Reputable providers of laser vision correction surgery should turn away patients who would be unlikely to benefit from it, industry officials say.
Unsuitable candidates can include those with large pupils, retinal problems, corneal scars or severe astigmatisms.
The patient should be in good general health and have a stable prescription.
The patient should be at least 18 years old (21 for some lasers), since the vision of people younger than 18 usually continues to change.
By JOHN NOLAN
CINCINNATI -- The rapid growth of laser vision correction has given those thinking about the surgery lots of choices in where they have it done and how much they pay.
Those in the business say it's up to consumers to find out about the doctor who will operate on their eyes, what problems they might encounter afterward and what after-care they will receive.
"There are risks. It's surgery," said Dr. Stephen Joffe, a former Cincinnati surgeon who has built LCA-Vision Inc. into a company with 33 U.S. laser vision correction centers, two in Europe and one in Canada.
LCA-Vision grew within five years to a publicly traded company with $57 million in revenues and $10.7 million in profits last year.
Joffe said his company always pre-examines patients and turns away those not suited to the surgery. Critics of the fast-growing industry say not all providers take that precaution.
Washington lawyer Aaron Levine represented a man who accused doctors at a Tysons Corner, Va., laser vision correction center of operating on him despite knowing that he had keratoconus, a condition that causes the cornea to bulge and thin.
The man said doctors should have told him not to have the surgery, which further weakens the cornea. He said the operation left him legally blind.
Levine said the lawsuit was resolved, although he wouldn't say how. His office has taken up four similar lawsuits, he said.
Levine said he would like to see a requirement that each patient considering the surgery have a prior consultation with an independent ophthalmologist who doesn't do the laser surgeries.
High volume, lower cost laser surgery centers are competing with ophthalmologists, sometimes by opening offices in shopping malls. Big players including Visx Inc., Summit Technologies, Lasik Vision, Laser One and Bausch & Lomb Inc. share the market with small providers.
Dr. Joe Barr, assistant dean of Ohio State University's College of Optometry, worries that consumers have little guidance in choosing a reliable provider.
"You can't necessarily find a relationship between cost and quality," Barr said. "The two don't necessarily go together.
"I think people should know that they're going to an experienced person who is a refractive surgeon, and not just doing the procedure to add to their resume or practice," he said.
The Food and Drug Administration first gave clearance for laser refractive surgery in 1995. Industry watchers estimate from 800,000 to 1.4 million Americans may undergo the surgery this year, up from 210,000 in 1997. Prices range from $499 to $2,500 per eye.
Marcandrea Musa, an owner of Laser Vision Institute, said his company charges $998 per eye for the surgery and lifetime follow-up care. He said there is an additional charge if the patient has an astigmatism, a condition that blurs and distorts both distant and near objects.
Musa warned that discounters won't make money charging $499 per eye, and are likely to spring additional charges on the patient for follow-up care.
Some studies have found 10 percent to 15 percent of patients must return so the surgeon can redo or fine-tune the work.
"Price is important to a lot of people, but it shouldn't be the only thing," said Irving J. Arons of Spectrum Consulting in Peabody, Mass., which publishes a monthly newsletter for the medical laser profession.
Consumers should seek out a doctor who has done the surgery at least 1,000 times and whose rate of post-surgery complications is less than half a percent, Arons said.
Dr. Roy Rubinfeld, an ophthalmologist in Chevy Chase, Md., who estimates that he has done about 10,000 laser vision operations, also urges consumers to do their homework.
"I think there has been a commercialization and perhaps trivialization of the procedure as if it weren't surgery," he said. "The surgical results are dependent on the experience and skill and judgment and the ethics of the surgeon.
"I don't want to scare people. I think it's a wonderful procedure," he said. "But people need to know that it isn't like buying toothpaste or getting a haircut."
The Federal Trade Commission, which investigates claims of misleading advertising, has teamed with the American Academy of Ophthalmology to put out a brochure, "Basic Lasik: Tips on Lasik Eye Surgery."
In the Lasik surgery now used almost exclusively, the surgeon cuts a flap on the cornea's surface, lifts it and uses the laser to burn away some cells and etch the prescription inside the cornea before replacing the flap.
The rare problems could include wrinkling the cornea, causing inflammation or infection or leaving the patient with a "nighttime glare" effect. Most of the problems can be easily treated if caught promptly.
Rubinfeld said he has found it is important to give the patient realistic expectations: The fully improved vision may not be attained for days and the patient may have to return for follow-up surgical care.
The surgery gives some people 20-15 vision, but others wind up with 20-40.
There are plenty of testimonials to the surgery's benefits.
Cincinnati nurse Margie Lanza said she was brought to tears when, after wearing glasses or contact lenses for two-thirds of her life, the Lasik surgery immediately enabled her to see clearly.
"I'm just floored," she said. "I can't find the words. It's just amazing."
Lawrence Kurtzman, a plastic surgeon, said he waited until two brothers and two of his medical partners underwent the surgery before trying it.
"I was very skeptical," he said.
But the surgery this year corrected his vision from 20-200 to 20-20, he said. Kurtzman underwent it at 5 p.m. one day and was operating on one of his patients at 8:30 the following morning.
On the Net:
American Academy of Ophthalmology: http://www.eyenet.org
Federal Trade Commission complaint form: http://www.ftc.gov/ftc/complaint.htm
Spectrum Consulting: http://www.expertsinternational.com/arons
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