You are interested in laser eye surgery. You have been doing what everyone else does first, which is search through the websites of various laser eye surgery clinics including the big three chains: Ultralase, Optical Express and Optimax, plus independent clinics such as FOCUS Laser Vision, Centre for Sight, London Vision Clinic etc.

The first thing you notice is that some clinics outline some or all their prices, while others give a headline price and give more details after you contact the clinic directly. One very handy site that can help you get all that information quickly is www.lasik-eyes.co.uk where patients can post independent reviews of their experiences at all of the UK’s laser eye clinics plus the price they paid for surgery.

There is a huge variation in the prices paid at UK clinics. Prices paid for both eyes for laser eye treatment vary from around £1,500 up to over £6,000.

But what does this mean for you? What about quality? Do you get what you pay for? Or do prices not correlate well with the quality of the surgery, vision result or service?

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The choices can seem bewildering! You want to have laser eye treatment e.g LASIK and now you need to choose the clinic for your surgery.

But which one?

There are over 100 clinics in the UK, although 75% of those are made up of only three large business laser chains: Optical Express, Optimax and Ultralase. The other 25% are mainly owned by doctors and optometrists, who practice from their centres.

80% of UK centres have adopted the advanced blade-free femtosecond lasers, and so now offer blade-free LASIK (a.k.a all-laser LASIK, Intralase, Z-LASIK). These include:  FOCUS Laser Vision , Optimax, Optical Express, Ultralase, Moorfields Eye Hospital and Centre for Sight.

20% of UK centres have not yet invested in this technology, and only offer bladed LASIK, where a device containing a short blade is used to cut the LASIK flap. These centres include Advance VisionCare and Accuvision in London

Having your laser eye treatment with a blade free femtosecond method has rapidly become the standard of care for UK LASIK laser eye surgery.

For LASIK laser eye surgery safety, there are 3 things you must look for when you plan to go ahead. This LASIK safety trio means a more accurate result and the safest procedure we know of today:

1. Choose a blade-free all laser LASIK technique – using the latest femtosecond lasers means no blade is used in the surgery. Check with any clinic you talk to that they can offer blade-free LASIK – if they can’t then they are out of date and should be avoided.
2. Wavefront-based LASIK is a must today, so make sure you go for that option. For example, at FOCUS Laser Vision we only do wavefront treatments so that is taken care of. At other centres such as Optical Express, do not choose their non-wavefront option.
3. Get the safety and reassurance of NHS consultant corneal specialist surgeons to do your treatment – the three laser eye chains do not offer this for the great majority of their treatments. Premier centres like Moorfields Eye Hospital, Centre for Sight and FOCUS Laser Vision do.

The number of people having laser eye surgery in the UK has increased following a boost in March 2006 when the National Institute for Health and Clinical Excellence (NICE) issued their guidance that laser eye treatment was sufficiently safe and effective to be carried out on appropriately selected patients.

Since then, the number of clinics offering laser eye surgery has increased. The three UK laser eye chains – Optical Express, Optimax and Ultralase – have all stated plans to increase the number of clinics they run.

The credit crunch and stock market falls have led to a dip in recent weeks reported by most consultants doing private laser eye correction. However the overall trend has been a rise in the number of procedures carried out in the UK.

Continuing from yesterday:
Some surgeons recommend PRK or LASEK (both forms of surface laser eye treatment and basically the same) over LASIK. The article referred to by Kay in her original post and advocating LASEK was written by ophthalmic surgeon Sunil Shah, who was one of the creators of that particular approach (and so has some personal interest in writing about it one presumes).

One of the very vocal and respected advocates of surface laser (PRK) over keratome LASIK was Professor John Marshall in London, UK, a founding father of laser eye surgery back in the 80s. Prof Marshall argued convincingly that the cornea was considerable stronger after PRK compared to mechanical (thicker flap) keratome LASIK.

However, the game has changed with the introduction of femtosecond lasers with much thinner flaps. Even Professor Marshall now supports the move to thin-flap LASIK using a dual laser, blade-free approach.

So if a clinic cannot offer dual laser LASIK (and many still can’t) they may offer PRK/LASEK instead. There are some clinical reasons to perform PRK instead of LASIK but the percentage of these cases has shrunk from 10-15% down to around 5% today, with dual laser technology. Patients much prefer femto-laser LASIK over PRK, as the latter is fairly unpleasant for a few days post-op.

In summary, there are definite clinical reasons why we as treating clinics have moved over to wavefront LASIK and using a blade-free dual laser approach. More accurate treatments so better vision, removal of an older mechanical device technology and improved long-term safety.

To recap from earlier this week, there are two ways you can upgrade your laser eye treatment: (1) upgrading on the quality of the final vision (you will see better afterwards) and (2) improving the safety and accuracy of the laser eye surgery. These are upgrades on what used to be the best treatment only a few years ago, which is known as non-wavefront LASIK and using a blade device to cut a thin flap in the surface of the cornea (the clear window at the front of the eye).

Upgrading on (1) involves paying for what is called ‘wavefront‘ laser eye surgery over ‘non-wavefront’.

Upgrading on (2) means getting rid of a metal razor-type blade in favour of a laser for the first part of the LASIK treatment (lots of names here… blade-free, dual laser, femtosecond, Intralase, Ziemer, Z-LASIK).

Kay’s questions have been about: is it really worth it to pay more? The short answer is that, yes, you should always look for ‘wavefront’ laser eye treatment. But why?

Well, the reason for this is not as obvious as laser eye clinics may tell you!

Wavefront refers to a technology adapted from astronomy which allows better resolution and clarity when looking at images of space. The principle is to remove tiny imperfections of focus, rays of light that are not getting focused properly and which cause blurriness, glare or hide details. Let’s look at an example from astronomy. In this image you can see how a blurry image of a star was improved though wavefront technology to reveal in fact two stars, known as a ‘binary star’.

'Wavefront' laser eye surgery can improve quality of vision

These imperfections of focus (known usually as aberrations) are not corrected by glasses. They are still there even after putting on your glasses or contact lenses. So after correcting your prescription fully and getting clear vision, you can still have imperfections in your vision which are usually more obvious at night.

Check back tomorrow for the next installment and the full answer on whether it is worth it to pay more  in order to get the best vision results (at most clinics – not mine, I add, FOCUS Laser Vision! – we don’t charge extra for you to get wavefront correction! In fact we charge less for wavefront surgery than other clinics do for their non-wavefront treatments).

See you tomorrow!

Following on from yesterdays post on some key LASIK and laser eye surgery questions, lets look at these:

• Do clinics try to sell you on the most expensive treatments?
• Are these expensive treatments no better than the cheaper ones?
• Is there really any difference between blade LASIK and the newer (more expensive) blade free dual laser option?

The main point here is about more expensive laser eye treatments over cheaper ones. What is the difference?

When you buy anything you normally have a choice of quality and price, for example an HD television or more basic one. Or a Mercedes over a Fiat Punto. We all understand that more money usually gets a higher value brand and clinics typically price the surgery this way too.

There are two ways you can upgrade your treatment: (1) upgrading on the quality of the final vision (you will see better afterwards) and (2) improving the safety and accuracy of the eye surgery. These are upgrades on what used to be the best treatment only a few years ago, which is known as non-wavefront LASIK and using a blade device to cut a thin flap in the surface of the cornea (the clear window at the front of the eye).

Let’s look first at spending more to get better quality of vision than the older ‘standard’ treatments (which are STILL available at most clinics, not at my centre – FOCUS, by the way, although there is a good case to abandon this older technology). The high street chains (Ultralase, Optimax and Optical Express) all offer two levels of surgery for quality of vision.

The basic cheaper treatment is called by various names but all are what are termed ‘Non-Wavefront’ surgeries. For example Ultralase call it just ‘laser eye surgery’, Optimax and Optical Express refer just to ‘LASIK’.

The higher quality, better vision treatments all come under what is called ‘Wavefront’ laser eye surgery.

‘Wavefront’ simply refers to a technology that is claimed to offer higher-definition vision, especially at night time, which was introduced several years ago.

Just to confuse you there are different names, again depending on which clinic you visit! For example, Ultralase call this ‘ULTRALASIKplus‘, Optimax opt for the simpler ‘Wavefront LASIK‘, while Optical Express go for the mouthful of ‘Advanced CustomVue Wavefront LASIK‘. Other independent clinics use various names.

At my own clinic FOCUS Laser Vision, we only offer the higher quality vision ‘wavefront’ laser eye treatments. You cannot get non-wavefront eye surgery with us.

Please note that paying more at one clinic doesn’t mean you get better surgery than at another clinic. You need to look at what you are paying for. For example FOCUS Laser Vision charge less for advanced wavefront correction than most other clinics do for older technology non-wavefront treatments. Blowing my own trumpet here, I know! But paying more does not always equal getting more. More on this later.

Kay also asked in her mail about the ethics of treatment offerings and we will cover that topic in the next blog postings. Basically, is it ethical to offer lower quality treatments when newer higher quality ones are available? No-one cares about this for other products and services (is it ethical to sell Fiat Puntos when Mercedes are available?) but it can be a hot topic in healthcare. I will write on this subject during the coming week. And I will welcome your comments!

OK, but are these ‘wavefront’ treatments really better than ‘non-wavefront’? Come back tomorrow to get the truth!

How to different laser eye surgery clinics charge for treatment? It can be confusing to understand different prices and messages from various clinics.

For LASIK pricing, there are two common ways to charge. The first is 1 price for all prescriptions – in effect the lower prescriptions are subsidising the higher more difficult cases. The second method, used by ourselves and some others, is to charge based upon the prescription.

So the easier the treatment and the simpler the case, the less that patient pays – and vice versa. This seems the fairer way overall.

Also, younger patients (who are mainly short sighted) generally have less money and so can more easiy afford to have laser eye treatment with FOCUS, as their prescriptions come in at a lower rate. Long sighted treatments are more complex (we specialise in these, unlike most clinics) and are more expensive. These patients are typically in the 40s and 50s and often can often afford a bit more.

I know it sounds rather like Robin Hood(!) but this allows more people to get a superb level of treatment with a very experienced surgeon, with lots more time in a relaxed clinic, away from a high-volume quick turnaround setup. For example, one of the laser chains has surgeons performing up to 40 laser eye procedures per day. At this level, the chances of the surgeon making a mistake increases. For any of us, if we are rushed at work we cannot do our best. We believe it is better to have fewer patients and spend more time.

I really have tried to make top-end ‘Harley Street’ laser eye treatment available to more people, hopefully in a fairer way (we are actually next door on Wimpole Street). I wish everyone with glasses could afford to come for treatment but, if you see my next post, this is not likely to happen.

To help you find a UK laser eye surgery clinic, I have put together two maps. Just click on each marker to see the name and telephone number of each clinic or click on the name to go straight to their website. Couldn’t be easier.
They maps don’t include the big 3 laser chain centres, who now have 60 locations. The map shows independent clinician run (usually NHS consultants) clinics rather than commercial chains.

1. London laser eye surgery clinics
2. United Kingdom laser eye surgery clinics (click on London to see details)

Enjoy!

[tags] UK, clinics, laser eye surgery, LASIK, locations, map, UK [/tags]

You can see a below all the GB laser eye clinics that have an actual building and their own laser – what we can call ‘complete’ self-contained laser eye clinics.

Click on each clinic name to visit their website.

If you would like to more easily see where laser eye surgery is happening near you, click here to see laser eye clinics in the UK, or click here to see laser eye clinics in London.

I have excluded a few others that you can find listed elsewhere but which do not have a dedicated clinic building of their own or have their own laser (some surgeons use a mobile laser delivered on a truck as and when they have a need). Clinics in N. Ireland will also be added presently.

Below are actual permanent clinics that have invested in a premises and laser and offer routine ongoing laser eye treatment on a daily basis. If you find this permanence reassuring you can start with these clinics in your search for a laser vision centre for your treatment. The three big laser chains (Optical Express, Ultralase, Optimax) operate 60 out of the 82 clinics listed here.

So there is a clear split between the three large volume chain operators and the independent single clinics.

** The big 3 are owned and managed by business interests and are commercial ventures. They employ clinicians (surgeons and optometrists) and other staff to deliver the laser eye service to customers. They all have a stated goal of expansion to more locations and compete with each other in most locations around the UK.

** The single independent clinics are owned and/or managed by surgeons or optometrists. These are business ventures although can be thought of usually as a committed private practice by an individual or a team of clinicians and without the goal of geographical expansion. They are likely to stay as solo clinics.

Optimax, one of the UK’s big 3 laser eye chains, has made a significant price hike for their wavefront LASIK treatment, the UK’s most popular type of vision correction.

Patients will now pay an additional £480 to have both eyes correct with blade free wavefront LASIK. Bilateral (both eyes) treatment has risen from £2,890 in August last year up to £3,370 today.

One of the big changes in the laser eye treatment industry is the battle for a low headline price. Optical Express lead the way with a “from £395” price headline with a huge marketing campaign across the UK. Optical Express have raced ahead over the past few years and now do more treatments than any other UK laser provider.

Optimax has responded to the challenge by dropping their headline price to match OE’s at £395 per eye (Epi-LASEK).

However, you have to look closely to see what is on offer. For Optimax, £395 will not get you either LASIK or superior wavefront vision correction. For that you will have to pay £1,290. The £395 headline is for non-wavefront surface laser which lacks the comfort and rapid recovery that makes the LASIK procedure the most popular amongst patients.

And if you want the advanced blade free Intralase laser rather than a blade, there is an additional £395 (up from £300 per eye last year) to make an Optimax price of £1,685 per eye or £3,370 for both eyes.

Optimax prices in blue as of April 30th 2008. You can compare to prices from August last year just below, in green. You can see how all prices have risen, except for the Epi-LASEK entry price of £395 per eye, which does not include wavefront advanced optics.

A complaint we hear from LASIK patient is just how much more the price escalates to once you attend for a consultation, above the advertised ‘from’ price.

As I wrote about in a recent post, Ultralase have also raised their prices to £1.945 per eye for blade free wavefront LASIK vision correction.

Both Optimax and Ultralase charge a fixed fee for all prescriptions, while Optical Express have a sliding scale based upon the strength of the prescription glasses correction required; the worse the vision, the higher the cost.

The patient attending Optical Express will find typically 3 jumps in price:

1. Additional cost for a prescription above the mild prescription of the headline price
2. Additional cost for wavefront correction ( an upgrade issued back in 2002 by VISX)
3. Additional cost for Intralase blade free dual laser correction

So overall, the UK trend is to offer a low headline price, while actual LASIK prices are on the increase.

I should add here, humbly, that FOCUS Laser Vision prices are against the trend, and we have lowered our advanced blade free wavefront correction price to the best available in the UK. However, we are a specialist clinic serving London and the South-East and without a nationwide footprint. Sorry to the rest of the UK! Blade free ‘Intralase-type’ wavefront LASIK starts at £595 per eye and most patients are not spending much more than around £1,000 per eye for this advanced treatment at FOCUS. OK, personal plug over!

Ultralase laser eye surgery chain has increased prices again. They recently moved to only offering blade free LASIK using the American Intralase femtosecond laser, removing the cheaper option of keratome LASIK.

Ultralase laser eye clinics price for Intralase LASIK including the upgrade for wavefront based correction is now £1,945 per eye.

Click here to the US govnerment clinical laser eye surgery trial results for the Bausch and Lomb laser used by Ultralase and how it compares to the VISX laser used at major competitor Optical Express and the WaveLight laser used at FOCUS Laser Vision.

Private equity company 3i recently paid a whopping £174 million to purchase Ultralase (read the blog post here) so perhaps they would like to start getting some money back…? Just a thought.

The results of the first 50 people to poll our blog are now in!

Nearly 80% of people want to pay no more than £1,000 per eye for their LASIK laser eye surgery. This price is considerably lower than most clinics are actually charging for laser vision correction per eye.

If you want, click here to see a price comparison of various prescriptions at several laser eye surgery clinics.

Please ensure that you check the final price you will be charged at any clinic you are evaluating prior to going ahead. But be careful – one laser chain seems to not want to disclose any prices until you have arrived for your consultation. You may well be very surprised as just how much the final bill will come to.

Prices do vary considerably and often without apparent differences in the quality of care offered. You can see a comparison of LASIK laser eye surgery prices here.

The results of the first 50 people to poll our blog are now in!

Nearly 4 out of 5 people want to pay no more than £1,000 per eye for their LASIK laser eye surgery. This price is considerably lower than most clinics are actually charging for laser vision correction per eye.

Despite headline grabbing prices of ‘from £395 per eye’ coming through our doors, the actual price charged at LASIK laser chain clinics is significantly over £1,000 once you have added in the extras not included in that advertised price. Such as modern wavefront advanced optics and blade-free all laser surgery.

Please ensure that you check the final price you will be charged at any clinic you are evaluating prior to going ahead. But be careful – one laser chain seems to not want to disclose any prices until you have arrived for your consultation. You may well be very surprised as just how much the final bill will come to.

Prices do vary considerably and often without apparent differences in the quality of care offered. You can see a comparison of LASIK laser eye surgery prices here.

Please note that only Moorfields Eye Hospital and FOCUS Laser Vision routinely offer a fellowship trained NHS consultant specialist surgeon for laser vision correction surgery.

Optical Express is planning a huge recruitment campaign to find 1,000 optometrists, opticians, optical assistants and laser vision counsellors in preparation for a market share push that will see a doubling in its number of practices.

Chairman and CEO, David Moulsdale, said: ‘The pace of growth within our laser and intraocular lens business, plus continued expansion of the Optical Express core retail store base, have outstripped the rate at which we have grown our human resources. Right now, we have approximately 4% of the UK optical retail market but envisage this growing to in excess of 10%, so job opportunities within the group are excellent.’