2021 was the biggest year ever for laser vision correction.
But no one benefited more than “Big LASIK” – and that needs to change.
By Craig Moskowitz, MD
According to the American Refractive Surgery Council, almost 834,000 people received laser vision correction in 2021 – the highest number ever recorded, and a 92% increase (!) compared to 2020.
There’s a good chance we see one million surgeries this year (an unthinkable number as recently as 2019), and this incredible growth warrants closer attention.
Laser Vision Correction Procedure Volume
I’ve written about some of the factors driving this increase. For many New Yorkers, constant eyeglass fogging from face masks was the final straw leading them to explore laser eye surgery. Others found that the remote-work, travel-less nature of the pandemic presented an opportunity to invest in their health – specifically in an operation that should have life-changing, life-long benefits.
That all sounds like great news for both the industry and the patients who had increased access to laser eye surgery, right?
As an ophthalmologist specializing in laser eye surgery, I’m both excited and anxious for all people who’ve had surgery in 2021 and in previous years.
Here are my two reasons for concern.
First, the “Big LASIK” industry was responsible for too much of this growth.
“Big LASIK” describes large and mega-scale LASIK centers where patient outcomes take a backseat to the demands of banks and shareholders. They prioritize quantity over quality and profits over patients.
The Wall Street Journal (WSJ) published an exposé on LasikPlus in November 2021. LasikPlus is part of a massive corporation that does about one-third of all LASIK surgeries in the U.S.
Big LASIK must make money for its parent company, so it often adopts processes that unintentionally jeopardize patient care. In the words of the WSJ, surgeons “were pressured by corporate management to follow practices that they felt put the company's profits over patient care.”
Here are four examples of those patient-unfriendly practices:
“Big LASIK” Problem No. 1
According to the WSJ, LasikPlus asked surgeons to boost the share of potential clients approved for surgery. A consequence of this strategy is that surgeons felt pressured to approve patients for whom LASIK might not be suitable, and some surgeons said LasikPlus discouraged them from directing patients to other eye surgery options that would be better for them.
This is a troubling practice because the American Academy of Ophthalmology tells us some people aren’t good candidates for LASIK, such as those with thin corneas, severe dry eye, or extreme prescriptions. Additionally, the Refractive Surgery Council says “approximately 20 percent of people who want LASIK are not suitable candidates for a variety of health and medical reasons including thin or damaged corneas or sometimes chronic conditions such as diabetes or autoimmune diseases.”
With those comments from highly credible sources in mind, consider these numbers from the WSJ story:
Some independent eye surgeons said they accept 70% to 90% of people who ask about LASIK.
LasikPlus clinics performed LASIK on an average of about 90% of prospective clients in both late 2017 and late 2018. The rate at some locations was above 95%.
One surgeon said his LasikPlus clinic approved 90% of people when he was there, and after he left LasikPlus for private practice, he accepted about 80% of potential clients as LASIK patients.
I’ll summarize. Outside of LasikPlus, LASIK surgeons accept between 70% and 90% of prospective patients. Per the WSJ, inside LasikPlus, the rate is between 90% and 95%.
“Big LASIK” Problem No. 2
LasikPlus management pushed surgeons to relax or abandon some standard industry practices that were included in guidelines from the American Academy of Ophthalmology.
For example, the academy recommends multiple post-op visits. According to the WSJ story, “some LasikPlus clinics have moved to seeing many patients just once within a day or so after surgery, relying on them to come back if they have problems.”
Would you be able to distinguish a common discomfort from a serious problem that requires immediate attention?
Looking for a safe and effective alternative to “Big LASIK”?
Ask me about ASA at my practice.
“Big LASIK” Problem No. 3
LasikPlus surgeons felt pushed to do more daily surgeries than they were comfortable with.
One surgeon felt 28 was the right daily volume for her but was pressured to raise her surgeries to between 40 and 50 each day. Others recalled being encouraged to join the “100 Eye Club” by performing 100 surgeries in a day. At some point, this pace becomes unsafe because surgeons (like everyone else) get tired, and as one of them said, “when you get tired, the risk of making a mistake goes up.”
“Big LASIK” Problem No. 4
The patient often has restricted access to their surgeon.
In fact, most of the work and post-op visits are done with trainees and optometrists. As a result, Big LASIK tends to be impersonal. Consider this anecdote from a Reddit discussion on LASIK mills:
“There is a bit of detachment between the surgeon and the patient. To explain: I always felt like I was attending a routine doctors appointment/eye appointment. The surgeon never really remembered my name, and would check the clipboard before pronouncing it. I never felt like he personally knew me, nor I him. This may be off putting to many since they may feel like they are just another paycheck to the location. But in reality, you are.”
Those are just four ways Big LASIK cut corners to increase profits, even if the efficient practices do not benefit the patients.
Remember: Big LASIK centers in New York City and nationally don’t advertise that they’ve implemented any of these cost-saving practices that may have a negative impact on your outcome. Unfortunately, it’s all too common for consumers to innocently shop for a good deal on LASIK and end up at one of these locations where your money is valued more than your eyesight.
LASIK is a bad surgery regardless of who performs it.
My second reason for concern about the big year that LASIK had in 2021 is more straightforward: LASIK is a flawed operation. And of course, more of a bad surgery can only be a bad thing.
I’m not alone in criticizing LASIK’s significant long-term risks and complications. NBC’s Today recently sounded an alarm. In their story, Dr. Cynthia MacKay, a retired ophthalmologist with decades of experience performing laser eye surgeries, had this to say:
“The excimer laser used in LASIK does not save sight, it degrades it … severs corneal nerves … leads to under correction, over correction, scarring, warping, irregular astigmatism and, inevitably, decreased vision.”
Additionally, the FDA, the National Eye Institute (NEI), and the Department of Defense (DoD) launched the LASIK Quality of Life Collaboration Project (LQOLCP) in October 2009. Their goal was to gain a better understanding of LASIK’s possible negative outcomes. Key findings include:
Up to 46 percent of participants, who had no visual symptoms before surgery, reported at least one visual symptom at three months after surgery.
Participants who developed new visual symptoms after surgery most often developed halos. Up to 40 percent of participants with no halos before LASIK had halos three months following surgery.
Up to 28 percent of participants with no symptoms of dry eyes before LASIK reported dry eye symptoms at three months after their surgery. This is consistent with previous studies.
Despite the initial “wow!” right after LASIK, patients may develop significant vision problems months later. That’s a bad surgery.
The benefits of laser eye surgery are widely available without the risk posed by LASIK (and especially “Big LASIK”).
At Moskowitz Eye Care, I manage every aspect of care from pre-op consultations, to the surgery, and then answering post-op questions. Ask me anything about laser vision correction.
There’s good news for anyone reading this who wants laser vision correction surgery but is concerned about the case against LASIK that I just presented.
There is a safe and effective alternative to LASIK called Advanced Surface Ablation (ASA) surgery, which does NOT cut into the cornea at all. Because if your cornea isn’t cut, there’s no risk of flap-related complications of dry eyes, halos, starbursts, and ghosting.
I invite you to investigate ASA surgery at Moskowitz Eye Care. Because while LASIK brings great benefits with some very real risks, ASA brings those same benefits with none of LASIK’s risks.
Another important feature of care is our one-on-one approach.
Each patient is treated like family here.
I perform all the surgeries, and never hand you off to a trainee or assistant. You’ll have my cell number and can reach me 24/7 to ask questions or come in for a follow-up visit. I didn’t sell out to private equity, so I’ll never be pressured by an MBA boss to meet his quota for cases so he can get his year-end bonus.
Don’t just take my word for it. Read testimonials from my previous ASA patients!
And get in touch for a free testimonial by filling out the form below. I value your privacy and will not be bombarding you with marketing messages!