Keeping an Eye on Lasik Business Practices

Proponents and detractors of Lasik (laser-assisted in situ keratomileusis) surgery agree that patients have a right to know the risks and shortcomings of the procedure to make an informed decision. Unfortunately, this doesn’t always occur, and Food and Drug Administration doesn’t have the authority to ensure that doctors provide patients with this information.

High-volume Lasik centers account for 30 percent of the market, according to Market Scope, which is an ophthalmic market-research company. Typically at corporate Lasik centers, patients don’t meet the surgeon until the day of the surgery, which makes it impossible to get his/her answers in a timely fashion. Instead, patients and activists say, pre-operative evaluation often is performed by optometrists, and questions often are answered by salespeople. Further, despite American Academy of Ophthalmologists’ recommendation that patients be given a day to go home and read through consent forms, patients and activists say that the forms often are presented right before surgery—often when patients don’t have their glasses and can’t read the tiny print.

Dr. Edward Boshnick, who is an optometrist who specializes in Lasik complications, and other Lasik critics whom we interviewed believe that greed is a factor. “I can’t think of another surgery that pays more per unit of time,” Boshnick says. How lucrative? Lasik, which isn’t covered by insurance, averages $2,000 per eye, according to Market Scope. According to Cynthia MacKay, who is a Lasik critic and ophthalmological surgeon, insurance pays her around $733 per eye for cataract surgery.

Lasik surgery websites and our interviews with patients and activists indicate that many corporate Lasik centers look a lot more like businesses that try to increase traffic rather than medical offices. We saw and were told about pushy salespeople and misleading advertising that promotes prices for which almost no one qualifies—all while failing to mention risks, as is required by FDA. We even noticed discount coupons for the surgery!

We also learned that optometrists get fees for referring patients to Lasik surgeons: We saw a March 2015 letter to an optometrist that offered him $425 per eye for referral to a refractive surgeon. The letter calls the fee “co-management” and specifies that the optometrist must provide the follow-up care. Critics say that’s nothing more than a kickback scheme that’s aimed at driving traffic to Lasik centers, which is illegal under state and federal law.

Attorney Carolyn Merchant, who has handled 100 Lasik cases, she learned about Lasik surgery centers where employees have approval quotas and get bonuses for meeting those quotas, thus creating a perverse incentive to qualify candidates who might not benefit from Lasik. She declined to identify which centers do this.

As attorney Todd Krouner says, “The lion’s share of the [Lasik] cases I’ve handled are not where the surgery was performed negligently, but where it never should have been performed.”