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Interpreting Advertising Claims
Discount LASIK
LASIK surgery charges vary greatly and are oftentimes advertised at what seems "too good to be true" pricing. Corporate LASIK discounters frequently advertise discount prices with small print restrictions. Those prices offered in the ad only apply to a limited group of patients who qualify for the "lowest advertised price." These patients typically have a very low prescription with no astigmatism. Most patients ultimately pay substantially more, thus being attracted to a "bait and switch" approach often used in sales.
When there are significant charge differences between local LASIK centers and a corporate LASIK discounter, patients should find out for themselves which laser technology will be used, and how these technologies differ. Because the technology used in LASIK is difficult to understand, patients often do not perceive the differences. The differences between a premium LASIK center and a corporate LASIK discounter are blurred by the perception that LASIK is a commodity, much like a TV or a refrigerator, and is all the same. This is far from the truth.
Excimer laser manufacturers require from the LASIK center additional upgrade and per/procedure fees for newer up-to-date technology, such as CustomVue with wavefront guided treatment options. Corporate LASIK discounters reduce their charges by using an Excimer laser that is less expensive to operate. The patient should know if they are receiving advanced technology custom wavefront guided treatment versus older conventional treatment. The patient should also ask whether their flap will be made with a conventional, hand-held mechanical bladed keratome or advanced technology IntraLase femtosecond computerized laser. Especially in the field of LASIK, technology is very important. Just as with computers, cell phones and HDTV constantly upgrading to new improved technology is expensive and much better.
In terms of physician involvement, the patient should also know that corporate LASIK discounters utilize their staff in an assembly line approach, relying on the lowest provider to conduct preoperative consultations, testing, and tentative clearance for surgery. Many times at a corporate LASIK discounter, you may not meet your surgeon until five minutes prior to having your LASIK procedure performed. Will you really have a chance to meet and get to know your surgeon in this time frame? Will your surgeon really have an opportunity to understand what your needs and expectations are? When other staff members perform pre and post operative care, this may relegate the LASIK surgeon to a position of an over qualified technician. The corporate LASIK discounter's national experience is irrelevant compared to the experience of the surgeon who will be performing your procedure. Corporate LASIK discounters may claim to have vast experience, but this is typically across the nation among all their surgeons. The doctor you may see, however, may not have the results and experience implied by the corporate LASIK discounter's promotions.
While LASIK is very low risk, it is not considered to be no risk surgery. If you experience a complication, will your original surgeon be there to identify and treat it? Find out if you will be seen and examined by your surgeon post operatively or will you be assigned to a less qualified staff member or Optometrist who was not there at the time of your surgery. Depending on the problem, this may have an impact on your results.
You also want to know exactly what the price includes. Are enhancements included? How long is the follow up? What are some of the add-on costs not described in the promotional ad? What kind of "customer service" should you expect? Will you be satisfied with the service provided at a LASIK "mill"?
The cost difference between a premium LASIK center and a corporate discounter should be considered fairly insignificant when averaged over a patient's lifetime. Price oriented advertisements should be viewed as a warning sign to proceed with caution.
What about "Lifetime Guarantees" and Direct Mail Marketing
Everywhere you turn there are LASIK centers advertising the "latest technology" or the "lowest price", offering "lifetime guarantees" or touting "most LASIK performed". This undoubtedly can be very confusing. When it's all said and done how do you determine where you have your procedure performed.
When considering a LASIK center, patients should realize in the beginning that the safety and results of the type of LASIK being performed at different centers are not all the same. At Moretsky Cassidy Vision Correction our goal is to provide you the information needed to help make the most educated decision possible in the selection of a LASIK center. Here are a few items to consider in your decision making process.
Community LASIK Centers
Moretsky Cassidy Vision Correction is owned and operated by the Doctors who are represented in the centers name. Dr. Moretsky and Doctor Cassidy involve themselves in every aspect of your LASIK experience from the initial consultation, pre-operative care, during surgery and post operative follow ups. Doctors Moretsky and Cassidy decide on the equipment, the staff and all issues related to patient care. They have been in independent practice here in the Valley for over 25 years and have established their practice as one of the top LASIK centers in the Southwest through direct involvement in every decision related to the care of their patients.
Corporate LASIK Centers
Doctors are employees of corporate LASIK centers. These doctors typically have little control or influence on how the center operates. They may travel back and forth to multiple locations to perform procedures, with limited involvement in the pre and post-operative care of patients at different centers. Because of the corporate structure, often surgeons are hired, fired, quit or go elsewhere. The surgeon doesn't typically have a high stake in the long term aspect of the practice. The operational protocols of these facilities are often dictated by corporate managers who answer to executives. The executives in turn report to stockholders who are interested in the bottom line, not primarily the patient.
"Lifetime Guarantees"
Some corporate centers also entice potential patients by offering a "Lifetime Guarantee". While this sounds very attractive, it can be misleading. "It's admirable for a clinic to provide a high level of commitment to its patients, however, the reality is what constitutes a lifetime and what is covered may be a matter of contention and circumstance," says Glenn Hagele, Executive Director of the Council for Refractive Surgery Quality Assurance (USAEyes.org), a nonprofit patient advocacy that evaluates patient outcomes and certifies LASIK doctors. For example here in the Valley, what about national LASIK centers, such as Icon, Axis or Luna that performed LASIK on patients who opted for a guarantee, but then closed their doors and shut down their business?
One such national corporate LASIK center's "lifetime warranty" has raised Wall Street concerns after a review by the Securities and Exchange Commission (SEC). The unforeseen costs of a lifetime guarantee has helped drive down the stock price due to the potential impact on future earnings of LCA-Vision, Inc. (NASDAQ:LCAV) which operates 63 LasikPlus centers across the country. As of 4-1-08 the current share value (stock price) of LCAV was $14.10 compared to a 52 week high of $50.18 and a 52 week low $13.79. As a consumer, you should be familiar with this background information, because the viability of the guarantee is as good as the viability of the company that backs it.
The reality of or need for a "lifetime guarantee" is typically unnecessary. Rarely is there a need for a retreatment or enhancement beyond our one year post operative window that is already covered following the procedure. In tracking our results and outcomes only 3% of our patients even require an enhancement within the first year when the healing process varies most. Some LASIK centers may reach as high as a 15-20% retreatment rate within the first year. Beyond the year time frame the frequency in our practice of need for enhancement decreases to a fraction of a percent over the next 5-10 years.
Mass Mailings and a "Personal Approach"
Some national corporate LASIK centers in an attempt to generate more patient leads will send out bulk mail pieces addressed in a manner that makes the recipient of such mail believe that they have been specifically selected. This is misleading due to the fact that they have not been specifically selected, they like thousands of others have received this same mail piece as part of a mass mailing advertising campaign.
This is playing on the emotions of individuals by addressing the content of the letter to each individuals name as opposed to "resident" like other pieces of bulk mail.
This is reminiscent of the old Publishers Clearing House where the recipient of the "Junk Mail" would expect someone showing up at their door with balloons and a check for a "million dollars". Again any thing that looks or sounds questionable probably should be perceived as such.
Pro-Sports Team Affiliation
As a prospective LASIK patient, is there any benefit for you to go to a LASIK center that displays an affiliation with a professional sports team? The inference is that this lends special LASIK credibility to the practice. However, is this so? The promotional benefit of name recognition with an NBA, NFL, MLB or NHL professional sports team, is associated with high "marketing value" to any business or healthcare practice that displays such pro-sports team affiliation in their advertising.
Billboards or lighted signs are used in pro-sport arenas or stadiums to promote products or services. When a LASIK center is selected as the "team consultant", "team Ophthalmologist" or "team LASIK center" it should be apparent it is no coincidence that you will find paid for billboard-type marquee advertisements promoting the LASIK center on display at the respective sports arena or stadium.
We at Moretsky Cassidy LASIK Vision Correction, have performed LASIK on
various professional athletes including Jeff Culpepper (Chicago Cubs), Krys Kolanos (Phoenix Coyotes), Cedric Walker (Arizona Rattlers), Bob Howry (Cleveland Indians), Lisa Harrison (Phoenix Mercury) and Toney Foster (Phoenix Mercury).
We have also performed LASIK on over 140 area doctors whose names we
display on our website. They were satisfied with their results and eager to recommend our center to the public. On the other hand, we have declined pricey bids offered to our center for affiliations with various pro-sports teams.
Everyone realizes that pro-athletes receive endorsement fees to promote products and services. Pro-sports teams also receive endorsement fees through paid for signage at the stadiums or arenas. Since you are not just buying athletic wear, soft drinks or burgers, as a prospective LASIK patient, don't forget that LASIK centers pay substantial fees either directly or indirectly to pro-sports organizations to obtain these titles. Each of the team logos on display in the LASIK ads indirectly carry a hefty price tag. They are not awarded for quality care, they are simply bought and paid for.
VISX CustomVue Wavefront Guided vs. Alegretto Wavelight Wavefront Optimized
When investigating different LASIK technologies and treatment options it is important to realize some significant differences exist between "Wavefront guided" and "Wavefront optimized" technologies.
In the United States, the FDA has approved four different wavefront responsive lasers. The trade names are CustomVue using the VISX STAR S4 IR laser, Custom Cornea using the Alcon LADARVision and Zyoptix using the Bausch & Lomb Technolas 217z laser. These three lasers have the ability to create an ablation pattern customized from an individual patient's Wavefront diagnostic evaluation or map.
The fourth, WaveLight Allegretto laser uses Wavefront-derived data in the laboratory to "optimize" its laser ablation pattern but does not use an individual patient's Wavefront diagnosis to create a customized ablation pattern. CustomVue (VISX), Custom Cornea (Alcon) and Zyoptix (Bausch & Lomb), are all customized to the individual's eye. VISX, Alcon, and Bausch & Lomb are true Custom Wavefront Guided. Allegretto is not truely Custom, but instead "Wavefront Optimized". There is a significant difference between these two types of technology systems.
As a general rule the quality of vision with "Wavefront guided" LASIK is superior to "Wavefront optimized" LASIK. Individual circumstances however, will vary.
The chart below discusses the claims of "Wavefront optimized" LASIK verses the true custom "Wavefront guided" LASIK procedure.
| Allegretto WaveLight "Wavefront Optimized" | VISX CustomVue "Wavefront Guided" |
| Wavefront Optimized Only-Not "True" custom Wavefront Guided. | "True" Custom Wavefront Guided technology is superior to Wavefront Optimized |
Claim 1:
Preserves or improves quality of vision in regards to glare and night driving. | Response 1:
This is theoretical only, no clinical studies apply. VISX CustomVue was shown in clinical studies to demonstrate superior night vision satisfaction.
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Claim 2:
Maintains and protects natural shape of the cornea. | Response 2:
Allegretto only addresses steepening of the periphery of the cornea to maintain a more natural shape. VISX CustomVue also compensates by steepening the periphery of the cornea to maintain a natural shape and more importantly corrects all aberrations in a patient's vision.
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Claim 3:
Provides superior clinical results. | Response 3:
Superior results compared to what? Only proven superior results to results of conventional LASIK treatment, not "true" Custom Wavefront guided LASIK. Although Wavefront optimized is superior to conventional LASIK, it lacks the ability to correct higher order aberrations in the vision that "true" custom Wavefront guided treatment is designed to correct.
VISX CustomVue is superior to conventional LASIK and superior to Wavefront optimized because VISX CustomVue corrects all higher order aberrations.
VISX uses special instrumentation or a computerized map called an aberrometer to identify unusual irregularities in the vision and create a fingerprint of the eye's vision, which the laser then in turn corrects.
Allegretto WaveLight cannot take a fingerprint of the visual system of the eye and correct for irregularities, as does VISX CustomVue.
VISX results are unsurpassed at every level of correction, involving all unique higher order aberrations of each eye, not averaged response to data derived. |
Eliminating Reading Glasses with CK
Conductive Keratoplasty, (CK) is used to treat farsightedness or create a nearsighted refractive effect by using a radiofrequency heat-activated probe that is inserted into the cornea. This induces shrinkage of the collagen matrix, thus steepening the cornea and changing the way the eye focuses. Steepening the cornea by heating has been around for decades, evolving from a hot needle probe to an external Holmium laser application, and most recently radiofrequency technology. However, all these techniques have resulted in what is referred to as regression or returning back to the original shape of the cornea after the initial shrinkage occurs, typically a few years later. Although CK has shown the least regression of any heating techniques to date, it is still considered a temporary treatment by the Food and Drug Administration (FDA). It is believed that patients will lose their near vision over years, based on regression of results of the treatment and progression of loss of near vision with age. The procedure can be repeated at a future date, but no one knows how many times this technique can be used without inducing side effects.
Patients who consider CK mono-vision discover that this reduces their far vision, resulting in reduction of their binocularity and reduction of their depth perception. For patients who have previously worn contact lenses with this correction, this may be a satisfactory alternative. For those who have not worn contact lenses for mono-vision it is highly recommended that they experiment first with contact lens use.
We perform Custom farsighted laser vision correction for the same patient population as those eligible for CK. The one distinction between farsighted laser vision correction and CK remains that laser vision correction is considered a permanent treatment whereas CK is considered a temporary treatment. Only one half percent of all refractive surgery performed according to a recent poll involves CK. The frequency of this procedure being performed by American Ophthalmologists appears to be declining.
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