Centers and cost and procedures

[chapmgre]

I would like to say thank you for hosting a site like this, it makes research much easier. My question is this. I have a very mild prescription of about -1.5 with little or no astigmatism. At one center (center 1) that I was evaluated at the Optometrist said that I had little (less than 0.03) refraction defects and that conventional Lasik would be just fine for me. The sales rep was a little miffed as she was trying to sell me a custom wave front. The other large center (center 2) that I visited today said that they only did custom wave front and don't do custom any more. Center 1 had various plans that included No enhancements up to lifetime. Center 2 only had 1 year enhancements.

Now here is my dilemma. Center 2 stated and what I have gathered from researching Medline shows a very low need for enhancements with a low prescription like mine, (less than 2%) Center 1 cost for conventional lasik with no enhancements would be $799 per eye. Center 2 quoted a price of $3800 with one year of enhancements. Both centers use very experienced surgeons that are well known in the medical community and have performed upward of 10K surgeries.

What is your impression? I don't want to go with the lowest cost (if I did I would go to a nearby center that would do each eye for $480) but do I need the guarantee of an enhancement for double the cost?

Thanks for your help

Greg

[LasikExpert]

Let’s try to get a bit of perspective on your situation. Nobody wants to pay more than necessary for anything, but if you go on the cheap and something goes wrong, you will probably never forgive yourself. You are talking about your eyes. You will live with the result of these decisions for as long as you intend to see.

The $480 center must be using the Nidek EC-5000 laser because this laser does not charge a $250-350 per eye royalty. The Nidek EC-5000 is a currently FDA approved laser, but its technology is significantly older than the Visx S4, LADARVision, Allegretto, or B&L Zyoptix. Equally, the outcomes with the EC-5000 do not compare with the other systems.

Yes, you may get fine results from the Nidek and many do, but any elective surgery is a matter of beating the odds. The odds of having a good outcome with the Nidek are simply not as good as with the other systems (assuming the quality of surgeon, preop, and postop care is equal). Look at the FDA Lasik website and compare clinical trials.

If you are nearing or past age 40, you probably should not have any surgery to reduce your myopia at all. Visit our article on presbyopia after Lasik.

You really need to read about the advantages of wavefront Lasik compared to conventional laser ablation.

The probability of the need for Lasik enhancement with your refractive error does not sound like it would be elevated from the norm.

[chapmgre]

Thanks for the quick reply. I find it difficult to research the topic as is seems no one reports the data in the exact same way. The FDA sight was somewhat helpful, but I am also somewhat confused with their results and your statement. I compared the Nidek EC-5000 to the Visx S4, LADARVision systems and here are the results that I found, please correct me if I am wrong. With my current eyes falling into the < -2.0 criteria the UCVA for 20/20 or better was 88.2% at three months. The other systems were 79% and 87.1% respectfully. Please help I am now very confused.

Greg

[LasikExpert]

You are correct that the FDA published data does not present outcome information in a consistent format. There is no wavefront data for the Nidek because at the time of approval wavefront did not exist in ophthalmology. Snellen 20/whatever is an important measurment, but it does not represent real world vision of variable environments.

If you look at the LADARVision 4000 myopia wavefront approval Table 11 you will see significently higher increase of higher order aberrations (HOA) with conventional ablation when compared to wavefront-guided. Many studies with many platforms have show this to be consistently true.

A California surgeon has recently completed an outcomes study of several platforms. I do not know if the Nidek was included. I am attending a medical convention where this study may be presented (I don't find it currently published yet) and I'll try to get details.