Managing LASIK patients

Optometric Management,  May 2000  by Angelucci, Diane

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Is their care being taken out of your hands?

As the public learns about the wonders of refractive surgery, advertisements boasting rockbottom prices for LASIK surgery are transforming some potential patients into sale-searching bargain hunters. Scores of patients have crossed the border to Canada, prompted by the favorable currency exchange rate.

But patients aren't just confining their search to north, or south, of the border. Many are undergoing LASIK after being enticed by a local ophthalmologist's radio or print advertisement. Often, ophthalmologists are handling the preoperative care, and sometimes postoperative care, of patients without the O.D. even knowing that his patient had undergone LASIK. Or worse, the patient undergoes LASIK and then arrives at his optometrist's doorstep assuming that the O.D. will provide postoperative care - in many cases because that's what the laser center told the patient.

To add injury to insult, some patients are led to believe that the surgery fee covers your care!

Many O.D.s across the nation are starting to feel the sting of being left out of the loop of care whether their patients have crossed the border for LASIK or just gone across town.

We'll talk to O.D.s who have encountered these "surprise" refractive surgery patients and share what they've learned so, if you find yourself in this unfortunate situation - as a growing number of O.D.s have - you'll have advice to fall back on.

The misinformed patient Elizabeth Gray, O.D. (not her real name), who practices in the state of Washington, explains that one of her patients broke the news to her as he settled into the exam chair. "Oh, by the way," he said, "I had LASIK about a month ago, so I'm just coming here to use my vision plan for my routine follow-up."

"I was so shocked, I didn't know what to say," Dr. Gray says. "I didn't want to just dump him and say, 'I can't do that.' At the same time, I didn't want to just see him for a routine exam either, but I felt like I was kind of stuck at that point."

To compound the problem, the patient was misinformed about what his surgery would accomplish, Dr. Gray explains. Although he was originally a 3.00D myope, he ended up +1.50D and -0.50D, with 2.00D of anisometropia between the two eyes.

"He didn't understand how that was going to affect his vision, and that the fact that he was in his 40s meant that he was going to need glasses at near."

The LASIK center staff told the man that he wouldn't become presbyopic any sooner if he had LASIK, she offers, "But they also didn't bother to tell him that as a 3.00D myope, he would always be able to see up close without glasses and without the surgery. With the surgery, he'd always need glasses for near."

Because her office is so close to the Canadian border, Dr. Gray often gets calls from people who've already had surgery in Canada and now are inquiring about post-op care after the fact.

"When we tell them our fees, they decline, and I think some of them probably just neglect to have any post-op care due to cost and the inconvenience of going back to Canada," she says.

"They don't seem to be checking the credentials of the people who they're going to for the procedure," says Dr. Gray. "They're just going to whomever's the cheapest, and it's absolutely unbelievable to me that someone would do that with their eyes."

Driven by a bargain

Patients have consulted with Donna A. Higgins, O.D., after having refractive surgery performed by an ophthalmologist located several hours from her office in Prairie du Chien, Wis. Not wanting to drive the distance to the surgeon's office, they look to Dr. Higgins for postoperative concerns or for reassurance when their results are less than they expected.

Although she has tried to convince patients not to bargain shop for their refractive surgery, they're encouraged by others when they hear that their procedures were only $500 for both eyes. Of course, these patients didn't have LASIK, they had RK, not realizing the difference.

Not the easiest cases

Janet Carter, O.D., F.A.A.O., is in private practice and is the clinic administrator of the Pacific Laser Eye Center in Reno, Nev. A few years ago, she saw a patient after he had refractive surgery in Mexico. Because he'd previously received a corneal transplant, M.D.s in the United States refused to perform refractive surgery. "He called me when he got back and said, 'I need you to check this, someone has to check this,"' she recalls.

"Most people who go out of the country or out of the area to have refractive surgery are usually seen by the surgeon the first day afterward, but now they're coming to your office a week or a month later," says Dr. Carter.

"Most people, if they had an excellent result, aren't going to need that much help a week or a month later, so they may not even bother to come for their post-op visits. Those who make the effort to show up for their 1 week and 1-month post-op appointments are often those who are experiencing less than optimal results."