Examining the “LASIK-Industrial Complex”
LASIK is an unfortunate example of the influence of for-profit decision making in American medicine.
It seems like the tension between profit generation and patient care at the heart of our healthcare system has never been more troubling to so many Americans.
70% of Americans recently reported that the healthcare system is failing them – a reflection of rising costs and lower quality, among other factors. 68% describe the condition of the system as being in a “state of crisis” or having “major problems.” Individually, many of us have intimate stories about how Big Pharma, health insurance providers, and private equity companies have malignly affected families in the past few decades.
When all the symptoms of the “Medical-Industrial Complex” are viewed as an interconnected web, I think it’s one of the few things that almost all Americans regardless of background and political or ideological affiliation can agree is a monumental problem.
Unfortunately, as most physicians, nurses, and other healthcare professionals will passionately attest, the status quo only seems to be getting worse. As boardrooms debate how to make their healthcare holdings more profitable, the burden of their cost-cutting decisions falls on doctors and nurses, who are acutely aware that the standards they would prefer to honor for patient care are casually sacrificed in the interest of profit maximization and quarterly earnings reports.
A 2018 STAT op-ed that went viral in the medical community described the ethical dilemma many of my colleagues face on daily basis:
“Continually being caught between the Hippocratic oath, a decade of training, and the realities of making a profit from people at their sickest and most vulnerable is an untenable and unreasonable demand. Routinely experiencing the suffering, anguish, and loss of being unable to deliver the care that patients need is deeply painful.”
Of course, many of these problems only metastasized during the pandemic. So it’s not surprising that a January 2023 study found that 30% of US Doctors have considered leaving clinical care, and 55% know a colleague who already did. Only 6% have faith in the state of the system as a whole.
How LASIK relates to the Medical-Industrial Complex
“With the LASIK-Industrial Complex, quantity (the number of surgeries performed every day per clinic and per surgeon) is the main priority, not quality (outcomes measured by long-term patient satisfaction).”
As an independent ophthalmologist specializing in an elective eye correction surgery called Advanced Surface Ablation (ASA), I encounter these same market forces on a daily basis. The laser eye care industry is corrupted by profit motives, aggressive marketing, and overlooked risks.
Given the expensive, out-of-pocket nature of laser vision correction procedures, the financial interest in keeping LASIK the default choice in the laser eye surgery market is larger than most can fathom.
LASIK is considered “too big to fail.”
Because of this, it is not uncommon for large-scale regional and national LASIK centers – “LASIK Mills” – to subordinate patient outcomes to the demands of corporate balance sheets. These individual LASIK centers must continuously generate revenue for their parent companies or else they will be downsized or closed.
In layman’s terms, this often means that with the LASIK-Industrial Complex, quantity (the number of surgeries performed every day per clinic and per surgeon) is the main priority, not quality (outcomes measured by long-term patient satisfaction).
LasikPlus, which belongs to a large corporation responsible for about 33% of all LASIK surgeries in the United States, is the best example of this.
In a 2021 Wall Street Journal (WSJ) article, reporters found that surgeons “were pressured by corporate management to follow practices that they felt put the company's profits over patient care.”
This includes approving between 90-95% of all prospective patients for surgery (20% higher than the average rate for independent LASIK providers), and being pressured to perform more daily surgeries than they were comfortable with – between 40 and 50 per day instead of ~25.
Patient care was routinely jeopardized in the interest of profits.
Not all LASIK clinics fit the criteria of being a LASIK Mill. But considering the corporate takeover of so many LASIK clinics in New York City and beyond, it can be easy to fall into the trap without even knowing it.
That means – until the FDA officially implements a plan to warn patients of potential complications before the surgery – it is entirely incumbent on patients to research the risks associated with LASIK and know the “LASIK-Industrial Complex” when they see it.
Defining the LASIK-Industrial Complex
I define the LASIK-Industrial Complex as the influence of commercial interests in the laser eye surgery industry that ignores the best interests of patients and diminishes the autonomy of ophthalmologists for the chief purpose of profit growth.
The raison d'être of LASIK-Industrial Complex is to grow LASIK like a commodity, selling it out-of-the-box to more and more people, despite mounting evidence that there are safer, better alternatives for most people.
So, if you are interested in getting laser vision correction now or in the future, how can you avoid the LASIK Industrial Complex? Here are some red flags to watch out for:
Pressure & Salesmanship
Run, don’t walk, from clinics that use aggressive sales tactics to try and “close you.”
Reputable surgeons and clinics will prioritize your well-being and provide you with all the information you need to make an informed decision without pressuring you. No matter how many emails or phone calls with the surgeon it takes to answer your questions and put your concerns to rest!
LASIK Mills will pressure you to get surgery as soon as possible and so that they can hit their sales quotas.
If a surgeon or someone else at a LASIK clinic is continuously pushing you to commit to a surgery date and brushing off your questions, get out of there as fast as you can.
You should be the person going to them saying “I’m ready.”
Relationship with Your Surgeon
Size doesn’t always matter (big clinics aren’t always bad, and small ones aren’t always good). There are many large independent surgery centers that do good work, for example, even if I take issue with the safety of the LASIK procedure itself.
The most important thing is – do you 1) actually know your surgeon and 2) are you confident that they fully understand your needs and are looking out for your long-term health (visual acuity and wellness) above all else.
Many large surgery centers (“mills”) rely on revolving-door surgeons who perform your operation and then are never heard from again, leaving you to communicate post-op concerns with trainees.
You deserve to be treated like a friend or family member of the surgeon and your access to him/her shouldn’t feel gate-kept.
Questions about Your Lifestyle
Your unique eyesight, occupation, and lifestyle must determine which laser eye surgery is right for you.
Regardless of if you are considering LASIK, ASA, PRK or another procedure – these are not one-size-fits-all operations.
It is the surgeon’s duty to objectively assess if you are a good candidate for their procedure. As I wrote in Men’s Health:
Regarding your lifestyle and career, LASIK and other cutting procedures (i.e. SMILE) are strongly discouraged for individuals who participate in contact sports, those who work blue collar jobs (i.e. factory workers), and those in professions where acuity – including night vision – is paramount (first responders, aviation, aerospace and defense, transportation, etc.).
This is because the flap (usually about 20% of your cornea) never completely fuses with the rest of the cornea after the surgery. A poke in your eye on the basketball court or by your toddler can dislodge the flap, creating a whole host of problems.
Likewise, white-collar workers who spend most of their day on the computer are not good candidates for LASIK. When you combine the propensity for dry eyes from LASIK with 8 to 14 hours of screen time per day, you could be dealing with chronic dry eyes for decades.
If a surgeon is disinterested or ambivalent in these types of details about your personal life – or if they are dismissive that dry eyes and flap dislodgment are serious concerns with LASIK – then it’s a sign that you’re just another paycheck to them and it would be best to seek another provider more honest and attentive.
Discounts, Promotions, & Financing
This is a tough one – but don’t allow yourself to be sold on LASIK because of a great promotion that you saw in an ad.
Lasik Mills are also notorious “bait and switch” advertising and have been fined by the FTC for deceptive marketing practices.
Remember that “Big LASIK” largely controls the industry and can easily manipulate LASIK fees accordingly. “Race to the bottom” pricing is a common tactic that corporations deploy to put higher-quality independent operators out of business.
Similarly, because laser eye surgery can be cost-prohibitive for many people, LASIK Mills who offer financing plans may be an attractive option.
But this really is a case where you get what you pay for. Saving a few hundred dollars – or receiving a low-interest payment plan – by going with a LASIK Mill does not justify the long-term risk of getting LASIK from a clinic whose chief concern is growing profits and reducing competition.
Final Thoughts
Like the Medical-Industrial Complex, the LASIK-Industrial Complex raises valid concerns about the LASIK industry.
Prospective patients shouldn’t be deterred from getting laser vision correction – on the contrary, there are plenty of great surgeons out there, and countless stories of why laser eye surgery is life-changing. But they should approach their journey with a discerning eye, conducting thorough research, and seeking advice from reputable ophthalmologists to ensure they make the right decision for their vision and overall health.
The best piece of advice I can give is to encourage you to choose a surgeon, not a surgical center.
Research your actual surgeon’s reputation instead of the clinic. Check Google Reviews. Check Reddit. Look for testimonials from real people that go into detail about their operation and experience.
Are you interested in a safer laser vision correction procedure?
Do you live in New York City or the Tri-State area?
Then I invite you to investigate ASA surgery with me at Moskowitz Eye Care. Because while LASIK brings great benefits with some very real risks, ASA brings those same benefits with fewer risks.
Each patient is treated like family here and I manage every aspect of your care from pre-op consultations to the surgery and post-op. Don’t just take my word for it. Read or watch testimonials from my previous ASA patients!
Get started by setting up a free consultation.