LASER WARS/ Focus on reality when pondering eye surgery

Gazette, The (Colorado Springs), May 2, 2000 by Bill Radford

The competition for the eyes of Colorado Springs has never been fiercer.

Three new laser eye-surgery centers have entered the Springs market since last summer, bringing lower prices with them. Business is booming, with two of the new centers performing surgery seven days a weeks.

In all, it appears as many as 3,000 LASIK procedures - at about $1,000 each - are being done in the Springs each month. Meanwhile, radio, TV and newspaper ads constantly pitch the wonders of LASIK, the laser eye surgery that could end your dependence on those contact lenses that irritate your eyes or those glasses that slip down your face when you run.

"The amount of advertising has just skyrocketed in this town with the different companies and they've all turned up their volume quite a bit," says Dr. Britt Buckley, surgical director of Peak Vision Center.

But over that roar, are patients hearing of the risks and realities of LASIK?

"A lot of people are being sold on the 20-minute miracle," says Glenn Hagele, founder and executive director of the nonprofit Council for Refractive Surgery Quality Assurance in Sacramento, Calif. "It is possible. But refractive surgery is more a six-month process than a 20-minute miracle. During that six months, you have a probability of fluctuation, dry eye, night-vision problems ... even a possibility that you'll need an enhancement. But that's part of the normal healing process with this procedure."

Depending on how bad their eyes were to begin with, people who undergo LASIK face a 5 percent to 20 percent chance they'll need to return to the doctor for an enhancement - generally at no extra charge - to get the quality of vision they want.

Enhancement is a term, says Dr. John Christiansen, a Springs opthalmologist, "that some marketing genius came up with. ... I would prefer they call it a reoperation."

Christiansen, who doesn't perform LASIK but does refer patients to a laser surgeon in Denver, adds that he's bothered by the "marketing hype" surrounding the procedure. "I don't feel patients are being adequately informed of the risks and the things they are going to run into."

There are people who don't seem to realize at first that it's a surgery, says Dr. John Wright, who performs LASIK and other refractive procedures at the Wright Eye Center. "They think you just step on a pedal."

But it is a surgical procedure - and there are things that can go wrong, says Dr. Paul Garland, who was medical director of the Laser Vision Institute and in February opened his own practice, Laser Vision USA. "It is highly successful with very low risk, but it isn't risk-free."

While unhappy customers apparently remain a small minority, their numbers are growing as the number of LASIK procedures explodes. Surgical Eyes (www.surgicaleyes.com), a grass-roots group based in New York City, was formed last year to help people who have had unsuccessful LASIK and other refractive surgeries. One area of the Web site is full of complaints and horror stories.

A check of local court records and with the Better Business Bureau, however, found nothing to point to a problem at any local laser center.

Unhappiness with the results of LASIK often stem from unrealistic expectations - and those expectations can be fueled by the advertising blitz.

"You may never need contacts or glasses again!" shouts one laser center's ad.

The key word is "may." As many as one in 10 people who undergo LASIK may still need glasses for night driving. And LASIK does not prevent or correct presbyopia, a natural aging of the eyes that leads to the need for reading glasses. In fact, people over 40 may find that having their distance vision corrected with LASIK hastens their need to use reading glasses.

"The probability of you spending the rest of your life without glasses is nil," Hagele says.

Christiansen's advice? "People should meet with an opthalmologist who is familiar with (LASIK) who will spend enough time with them and explain it thoroughly. This way it avoids disappointments and misunderstandings and they go into it with realistic expectations."

In deciding on a LASIK surgeon, the doctor's experience - and your comfort with that doctor - are key, experts say. Don't pay much attention to patient testimonials in ads, Hagele says. "First of all, you're never going to hear from a bad patient. And secondly, even the worst surgeon can get it right sometimes."

Not only should you review the surgeon's track record, you may want to consider whether that doctor will stick around to add to that record - and to continue your care. That's one point made in some of the Wright Eye Center's advertising: "Always been here & always will be!"

The Laser Vision Institute and Total Vision ICON Laser Center, both parts of chains, opened at about the same time last fall and have changed surgeons since.

Garland left Laser Vision Institute after about six months. "I quickly realized it was not something I could do long-term," he says, noting that he didn't have as much control over medical decisions as he wanted and that the volume of business meant a six-day work week at times. He was replaced by Dr. Paul Cutarelli, who says he is very pleased with the working environment at Laser Vision Institute.