LASIK Grows in Popularity

Robert Marberger, RN, research coordinator at Cooper Medical Center Trauma Unit sits with James Lewis, MD. After his LASIK Robert said, “Thanks to a wonderful team.”

by James Lewis, MD

LASIK is an experience rather than a surgical event. It begins with your first call, and it should never end. You should be able to count on someone being at the end of the phone (or email) to answer brilliant questions as well as “stupid ones” for life.
Surgeons emphasize their experience, their great equipment, their safe environment, their high-powered references and their brand affiliation; these are prerequisites. Geniune concern for your total well-being (standard at iHateMyGlasses.com™) sets us apart. This is why we don’t have “levels” of service or “treatment plans” for our patients. Everyone’s eyesight is precious.
It took time to assemble a group of caring, motivated staff. Sue Cross, our LASIK coordinator can handle almost anything. Debbie Breig, our experienced scrub nurse and LASER technician has never been seen making a mistake or losing her cool. Michelle Nolan had LASIK and tells patients exactly what to expect and how to take care post-operatively.
We’ve set a maximum on the number of LASIK procedures we will perform in a day. We can’t provide enough attention to the surgical detail and your emotional needs if we try to do more. (No assembly lines here.)
Everyone is nervous about surgery. Everyone wants the best result. My staff insists I exercise regularly and stay healthy for surgery. They won’t tolerate a “second best” surgeon so you won’t either.
I am touched that Nancy and Brenda always stay late. They are there for you and never look at the clock. I am lucky to work with my closest friend Barry Fabriziani, OD in Phoenixville and Jenkintown. He is the best doctor I know. We affectionately call him “FAB”. We’ve started to call Marc Myers, OD, pre-FAB, because he has all the same traits except he doesn’t have grey hair. Dr. Myers splits his time between Mount Laurel and Jenkintown.
As a cornea subspecialist, it took time before I was comfortable operating on a medically-healthy eye. If the results hadn’t been outstanding and the patient experience emotionally rewarding, I would have stopped immediately.
LASIK is the most exciting advance in our field in years. Whether you visit us or another reputable provider, you should see whether LASIK makes sense for you.

More Area Residents are Discovering the Benefits of LASIK

Stephen Reed of Dresher studies audio engineering. He was happy with the caring and supportive staff and felt no pain.

Jeff Kochanowicz’s daughter plans to be an eye doctor. She watched her father’s LASIK very, very carefully.

Eye News has been published every week for the last 3 months. I want to thank the folks at the Courier-Post for their talent, professionalism, and wonderful sense of humor.
Eye News may “reemerge” this fall in a similar format, or, it may be transformed into a question and answer column on eye health.
In the interim, feel free to visit our websites: http://www.iReadEyeNews.com
http://www.iHateMyGlasses.com
Let the Courier-Post (856-663-6000) know how it can best keep the community informed about LASIK and other advances in eye care.

Is Summer a Good Time for LASIK Surgery?

Dr. Lewis and Dr. Myers discuss their submission to the FDA. This research uses LASIK to improve vision in patients who have had a corneal transplant.

photography by Sue Cross

Swimming without Glasses or Contacts Makes LASIK Popular in the Summer

by James Lewis, MD

LASIK patients want to know when they can resume their normal activities.
As surgeons, we want to be conservative but as realists we want patients to get back to their daily routine. Below are some general guidelines:
Driving is usually possible the morning after LASIK surgery. While night driving can be more variable, we need patients to exercise good judgment.
Swimming is usually restricted for two weeks. Recent discussions on Kera-Net (a chat line for Ophthalmologists) suggest that even less time may be required. Scuba diving, surfing, high diving, and waterskiing should be avoided for two weeks. Chlorine and saltwater are not a special concern.
Exercise can begin the next day. Effort should be made to reduce sweat by using a headband or a hat.
Showers can be taken any time after surgery. It is best to keep your eyes closed gently for a few days while showering.
Golf is a special case. We ask golfers to wait at least eight hours before getting back onto the green. You can use your surgery as an excuse for a bad game for six to twelve months.
Alcohol use is not restricted after the first twenty-four hours. Smoky environments (bars, concerts, parties) may require an extra dose of the non-preserved tears. They can be found in your post-operative kits. Sometimes your eyes will be tired. Go home.
Commercial airline travel is fine after you are seen the day following surgery. Because the plane’s atmosphere is extremely dry, you may need to use a lubricating gel and close your eyes on longer trips.
Makeup is not my area of expertise. Nor are questions like when is it OK to have my hair “done?” I recommend waiting about a week. Make sure nothing touches the eye (eyeliner) and no powders, cremes, ointments, lotions, fumes, etc. get into the eye for at least that long.
Allergies are rarely a problem for LASIK patients. The medications given control itching and can be used for an extended period if necessary. Rubbing the eye should be kept to a minimum, and a real good rub should be avoided for many months.
Little children are my biggest fear. Whether they belong to you or not, they have an uncanny ability to touch and wrinkle your LASIK flaps during the first 72 hours. It is best to keep children at arms length for at least that much time.
There is no need to avoid the sun or the beach. Sunglasses should be used to protect your eye from the sun, sand and wind. I ask all patients to make sunglasses a regular part of their gear. Studies have shown a reduction in retinal disease and cataract development with sun protection. Of course, sunscreen is not an eye drop.
Sleeping immediately after LASIK is a required activity. We tape on protectors for the eyes after surgery to prevent trauma (rubbing). Night shields (in your kit) are also advisable for several additional days.
Skydiving, extreme mountain climbing, and contact sports are best delayed for a month. There is no better substitute than good judgment.
Computer use and reading can begin soon after surgery. Remember, taking frequent breaks and non-preserved lubricants are required. If you feel as if you’ve had enough, you probably have!

Vince Shields, owner of Kenny’s in Southampton says farewell to Sue Cross, head LASIK coordinator.

LASIK Prices Revealed

Q: How can one doctor charge $5000.00 for LASIK and another charge $499.00?
A: Some doctors rent lasers. They are not committed to LASIK surgery. They don’t invest because they want to minimize their financial risk. Companies lease lasers to doctors and charge over one thousand dollars for each patient treated. Theses companies get 20 to 25% of your surgical fee.
Some doctors own their own laser but still charge too much! They are not better surgeons. They do not represent higher quality.
Others groups charge so little they have to run their office like an assembly line.
Q: Am I safer going to a University setting, a large corporation, or what?
A: No. An established physician is your best choice. Pick someone with a commitment to the community and an excellent reputation. They will be there for you tomorrow.
ihateMyglasses.com has never changed its price ($2500 for both eyes) nor its mission. We provide excellent care, top quality equipment, and a professional environment. We don’t overcharge, and we don’t run a LASIK factory.

Officer Mark Dietrich of Berks County found LASIK surgery simpler than expected.

The Secret to Successful LASIK: Realistic Expectations

Michael D. Nicholas, MD, and his wife Cheryl hold their two week old son Rhys. Dr. Nicholas is a prominent member of PENNCare Central Bucks Pediatric Associates of Doylestown.

Barry Fabriziani, OD, evaluates Dr. Nicholas one day after LASIK

A LASIK surgeon must be certain his or her laser is perfectly aligned and calibrated. This is the first step in optimizing clinical results and safety.
Traditionally surgeons followed the maintenance schedule recommended by their laser manufacturer. Precise control of temperature, humidity, and air quality are fundamental. Avoidance of vibration, movement, and transportation of the laser help reduce these concerns.
Precision-Dynamics of Ontario Canada feels testing the laser before use on patients is necessary. iHateMyGlasses.com™ agrees. They have become one of the first locations to obtain the PD-1000 Interferometric Sensor System.
“The PD-1000 is a profilometer. It checks the quality of the laser beam before we use it to remove corneal tissue,” Lewis said. “We spend so much time double and triple checking our data. It is vital we verify the performance of our laser before it is used on a patient.”
Most surgeons depend on a lensometer (the device used to measure glasses) to check the performance of the excimer laser. iHateMyGlasses.com™ feels this is unsatisfactory.
“There is too much variation between one service technician and another. I just wanted something to assure me the everything was accurate.” Lewis added.
The PD-1000 measures the exact contour removed by the laser. While it cannot “fix” a problem, it can recognize irregularities before they can injure a patient.
The device is expensive. Dr. Lewis plans to offer ablation profilometry to his colleagues without charge.

Do you really want perfect vision?

Patients ask me to aim for “20/20” or better yet, “20/15.” The entire industry is guilty of over-simplifying LASIK surgery.
Surgeons want their patients to see as clearly as possible. More important, they want patients to maintain excellent vision in both eyes for a lifetime. This is great when it happens on the first post-operative day. Surprisingly, some of my happiest patients have had enhancements because their vision didn’t reach our mutual goals and additional surgery was required.
LASIK is major ocular surgery. Initially fluctuations, dryness, and daily variations occur. Dr. Nicholas (see above) didn’t reach 20/20 on the first post-operative day. He knew his glasses were two to three times stronger than the average, and he expected his recovery to take more than a day. He understood biologic variation and anticipated these results. This knowledge has made him a very happy patient.
Overcorrection can occur when too much precious corneal tissue is removed. While this surgical approach can yield an early visual WOW, it jeopardizes the structural integrity of the eye and may lead to premature dependence on reading glasses.
Patients should be wary of doctors who boast their enhancement rate is extremely small. They are usually cavalier or just plain arrogant.
A conservative approach to LASIK produces a healthier eye and a patient with excellent vision.
Microkeratome technology continues to improve. Excimer laser technology is also improving. The body, however, is ruled by genetics, the environment, and more. Everyone is different, and we all heal uniquely.
You should expect an outstanding visual result from LASIK after a successful procedure. Sometimes this is immediate, in others it takes weeks or months. Sometimes a “tweak” or enhancement is appropriate. Occasionally an enhancement is foolhardy.
Our goal with LASIK is to make you dramatically less dependent on glasses. Most patients will eventually need reading glasses, and some will require spectacles for maximal acuity while driving at night or in rainy weather.
We don’t “set the laser for 20/20”; we aim to give you the most vision possible as safely as possible.
To be happy with your LASIK results means that you must respect your doctor, yourself, and nature. This is best achieved by doing your homework.
Learn about LASIK. Talk to your doctor. Make sure you want less dependence on glasses and not “perfect vision.”
We don’t want you perfect; we just want you happy and safe. Start with the right expectations.

Precision-Dynamics of Ontario, Canada delivers one of the first excimer laser profiling units for clinical use in the US.

Carolyn Pennypacker of Phoenixville brings Rusty to her post-operative visit. This magnificent miniature has a perfect disposition.

In LASIK, do you really get what you pay for?

EDITORIAL by
James S. Lewis, MD

Unfortunately, we have been conditioned to believe you get what you pay for. We assume the more you spend on something; the better it is.
Some LASIK providers have used this to their advantage. In public seminars physicians have described their lower cost competitors with these phrases, “They use old technology,” “the doctor who operates on you has very little experience,” and, “they reuse blades.”
Some LASIK discounters have done their best to minimize costs by limiting frills. It is unlikely that anyone, particularly in this highly-litigious area, would use materials, devices, or surgeons that could jeopardize visual results. The suggestion that blades are reused is slander. Doctors who make these statements without evidence should be prosecuted.
Comments regarding a competitor’s lack of sterile technique are equally appalling. No ophthalmic surgeon could remain in business more than a few days if he or she failed to follow these fundamental principles. Infection rates would skyrocket, and these surgeons would be carted off by the authorities, shunned by their patients or sued by the hungry malpractice attorneys that inhabit our locale.
Some LASIK providers use this sterility issue as a scare tactic. No one has a monopoly on sterile technique. We spent too many years of our lives learning how to perform surgery properly. I doubt amnesia would effect every LASIK surgeon except the members of one group. Can you imagine us all saying, “I’m sorry…I wasn’t sterile?”
LASIK discounters are focused on market share. They introduce low prices to get patients in the door. They hope happy post-operative LASIK patients will generate word of mouth referrals. These referrals are typically the most effective and reduce the need for traditional advertising.
People want the best for their eyes and are wary of these offers. LASIK is not a commodity. The discount model doesn’t work. Pre-operative evaluations and post-operative care are important and time-consuming. Nearly a dozen LASIK discounters failed to consider this part of the equation and have filed for bankruptcy. One company kept millions of dollars in patient deposits and has no plans to make restitution. Curiously, they are still in business outside the United States.
Tiered-pricing is a polite way to describe bait-and-switch. A patient will go to a LASIK practice promising a great price only to discover they have astigmatism and don’t qualify. They will be told they are too nearsighted and so have to spend more. They will be told they have to pay extra for the surgeon of their choice, the surgical date of their choice, and even the laser of their choice.
Some practices promising a low price will charge you extra for a pre-operative evaluation, and even charge you for post-operative visits.
The theory of bait-and-switch is simple. Get patients in the door with a promise of an inexpensive price, trash the competitors, and sign them up for surgery. Make sure they feel guilty about picking a lower cost “plan.” Make them worry that they may need an enhancement so they won’t select a cheaper option that doesn’t include them.
Some patients have told me that tiered-pricing reminded them of auto-shopping. When I did that last I went for the heated seats, the cool tires, and the turbocharged engine. I guess I’m no smarter than anyone else.
At iHateMyGlasses.com we have one price, despite astigmatism, the thickness of your glasses, and enhancements cost nothing. Previously, we covered enhancements for only one year. It seemed dumb, so we retroactively made the coverage LIFETIME. A patient asked me whether that meant my lifetime or the corporation’s lifetime. I told her (an attorney), it meant her lifetime. (Because of the recent bankruptcies by LASIK discounters, I see her point!)
We don’t charge for LASIK evaluations because it isn’t right. If you don’t want surgery or we don’t want you to have surgery, we don’t want your money either. We have only one plan. Our LASIK coordinator, Sue Cross calls it our titanium plan.
iHateMyGlasses.com is not a LASIK discounter. We don’t intend to generate market share and then change our price. We charge what we think will cover our expenses and a “reasonable” profit. I like the latest technology. I like to pay my staff well. We charge $2500.00, and it won’t change.
My advice is to visit several LASIK providers. Talk to friends, relatives, and co- workers who have had LASIK and understand their experience. Surf the internet and research your doctor. Send email, read the LASIK policies and check credentials. Don’t be too impressed by numbers (if a doctor doesn’t know how to do excellent surgery after a few thousand cases; he or she should retire!). Remember, the surgeon is performing your LASIK, not the University or Corporation with whom he is affiliated.
Finally, use your instincts. They will guide you.

No glasses for Howard Gribben as he schedules his one week post-operative LASIK followup. We liked his golf joke!

Stephanie is told by Dr. Fabriziani her mom can see 20/20 in her right eye and 20/25- in her left one week after LASIK.