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Quality Concerns Arise as Vision Centers Slash Prices

Competition: Cost reductions stir up a price war, worrying some doctors, who warn that you get what you pay for.


Only a few years ago, Southern Californians who wanted Lasik surgery to improve their vision had to pay about $2,500 per eye to one of a handful of high-profile ophthalmologists.

Now, they can have the laser procedure for far less--as little as $499 in some cases--and any of about 100 local physicians can do it.

Some doctors--those who have held prices steady--criticize the price reductions, saying they reflect shortcuts in patient care. Others, usually those offering the rock-bottom fees, say the trend is part of a normal, competitive process.

Both sides agree that corporate-backed vision centers are responsible for the reductions. With multiple doctors, each capable of handling about 15 patients daily, the centers have recently moved into the area and are seeking to quickly gain a large number of patients by offering the procedure for far less cost than that offered by their better-established competitors.

Some ophthalmologists have responded by dropping their own prices, though not as steeply as the corporate-backed centers.

Lasik Vision is among the companies offering the surgery for $499 per eye. The company has 15 centers in the United States, including five in Southern California.

James Watson, executive vice president of operations for Lasik Vision, calls it "ridiculous" to pay thousands of dollars per eye for Lasik surgery, saying it's a myth that higher costs mean better health care. "I wouldn't pay it as a patient," he said.

His company's size allows "efficiency and economy of scale," he says, acknowledging that profits are slim at $499 per eye and that the prices are available only to the first 1,000 customers at each new center. The usual charge is $999 per eye.

Other companies offering similar prices include LCA Vision, which operates 33 LasikPlus centers nationally, and Icon, which has 25 centers nationally. All of the rock-bottom prices are bound to increase, the doctors agreed, but will stay well below those of more established vision centers.

At those offices, prices have remained virtually unchanged, and the ophthalmologists there expect them to stay comparatively high.

Dr. Robert Maloney, of the Maloney Vision Institute, continues to charge $2,450 per eye. "The way I view it, cheap Lasik is like a cheap parachute," he says. "It usually works, but when it doesn't, it's a disaster."

But Dr. Yaron Rabinowitz, the chief ophthalmologist at Cedars-Sinai Medical Center, says it's difficult not to feel the market pressures. He normally charges $2,450 per eye but is offering a temporary discount price of $1,750 per eye through the end of the year.

The fee battles worry some ophthalmologists and consumer safety advocates.

"We have concerns that a driving down of price will be accomplished by a lack of proper screening to get as many people through the door as possible," said Ron Link, a spokesman for the Surgical Eyes Foundation. The foundation is a consumer group for people whose sight has been harmed by refractive surgery.

But Link acknowledged that surgery "all across the board" has its share of side effects and that price is no guarantee of good, or bad, service.

In Lasik, a thin flap of tissue about the size of a human hair is cut and folded away from the eye with a scalpel. A laser beam is then used to reshape the cornea, and the flap is replaced.

The procedure carries the risk of corneal scarring, corneal infection, worsened vision and permanent warping of the cornea that makes the patient unable to wear contacts.

Hazy or blurry vision, increased glare, a halo effect around lights, and light sensitivity are also possible--albeit usually temporary--side effects.

Dr. Andrew Phillips, an assistant professor and director of ophthalmology at USC, says doctors should screen prospective patients for corneal scars, cataracts, advanced glaucoma and systemic diseases such as lupus.

Special care should also be taken for patients with large pupil size, farsightedness or astigmatism; for them, the procedure is more complicated.

Phillips acknowledges that the increased competition and reduced prices may benefit patients unable to afford pricier versions of the procedure but says consumers shouldn't choose on price alone.

When looking for a doctor, he says, they should find out how much time they spend with patients and whether the doctor will do the postoperative evaluation as well as follow-up after the surgery.

Patients should also ask how many Lasik procedures a doctor has done and the rate of complication, Phillips says. Because there is no independent oversight monitoring rates of complication, a consumer should ask doctors for specific numbers.

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