If the only consideration were price, then the $9,455 Chevrolet Aveo would no doubt be a top selling car. Instead, the average vehicle sells for over $30,000, and many luxury cars top $50,000 due to a combination of technology, performance, safety, reputation and reliability that buyers find attractive. The cost of LASIK varies for many of the same reasons.
When analyzing the cost of LASIK, it is first necessary to clearly define exactly what is included in the price and then to understand the factors that influence LASIK prices.
What's included in LASIK prices?
Preoperative exam: A preoperative examination is an obvious necessity. However, some discount centers charge separately for the examination in order to quote a lower price for the surgery, so it's important to verify that the preoperative examination is not an extra charge.
The procedure: LASIK, IntraLASIK, PRK, LASEK or Epi-LASIK.
Antibiotic and anti-inflammatory eye drops: These can cost as much as $150 if not included.
Postoperative care: Again, discount centers sometimes itemize postoperative care separately, so it's important to verify that postoperative care is included and to document the duration.
Retreatments: A second procedure is often performed when the first one doesn't fully correct the vision. If not included, a retreatment could cost as much or more than the first treatment. Therefore, it may be wise to document the maximum cost of retreatment before making a commitment.
The factors that influence the cost of LASIK are numerous.
Office overhead: This includes rent, staff salaries and benefits, computers, telephones and other items of infrastructure. Perhaps the greatest source of variance is in personnel, as high-end practices often employ more costly certified ophthalmic assistants and certified ophthalmic technicians to assist in preoperative testing and surgery.
Supplies: Many disposable supplies are used in laser vision correction, including medications, sterile gloves, gowns and drapes, masks, shoe covers and microkeratome blades.
Insurance: With the present legal environment, even surgeons who have never had a malpractice claim must pay several thousand dollars a month for malpractice insurance, in addition to the cost of insuring their equipment.
Preoperative testing: Thorough preoperative testing is essential to identify risk factors and prevent problems. However, it is quite costly from a time standpoint, and the level of detail varies considerably among practices.
Equipment: The instruments used for important tests such as corneal topography, corneal pachymetry, keratometry, tear film analysis and pupil size are available at different price points. For example, some surgeons measure nighttime pupil size by turning off the room lights, holding a piece of paper with small black circles of known size next to the eye, shining a small flashlight on the eye and visually estimating the pupil size to the nearest millimeter. Others spend thousands of dollars on sophisticated instruments that measure to the nearest 1/10th of a millimeter under rigorously controlled lighting.
Surgeon provided care: In traditional private practices, the surgeon provides comprehensive patient care. The process begins with a consultation that includes preliminary tests and a one-on-one discussion with the surgeon. If the results look promising, then the next step is a comprehensive examination with the surgeon and another one-on-one discussion of the results. If surgery is advisable, continuity of care is maintained, as the surgeon performs the procedure and provides the postoperative care.
Because a surgeon's time is valuable, business-oriented discount centers have cut costs by eliminating the surgeon from most of the process. The initial consultation, preoperative examination and postoperative care are delegated to others. Quite often, the only time the patient ever sees the surgeon is under the laser for the procedure itself. The surgeons in these centers are typically employed as independent contractors and paid on a per-case basis. Known in industry lingo as "shooters", many of these surgeons travel between offices and perform surgery for multiple centers.
Lasers: The excimer lasers used in laser vision correction are expensive, with a price range of $300,000 to $400,000. Maintenance contracts cost around $50,000 per year, and periodic upgrades are often priced in excess of $100,000. Therefore, practices that invest in the latest technology typically charge higher fees.
Royalty fees: With the exception of NIDEK, all laser manufacturers charge the surgeon a per-eye royalty fee for use of the laser. For conventional treatments, these fees range from $100 to $150 per eye, and custom treatments are more costly, usually around $250 per eye. In a large part due to the lack of royalty fees, the NIDEK is the favorite laser in discount centers.
Advertising: Most practices with significant surgical volume advertise heavily, with monthly advertising budgets of $10,000 to $100,000 or more. Depending on local market factors and the success of a particular campaign, advertising can account for $100 to $300 of the per-eye procedure cost.
Custom wavefront technology: Custom wavefront-guided laser treatments are one of the main reasons for an uptrend in LASIK prices over the last few years. In addition to the higher royalty fees associated with custom treatments, practices that offer wavefront technology must invest approximately $75,000 for a wavefront analyzer and as much as $150,000 for laser upgrades related to wavefront technology.
Intralase: Increased use of the Intralase laser for creation of the LASIK flap is another reason for the uptrend in LASIK prices. The Intralase laser is enormously expensive (about $425,000) and requires its own $40,000 annual maintenance contract, as well as a $160 per-eye fee for the glass cones used in the procedure. Not surprisingly, practices that invest in Intralase must charge more to offset the cost of their investment.
Perhaps it is a testament to laser vision correction's high rate of success that some patients shop for discount surgery. After all, who shops for discount heart or brain surgery? More likely, bargain shopping is simply due to a lack of familiarity with the many factors that influence prices, which can lead to the erroneous assumption that all providers are the same. Once again an automotive analogy will help provide proper perspective on prices.
Look at the big picture: Almost everyone is excited to drive home in a new car. Unfortunately, by the time the car leaves the dealer's lot, it has depreciated by more than the cost of quality LASIK, and it will continue to lose value for many years to come. What's more, some relatively frivolous options cost more than the difference between low-end and high-end LASIK. After all, wouldn't it be better to forgo the $995 chrome package on a new Ford Fusion and instead upgrade your eye surgery to the highest standards?
LASIK provides long-term value: Unlike automobiles, which continuously lose value, laser vision correction is an investment in better vision that leads to tremendous long-term savings over eyeglasses and contact lenses, in addition to the lifestyle benefits that have made it so popular.
You get what you pay for, so use common sense: Sure, it is possible to get a good deal on a $56,000 Lexus, just like it is possible to find a nice price on a $9,500 Chevy Aveo. But you can't buy a new Lexus for $9,500. Nor can you find surgeon-provided care, detailed preoperative testing on top-shelf instruments, an Intralase flap, and wavefront-guided custom laser treatment for bargain basement prices.
LASIK is eye surgery. The only thing to consider is what is best for your eyes. There are millions of ways to save money that are better than having cheap eye surgery. Granted, LASIK is popular in part because results are generally very good, regardless of surgeon or center. But make no mistake, state-of-the-art technology in the hands of an experienced, conscientious surgeon produces better vision than outdated technology in lesser hands.
Find the best surgeon and finance, if necessary. When comparing apples to apples, the price difference between surgeons is usually small. However, if faced with a decision between a more experienced surgeon with a higher price and a less experienced surgeon with a lower price, always choose the better surgeon and obtain financing, if necessary. Virtually all LASIK practices offer financing and even at high-end providers, monthly payments are quite affordable.