The KAMRA Inlay is a breakthrough in correcting the need for reading glasses, and is now our primary treatment for anyone aged 45 upwards. You can read an article from yesterday’s London Evening Standard all about KAMRA. It features Karen who had the Keyhole KAMRA version, where no LASIK-type flap is created, and the inlay is simply inserted into a tiny pocket through a keyhole entrance. Unlike LASIK, there is no significant dry eye and the patient could even rub their eyes afterwards without risk of dislodging anything.

You can see the full article here: www.thisislondon.co.uk/standard/article-24014966-london-clinic-develops-10-minute-operation-to-freeze-failing-eyesight.do

You can learn more about KAMRA and presbyopia here at KAMRAvision.com

Gill asked this question about laser eye surgery for varifocal and reading glasses:

Dear Mr Allamby, I was told last year by my optician I would benefit from varifocal lenses, which I hate. My prescription was:
R: Plano (zero) /-2.75 x 180
L: Plano (zero) /-1.25 x 175
Near Add: +1.50D
I am 51 years old. I had a consultation for corrective surgery and told I only need right eye done. Is this correct and how much would this be likely to cost at Focus? Thank you, (brilliant and most helpful blog by the way)
Gill

Hi Gill, You have myopic (short-sighted) astigmatism, with mild astigmatism in the left eye and a moderately higher amount in the right. Additionally, at age 51 you also have presbyopia, which is an age related loss of near vision (itself a form of long-sight). So you have three eye conditions together – myopia, astigmatism and presbyopia, which all need correcting (!) if you want to be pretty independent of glasses. However, correction is certainly possible.

I specialise in correcting these kind of prescriptions, over the last 7-8 years, and have done thousands of cases. I would need to assess which is the dominant eye and correct that eye fully. However, contrary to what the other clinic said, leaving astigmatism in the eye which is to read rarely is successful. So with your prescription I almost always treat both eyes. Of course, everything depends on what we find at the consultation, but this will give you a strong idea of what you likely need.

I charge just under £4,000 for both eyes for wavefront Ziemer Z-LASIK. If you want me personally to do your initial consultation rather than one of my team, add £200. The blended vision presbyopia treatments will be increasing soon, likely to £4,400 for both eyes.

Hope that helps explain somewhat Gill. If you post on the comments below, your reply will also come to me.

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I was recently asked by Kaz to explain the Z-LASIK procedure in more detail. Watch this video and in a second post I will run through why I consider Z-LASIK combined with the WaveLight excimer laser to be the ultimate in LASIK laser eye surgery.

I recently treated Denise Van Outen at my clinic and you can see the full story in today’s Daily Mail. We also made the front page with a leader. The phone’s are ringing non-stop!
You can click here to see the full story on Denise Van Outen and her laser eye surgery in London at the Daily Mail’s website.

Denise can now see better than 20/20 in each eye and is delighted with the result. She had the operation to get ready for climbing Kilimanjaro next month for Comic Relief without her contact lenses.

You might want to take a look at the laser eye surgery Lifetime Care Guarantee introduced at FOCUS Laser Vision (www.focusclinics.com/treatments_after.php). There are millions of people who would like to have laser eye surgery, although worries about possible complications is the quoted main reason that people have not yet gone ahead.

People have been looking for peace of mind and want to know that a clinic will take care of them afterwards.

Currently only FOCUS Laser Vision and Ultralase offer a lifetime care guarantee after laser eye surgery.

The biggest thought in every patient’s mind is about safety and that is exactly how it should be. As a prospective laser eye surgery patient (LASIK or PRK) you need to do a little research beforehand, so take a look at various clinics’ websites. Check the FOCUS Laser Vision or Ultralase websites for more details of their Lifetime Care Guarantees.

You can also check out Optimax, Optical Express or Moorfields (or any other UK clinics in fact) but none of these clinics offer a lifetime guarantee.

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.

TECHNOLOGY that has become available over past two years means that reading vision problems can now be very effectively addressed through laser eye treatment. Although at present only a few clinics specialise in this area, it is the fasting growing section of the laser vision arena.

FOCUS Laser Vision specialises in the correction of loss of reading vision, either through advanced LASIK laser eye surgery or through the use of lenses inside the eye (IOLs)

Several approaches to LASIK are showing promise in the treatment of reading vision problems (presbyopia) for patients with otherwise normal distance vision, or long or short sight, according to studies presented at the 12th Winter Refractive Meeting of the ESCRS.

In research presented by Kenneth A Greenberg MD, all patients achieved good distance vision of 20/25 or better and were able to read telephone directory sized print, 12 months after undergoing customised LASIK treatments. The multicentre study involved 28 presbyopic long-sighted patients with an average age of 56 years.

You can still read Rick’s story about his treatment with me, online at the Daily Mail’s website. Rick talks about the whole process in a very interesting article from Rachel Kaufman.

Follow the link below to read the full article.

www.dailymail.co.uk/health/article-404859/New-laser-surgery-cured-long-short-sight.html

There are three main treatment choices for anyone thinking of having laser eye surgery. But which one will be right for you?

The final choice will be determined between you and your laser eye surgeon. BUT, of course, you have the eyes and your surgeon has the expertise so you will be heavily influenced by what the doctor or another clinic staff member says. It will be better to be prepared. With just a little knowledge you can be actively involved in making the right choice.

I will outline the 3 main options to help you have an informed discussion when the time comes to select which approach is best for your individual eyes. After all, you only have one pair so you want to get it right.

You will be overwhelmed at first by all the terminology, treatments and brand names. Don’t worry. There is no need to be blinded by science or some of the frankly misleading marketing information that is out there.

Firstly, whichever of the 3 treatment types (more on these coming in a couple of days in part 2) you go for, you must go for the wavefront option. The wavefront (or custom) technology has made a huge improvement in vision success rates with many more people getting 20/20 sight or even better.

Different clinics use different names for this technology: custom, wavefront, wavefront guided, wavefront optimised, CustomVue.

Many clinics will charge you more for wavefront based treatments over older non-wavefront options. Is it worth it? Definitely.

Back in 2000 when we were doing LASIK without wavefront, the benchmarks for success were getting 65% of patients to 20/20. In 2008 we expect more than 95% of patients to see 20/20 or better. This improvement has come from better technology, in large part from custom or wavefront based corrections.

Also wavefront laser eye treatment will give better vision at night or in low light situations. Patients will notice less halos and glare from light sources such as car headlights. It is like buying a more expensive camera with a much, much better lens.

This is the year 2008, so get the best current technology for your sight correction – you only will have this done once and you will live with the results for the rest of your life. Think about the computer you had back in 2000 and what is now available in 2008 – that is the level of difference in laser technology too. No brainer, really.

If you can’t afford the price, either don’t have it done yet and save up until you can afford it, or think about financing.

So if you go to Optical Express, go for the more expensive CustomVue wavefront version. Without it, the results really are not at a level that is satisfactory in 2008. If you go to Optimax or Ultralase, pay and get their wavefront guided option.

If you go to FOCUS Laser Vision, wavefront is already included in the quoted price. They don’t do any non-wavefront treatments.

Come back in a couple of days to read part 2 where we will finish this post by looking at safety and healing in laser eye surgery.

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.

Since we introduced the Z-LASIK blade free LASIK laser eye surgery procedure into the UK in January 2008, more than 90% of our patients have opted to go dual laser (no blade) for their vision correction.

The LASIK procedure has two parts – the first is the preparation of a thin flap followed by the second stage of vision correction itself. Traditionally, a bladed device has been used to cut this flap and gave some people pause about going ahead with the surgery.

Laser blade free flap makers were introduced in 2002 by the Intralase Corporation in the US. A next generation system was released in 2007 by Swiss ZIemer Group.

The added level of safety offered by eliminating the need for a physical blade cut has proved to be very popular for patients at FOCUS Laser Vision, with 9 out of every 10 people choosing to have Z-LASIK (blade free Ziemer technology). The additional cost of Z-LASIK leaves 1 in 10 people going with the traditional blade version, M-LASIK.

The high cost of femtosecond lasers means somewhat higher LASIK prices, usually around £300 per eye higher than bladed LASIK. The reason is that the blade systems cost around £30,000 per machine compared to £200-250,000 for a femtosecond laser.

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.