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?

_{»crosslinked«}

If you read yesterdays post you are up to speed on wavefront technology. OK, so far so good. It seems wavefront correction improves quality of vision after laser eye surgery. And indeed clinical trials confirm that vision results are much better after laser makers added the ‘wavefront‘ upgrades to their machines.

For example, the American made VISX lasers, used at all Optical Express laser clinics, have much better results when using their wavefront upgrade from 2002. I would not recommend having laser eye treatment today in 2008 without choosing the wavefront package on that system.

Wavefront laser eye surgery - is it the whole truth?

So now you want ‘wavefront‘ in your laser eye treatment! Of course, as the results are better. But when laser manufacturers introduced ‘wavefront’ they actually bundled in other improvements which may account for much of the jump in results! They just didn’t tell you. Why? Because it is complicated to describe all these improvements to someone who isn’t familiar with the technology – such as you, the patient!!

And honestly, I bet the sales people at most clinics talking on the phones who want to sell you a consultation don’t really understand it either! However, they have been trained to explain the wavefront part only, as something like this… “we take a scan, a unique fingerprint, of your vision and the use that fingerprint to perfectly correct your vision“. Go on, call them and check it out!

But for you, as a patient or customer, don’t really care about which part of that technology is helping you the most, you just want great vision, right?

So don’t let clinics blind you with science about wavefront scanners, wavefront maps, measuring hundreds of points of light or how much better their scanner is than other clinics scanners. It is usually marketing spin! Take it all with a pinch of salt.

However, you should choose the ‘wavefront option’ because within that package are the big improvements in laser eye treatment over the past several years. The success of surgery may actually be less to do with the true wavefront technology that has helped astronomy, but rather other improvements that may be confusing to patients but get wrapped up in the marketing of wavefront LASIK.

We come back to ethics again here. Is it ethical for some clinics to still sell ‘non-wavefront’ laser eye surgery technology that was replaced back in 2002?

For my own clinic, we do not offer non-wavefront treatments at all. None at all. I want every one of my patients to have the benefit of the newer laser eye surgery results. So we made it very affordable. In fact, we charge less for wavefront LASIK than other clinics do for their ‘entry level’ lower price non-wavefront LASIK. Really.

That’s my plug for FOCUS done! So, do choose wavefront but don’t pay more than you have to!

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!

Overall all laser eye surgery prices are increasing or set to increase. The cost of new technology to give you better and safer surgery is very high and needs to be constantly updated. Even though FOCUS have the UK’s best prices, you will find the trend everywhere will be up.

For example, laser clinics used to need one laser at a cost of £1/3 million. Now they need two to offer blade free dual laser LASIK, total cost £2/3 million and treatment prices are no different on average to back in 2000.

In a nutshell it costs a lot to do this type of treatment and costs are only increasing. The benefit of that though: highly accurate treatments with better safety than ever before.

At FOCUS, we made a decision to buy the very best technology and to bring that to the UK at the lowest price so that more people could afford to get fantastic levels of surgeon, service and technology, all without compromise. That is not hype. It is just what we have wanted to do.

But all of that does cost and has to be paid for. And no government bail-outs for anyone in healthcare! Unlike some banks we have to be prudent, cautious and look after our customers without risk so that we will be here next week, next month and next year.

Price wars in the US a few years ago meant cheaper surgery at first. Then bankrupt clinics closing with people having to pay all over again in order to get their aftercare. Not a good result for patients in the end.

You may see some special offers following these recent economic changes until things level out and then improve again. You may want to take advantage of those, as longer term costs will go up.

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.

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.

How much do you want to pay for LASIK eye surgery? Most people are voting that LASIK laser eye surgery prices should be under £1,000 per eye. If you haven’t yet voted, look over to the lower right hand side bar and have YOUR say!

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.

There are FOUR key points to look at when choosing a clinic:

1. The laser technology
2. The surgeon
3. The clinic
4. The price

Let’s look at these in more detail:

1. Laser technology
The improvements in success rates and safety of laser eye surgery, including LASIK and PRK, have been mainly down to improvements in sophistication of the laser technology. The lasers are dramatically better than they were even a few years ago.
NOTE: not all lasers are made equal, so you MUST look at clinical results to get accurate performance information.

Focus’ data are available on the results page of the Focus Laser Vision clinics website.

99.4% of patients saw 20/20 or better 6 months after Z-LASIK. 100% saw 20/25 or better.

Also note that each clinic makes a claim that they have the best technology, but this of course cannot be true. They can’t ALL have the best laser equipment, as they all have different systems. Focus Laser Vision bought the WaveLight Allegretto system from Germany as it had the best overall FDA clinical results in extensive trials.

2. Surgeon
Equally important for your result and safety is the surgeon who will perform the procedure and assess your suitability for treatment. The most important decision is who NOT to operate on. In the UK you can look for one or more of the following points in your surgeon: 1. NHS Consultant appointment, 2. Fellowship training in refractive surgery and corneal disease, 3. Extensive experience in treating your kind of prescription, 4. Has performed more than 5000 procedures, 5. Works in refractive surgery on a full-time basis or at least two days every week if involved in other areas of ophthalmology (the more time in refractive surgery, the better), 6. Teaching and presenting on refractive surgery skills, vision outcomes and research.

3. Clinic
Look at the support that each clinic will offer to you. Individual independent clinics can usually offer excellent continuity of care so you see the same clinician each time, but may not be as well geographically placed as some of the nationwide chain centres. Ask if you will get your surgeons private phone number after treatment in case of problems or advice being needed. This number is very reassuring for patients.

4. Price
Last of all, look at the price. You want the above three factors to be the best you can get first of all. If you are completely satisfied you have not compromised there, then you can look at price, but ONLY then. High price is not a guarantee of quality, of having the best laser technology, of getting the best surgeon. It may give you these things, but you have to look and make sure for yourself.

In summary, look for yourself and ask the right questions. I have more information of the FOCUS Laser Vision clinics website on this and other related topics.

I got an email this week from a Mr. John Andrews, who was confused about LASIK laser eye surgery pricing.

John wrote:

Having visited your site I am not clear what criteria you used to determine the cost of treatment. What level of myopia do you treat for £295 per eye assuming a thick cornea and no astigmatism?

And here is my reply to John:

Dear Confused

Let me clarify!

There are two pricing models in the UK. One based on prescription and the other a fixed price per treatment type. We base short sighted correction prices on prescription, in the same way that Optical Express does.

Prices for keratome based lasik start at £295 for WAVEFRONT based lasik. This covers up to 1.5D of astigmatism and up to 1D of myopia. Anyone with up to that prescription gets wavefront treatment at that price.

NOTE: You can see the £395 headline price from Optical Express and Optimax is not what you will pay at all when you want modern wavefront LASIK. Those prices are for non-wavefront treatments and you have to pay extra if you want up to date wavefront LASIK. They start at these clinics at £795 per eye.

Our prices are for wavefront based treatment with FDA confirmation that this method outperforms ALL other lasers for custom treatments (see our web site under results.)

We are cheaper than ALL other London based clinics for a range of prescriptions. Check out my blog on this topic with a graph comparison of prices for various prescriptions at various London clinics. (keratome (bladed) wavefront LASIK)

lasik-truth.com/2008/01/25/how-much-should-you-pay-for-lasik/

To clarify, if you want keratome (bladed) lasik, for the above prescription range, then it will cost £295 per eye. If you want to upgrade to a dual laser system (most , but not all, want to take the upgrade by choice) then that will be £595 per eye. This is still markedly cheaper than other London centres.

SO:
Cheaper price, NHS consultant corneal and laser fellowship trained specialist, lasers with best FDA results.

Easy choice, isn’t it??

If you still not sure, ping me a reply!

It is quite confusing for people looking at where to go for their laser eye surgery treatment. Especially so in London where there are many laser eye clinics to choose from.

In other cities you can usually find one or more of the big three chains: Optical Express, Ultralase and Optimax and these centres are probably doing about 80% of all laser eye surgery in the UK, partly because of their wide geographical footprint and so easy access for many people.

Most people really are not sure what to look for in a laser eye surgery provider. They don’t understand the difference between different laser systems and they don’t have easy access to the true performance or knowledge about individual surgeons.

So most people default to the ‘look and feel’ of the website and clinic if and when they attend for a consultation, or follow up from a word of mouth referral to a centre where someone has already had treatment.

Most of the brochures are pretty interchangeable, all making the same claims about experience, technology etc. You could swap the company name and not really notice the difference in various claims.

There are FOUR key points to look at when choosing a clinic, and these are coming tomorrow in my next blog post. Watch this space!!

Prices for laser eye surgery treatment in the UK have fallen by up to 80% for correction of short sight. However, tremendous variation between clinics means a difference in price of up to £4,000 ($8,000) for the same glasses prescription.

You can see the press release article on the fall in LASIK laser eye surgery prices here