Yelp!

I use Yelp on a regular basis. I like it so much that I contribute on a regular basis. However, recently, I realized that Yelp can be paid and bought. If you advertise with them, you can bury reviews that may be...mildly critical of the establishments.

Yelp claims they run reviews through anti-fraud filter. Basically, it tries to detect fake reviews and filter them out.

Guess what? Dr. Bindi recently has a prominent Yelp banner on his website. This means that he paid the company for the advertisement. What does this do for him? It pushes 5 star reviews high up and then...bury reviews that may not be exactly glowing. That's fine, they have to earn money somehow.

Interestingly enough, my review got filtered out. Yelp can push unfavorable reviews down, but when they filter out legitimate reviews as bogus, then they stepped into the the realm of shadiness. Now, I ask you, with my active review writing and even with my taking out some of the sharp criticisms, the review still got filtered out. Why? Because I spoke the truth. Unfavorable 3 line reviews are OK, but a balanced and truthful review backed up with research will get filtered out. Nevertheless, my review for Dr. Furlong stays. Am I bogus or not, Yelp? You can't have it both ways.

Did Dr. Bindi after having paid Yelp to promote him requested my review be buried? You decide.

That is so wrong, Yelp. Apparently, you can buy reviews on Yelp or pay to filter unfavorable reviews. This may not be Dr. Bindi's fault, but it may come back to hurt him in the long run. Most Yelp users click on the filtered reviews to get the whole picture sans shady dealings. Having a legitimate review buried is bad for business.


Update 3/22/12: Okay, it looks like it's part of Yelp's funky algorithm. It wasn't part of some diabolical conspiracy by Yelp and Dr. Bindi.  The trick is to add some friends and update your profile with your real name and it will eventually get your review out of filter.

1 Week Update

I guess I totally forgot about this blog. Her one week check-up shows that one eye is 20/20 the other is close to 20/20. Now that it's three weeks later, I have no doubt that she can see 20/20 in both eyes. We used the eye chart app for the IPAD and she can easily read the 9th line on it. She can make out only some letters on the 10th line (the 20/15 line).

The day after surgery, every light source had extreme halos. She is seeing some halos still with her eyes which were not there before. However, the halos had lessen more and more every day. The halos if most likely the reason why she's not able to read the 10th line. She can make out obvious letters but certain curved ones still glow too much.

Her dry eye is extremely minimal. She would have to remind herself to use the artificial tear because she often forgets. Her one month check up is coming up. We're still holding out for 20/15 once the halos go away. That could be up to three months away.

Why are we shooting for 20/15? The reason is 20/20 is only average human vision and not "perfect" which is a misconception most people have. 20/15 is very good. True perfect human vision is probably 20/12-20/10. It's very rare to have vision anywhere close to 20/10 but 20/15 is the gold standard for "perfect" human vision.

http://itunes.apple.com/us/app/eye-chart-pro/id364802332?mt=8
http://en.wikipedia.org/wiki/Visual_acuity

Lasik Complications

Isn't it odd that I'm posting about LASIK complications after the procedure was completed? Previously, my wife was so gung-ho about LASIK that she didn't want to wait (or cared) about the potential complications. Luckily for her, I actually cared and did all the research for her. Now that the procedure has been a success, I'm not sure what to do with those notes. I might as well share it here.

The first thing you need to know is that not everyone is qualified for LASIK (or PRK). This is where having a qualified and scrupulous doctor is very important, beyond just selecting the correct technology for your prescription. Ten years ago, there was a money grab with some doctors who was not always looking out for the patient's benefit. Even now, there are still cases of people who angry and upset about their quality of vision after LASIK or felt they were mislead by their doctors. Being able to see without glasses is great, but having star-bursts, halos, and dry eyes could be debilitating.

Therefore, it's not surprising that you are now required to sign the informed consent forms that state all the potential LASIK complications. The problem with the consent form is that it doesn't tell you what, why, or if you are in a higher category of danger for having those complications. It just states that there are complications as a result of LASIK. This is why it's important that you educate yourself first so that you can can ask the proper questions to the doctor and see for yourself and understand why and if you are a good candidate rather than just relying on the doctor's yay or nay diagnosis. Only you can decide if the risks are worth it. Unfortunately, certain individuals are in a higher risk category.

Pupil Size
If you research LASIK complications on the Internet, the vast majority them are due to the doctors not informing their patients that they have larger than normal pupil and pushing them unadvised LASIK procedures. Did you watch the 20/20 special on LASIK regarding double vision, halos and star-bursts? Doctors should turn away prospective patients if they have higher than normal pupil size. The average ablation zone for the laser is 6.5mm. The average pupil size is around 6mm. If your pupil expands at night beyond the ablation zone, that's when trouble starts. Problems such as star-bursts, halos, etc occur due to to the correction zone being smaller than the size of the expanded pupil. This is why most LASIK issues with halos and star-bursts occur at night when the pupil expands. Read this to understand more about problems with large pupils. Most modern wavefront laser attempt to fix potential night time vision issues by creating a bigger blend zone. This may help in some cases but there is no concrete proof that blend zone resolve the problem of having large pupil size! In general, if you have larger than average or larger than the laser's ablation zone pupil size, the doctor should turn you away. If the doctor doesn't, your spidey senses should tingle!

Higher Order Aberrations
Large pupils are not always the cause of problems, higher order aberrations can also be the cause of these problems. In an earlier posts, I mentioned that LASIK (and PRK) procedures tend to create higher order aberrations. Wavefront-optimized attempt to limit that whereas wavefront-guided attempts to correct it. Your objective is always to limit higher order aberrations, especially if you already have higher order aberrations, however all LASIK laser and procedures as a by-product create some sort of higher order aberrations.

Therefore it's important to have a wavescan performed to measure the existence and magnitude of it. My wife who had problems with higher order aberrations was never able to achieve great vision pre-op even with her contacts. I have 20/15 vision, but at night I see slight starbursts that is very slight, nothing as bad as the picture shown above. Even with my naturally excellent eye sight, I'm pretty positive that the existing higher order aberrations in my eyes are the culprits for the slight starbursts at night.

This is why some pay more and some pay less for their LASIK procedure. In my opinion, it's ridiculous that some surgeons even offer these as a choice for prospective patients unless they have a very slight prescription, even then I would be wary of not opting for the wavefront solution. Standard LASIK doesn't offer blending zone which is is why some patients in the past who had standard LASIK with average pupil size still ended up with problems of starbursts and halos. If these patients knew ahead of time that the cheaper standard LASIK laser may deliver substandard results for medium to high myopes as well as having a tendency to cause more higher order aberrations, would they choose it or opt for the more expensive option?

Dry Eyes
This is the other biggie. Most doctors today will ask you if you have existing dry eye symptoms. If you already have dry eyes, LASIK may further cause issues and you should reconsider. My cousin who did not have dry eyes pre-op had pretty bad symptoms for close to a year. My wife on the other hand had it for for the first couple days on only one eye. Five days later she is only using artificial tears every four hours or so. You never know. Chronic dry eyes could be a very bad problem. Discuss this fully with your doctor if you have existing dry eyes or the potential of having dry eyes.

Thin Corneas
If you have thin corneas, don't be surprised if the doctor recommend only PRK for you. Early on, some doctors performed LASIK on patients without checking their cornea thickness or pushing the boundary of safety. The result for some were ecstasia due to excessively thin corneas...and of course malpractice suits for the doctors. This is why if you have thin corneas, your doctor will tell you that you are only qualified for LASIK but instead offer PRK. Did you know that there are now advancements in PRK such as LASEK and epi-LASEK where the recovery time is much faster than PRK? So far, I haven't seen any south bay doctors offering this version of PRK. If faster recovery time is desirable, you may want to look for a doctor who offers LASEK.

Hacks
What is a hack? That's an unqualified doctor or one who cut corners in order to save money. It can be anything from reusing microkeretome blades to pushing people to perform LASIK when they are clearly unqualified. If you are on an assembly line, with 20 patients waiting for LASIK from morning until late into the night, the doctor obviously wants to get through each of you quickly. If something as delicate as surgery is hurried, mistakes may occur either through carelessness or tiredness. For example, this one individual waited until 10PM because the clinic overbooked. Not surprisingly, she ended up with problems. Here is this one person who had his vision ruined because the 'doctor' (who knows, this is Peru after all!) didn't calibrate their machine properly. Or then there are cases of people who had LASIK done too soon while their vision was still regressing. So be very careful if the doctor offer the LASIK at an extremely cheap price, you are not able to ask questions with your doctor, you are pushed to have a procedure, you see are waiting 3-4 hours for a consultation, or you show up to your surgery but end up sitting on the floor with the waiting area looking like a refugee camp.

Are you scared yet? Well, if LASIK was that dangerous, I wouldn't have let my wife go through with it. There has been 31 million LASIK procedures performed. The number of satisfied patients outnumber the unsatisfied patients by many factor. Also, many of the complications were a result of doctors pushing unqualified individuals to have LASIK done when they were clearly not candidates for it. Nevertheless, you should still prepare yourself for the possibilities of complications. The doctors we consulted with are all well respected and are careful to screen their candidates. They have their reputation to protect and have been in business a long time for a reason. However, based on the horror stories out there, not all doctors are that conscionable.


The majority of LASIK complications I've read online are due to (a) large pupils, (b) dry eyes, or (c) thin corneas. There are a small percentage with complications that are unrelated to the above three such as flap complications and misdiagnosis of prescription or miscalibration. It is an elective surgery and there are risks involved. Educate yourself before you go for a consultation. Question everything and do not take their answer as gospel. They may be medical doctors but they are also human. Greed sometimes cloud people's decisions.

LASIK is a miracle cure if everything goes right. As with anything involved with the human body, when things go wrong it could go very wrong. So think twice next time you go to Tijuana for the $800 LASIK. It's a decision that will affect you for better or worse for the rest of your life.

Disclaimer: This is my opinion. This should not be considered medical advice.

References:
http://www.realself.com/review/king-of-prussia-lasik-put-disability
http://www.usaeyes.org/lasik/faq/lasik-pupil-size.htm
http://www.allaboutvision.com/conditions/aberrations.htm
http://lasik-flap.com/forum/viewtopic.php?t=850
http://www.realself.com/review/new-york-terrible-pain-sleep-lasik-laser-vision-correction-surgery
http://www.allaboutvision.com/visionsurgery/lasek.htm
http://www.allaboutvision.com/visionsurgery/epi-lasik.htm
http://www.realself.com/review/lasik-brazil
http://www.realself.com/review/lasik-waist-money-canada
http://www.realself.com/review/only-last-few-years
http://www.realself.com/review/lasik-great-dont-do-it-too-young

The Procedure

The entire procedure lasted maybe 15-20 minutes including the prep time. The actual Intralase process completed in 15 seconds per eye. The Excimer laser lasted maybe 30 seconds per eye. In between, the surgeon and three support staff helped did their job. It was fascinating to watch the procedure on the television set.

The scariest part of the procedure and probably the most difficult portion of the procedure for my wife was the cutting of the flap. I think it was mostly psychological. By taking the oscillating blade out of the equation, the biggest fear was also removed. She opted to skip the Valium altogether. It wasn't necessary because to her the laser wasn't as scary as the microkeretome, which is a glorified oscillating razor blade. The anticipation of the surgery was the hardest part for her. The actual surgery was over before she knew it.

The Prep
For the surgery prep, her eye areas were wiped with antibacterial wipes. She donned the the surgical cap to keep her hair out of the way. Afterward they brought her into the surgical room where the Intralase FS and Visx S4 IR machines dominate the room. The room has a glass window to allow family members to view the procedure. There is a television that displays the camerea from the laser's and surgeon's point of view.

Before the doctor came in, the assistant adjusted the laser level so that so that it was level with my wife's head. She told me that the scene from Final Destination 5 kept popping into her head. Bad idea to watch that movie before the surgery. Fortunately for her, that movie made absolutely no sense. Let's see how many things that it got wrong. First of all, she was never left alone. There was always at least two person in the room with her. The laser does not work on autopilot, so it must always be operated by the surgeon. A rogue killer laser was just not possible. The laser has a fail-safe that shuts itself down in case of a malfunction. Furthermore, the laser beam is ultraviolet which is invisible. Heat would cook the surrounding cells. The reason excimer laser works so well is due to its ability for pin-point accuracy without burning the surrounding cells.

The Procedure
When the doctor finally came in, the surgery was ready to begin. My wife was positioned under the Intralaser laser and had the eye clamp positioned to keep the lids from closing. Yes, at least the director of Final Destination got that one right. Multiple numbing drops were applied to numb the eyes. Then they checked her corneal thickness again with an ultrasound device. Finally, they asked the patient her name and birth date. I assume this was to prevent accidental procedure of the "custom" procedure on the wrong patient.

The doctor asked her to look at his forehead in order to position the eye. The suction cup was laid over her right eye. On the TV, it looked like the eyeball got flattened by the suction device. What she saw under the suction cup was a series of white light. She didn't know or felt the Intralase laser cut the flap. On television, I saw the outline of the flap appearing by the changes in a lighter shade of her cornea as the laser cut the outline of the flap. Once the flap was finished, the doctor applied something like tape to keep it closed and then then the process was repeated for the second eye.

Once the second flap was cut, the doctor moved her over to the second machine to start the actual fixing of her vision. He used a surgical device to separate the flap. This piece looked kind of like a dentist's pick as he because it has a needle end to gently separate the flap. When the flap was moved, her vision became blurred and everything became 'bouncy'. That's her description, it was as if her vision was moving. The doctor asked my wife to look at the red light. On the TV, it looked like a circular red target. Imagine the point of view of the Terminator as he's looking at his target with the bracketed heads up display. That's what the red target looked like. When the laser started, there was a zapping noise that sounded like firecrackers going off. It was fairly loud. She told me that her entire vision blacked out at that point. My wife thought they turned out the lights. Except they didn't. Good thing she didn't know what was happening. It was probably more comforting to think that the lights were turned out than knowing that at that moment your eye just shut itself off by the blinding ultraviolet light. She said it smelled like hair burning when the machine was zapping her eyes. The corneal tissues that were responsible for her bad vision were going to a better place, vaporized into nothingness.

Once the process finished, the doctor scrubbed the cornea with a surgical tool with flat side. He reapplied the flap then pushed it down with another tool that was circular in nature. Then he applied a bunch of medicinal drops on her, perhaps antibiotics, steroid and numbing drops. She said once the flap was reapplied she could immediately see clearly albeit with a slight haze. One thing was for sure, it was much better than the pre-op vision. The same procedure was performed on the second eye. After everything was done she just got up and walked to the next room for the post-op consultation where they gave you the shades, the surgical eye cover for the first few nights of sleeping and the schedule of medicine application.

That was it. We arrived around 12:25. The procedure started at 1:05 PM. We left the building at 1:30 PM.

The First Night
Other than some dry eye symptoms on her left eye, everything appeared normal. Her right eye amazingly has no issue, no pain or dry eye. Only her left eye has dry eye symptoms. It was also the eye that required numbing drops the first night due due to the contact in the eye feeling. She describes it as feeling as if something was left in the eye. We were told that this was normal due to dry eye symptom from the LASIK procedure. She's actually lucky as her symptoms are very minor. I guess this is why LASIK is the preferred procedure over PRK. It's almost close to zero recovery time.

The Next Check Up
Her eyes were tested the next as 20/20 and 20/25. The left eye that was bothering her with dry eye is weaker than the right. Her vision is clear other than the haze that covers it. She describes it as kind of like looking through a foggy filter. The interesting thing is that other than the haze, she swears she can see better than she did with her contacts. Her vision is just sharper. I wonder if this was due to her higher order aberrations? Before the surgery, she had poor quality vision even when she wore glasses or contacts. Her distant vision was only half as good as mine. However, one day after surgery, her vision is of better quality than she ever had even with contacts! It's truly remarkable technology and nothing short of miraculous.

We're looking forward to the one week consultation. Hopefully once the swelling and haze go away, her vision  will  improve even more. She's extremely happy with her decision to have LASIK done. I asked if she had to do it again, would she go through with it? She says yes she would do it again in a heart-beat and that you can't put a price tag on her improved quality of life. Well, there you go. Another LASIK evangelist is born.

VISX S4 IR

One thing that has bothered me and caused me much trepidation was the fact that their website still shows the original Visx S4. I've contacted the doctor, the nurse, the receptionist, and everyone in between for assurance that the laser is the latest Visx Star S4 IR.  They all assured me that it is... but yet I was still worried. Why wouldn't they advertise the fact that they have the latest and greatest technology?

Here is the screen shot of the website the name of the machine highlighted in yellow.

How can they convince patients that they are using the latest and greatest when their own website states otherwise? Notice how there is no mention of IR or Iris Registration? This is what the AMO website describes as Advanced CustomVue. Notice the highlighted lettering:

Well, it is the IR. I saw the machine. The website should be updated to show the IR and the Fourier upgrade to help future patients understand that they are using the latest technology VISX Star S4 IR and Advanced CustomVue.

I know it could have saved me a lot of headaches.

(Update 1/9/12: To reinforce our decision of selecting the Visx S4 IR, here is a great comparison of this laser versus other. All of these are facts can be checked via other Internet sources.

1. Widest FDA approval
2. Fourier algorithm has the highest resolution for wavefront scan
3. Iris Registration and 3D Eye Tracking
4. VISX was the original Excimer laser which started this industry
5. It is the most proven laser system

The wife is now home resting. We'll see how she feels tomorrow. I'll post more information regarding the procedure later. It was actually relatively painless. The most painful part of the entire surgery was the first part--paying for it! =)

Reference:
http://www.willvision.com/compare-excimer-lasers-2.htm

Our Decision

We knew that whichever doctor we decide to go with, we were going to pick the best available technology out there and that's wavefront, be it optimized or guided. We would probably be happy with standard LASIK as well. However, we want the highest probability of the best possible vision coupled with the lowest probability of complications. That's why we pay for the best technology and the best doctor. It's a one shot deal and there's no point in trying to save a few bucks and go with older technology. Our only regret was that we did not max out our flexible spending account. We set aside only $4500! Too bad we started our research and consultation after we had already set our flexible spending account. Our only consolation is that this is $2000 more than the 2013 year max. I wonder if LASIK prices will drop next year once the flexible spending limit gets lowered?

Lifetime Guarantee
This is one of those 'feature' that some LASIK doctors tout. If you read my previous posts, I'm not too keen on the lifetime guarantee, but it's actually not just a gimmick. You shouldn't require it if you're lucky. Hopefully the newer wavefront tech has lowered the enhancement rate, but historically it's been 7%.

All of us want our eyes to be perfect the first time around. For the majority of people out there, a re-treatment after they get it right the first time is very low. If you do receive enhancement, it is likely within the first year.

If you read the fine print, your eye sight must fall below 20/40 or more than -1.0D prescription for them to allow you to "re-do" the eyes. Also, it must be medically advisable. So ultimately it's up to the doctor if they want to deny it for any reason. Doctors can make up pretty much any reason to deny you. I'm sure our esteemed Bay Area doctors would not resort to anything shady like that. However, not all doctors are scrupulous. Just saying.

Another big fine print guarantee buster: presbyopia. This is the inability of the eyes to focus close up as one ages. This condition usually starts in the fourth decade of your life. The "lifetime" guarantee is more like a 10-15 year guarantee. I can see why they call it the lifetime guarantee: the "until presbyopia set in guarantee" just doesn't have the same ring to it does it? All three doctors exclude presbyopia.

Dr. Hyver and TLC has the same conditions. TLC doesn't advertise it, but I've seen the fine prints. 20/40, -1.0, and no presbyopia. Now, Dr. Bindi's advertises his guarantee as Regardless of your level of vision. Really? Even if for hugs and giggles I want him to laser my eyes for fun? Heh. I assume if you wanted to and your vision is 20/30 he'll do it. Big plus for him. By the way, Dr. Furlong has informed me that his practice will offer the enhancement guarantee even if you miss your annual eye check. I'm glad to hear that's the case. The extra requirement of an annual eye exam is unreasonable and something inserted by their bean counters that only serves to undermine their "guarantee".

Of course, it still must be medically advisable, so none of that hugs and giggles please laser my eyes reason. If you have no corneal tissues left, they will likely deny it. I hope they consider PRK over the flap for those instances where the patients have thin cornea left from the previous LASIK procedure.

The guarantee is basically a 10-15 year long or until presbyopia sets in guarantee for all three doctors. The lifetime guarantee is not a make or break perk. All three doctors offer it so it's a wash. I would not select a doctor over this one item. It is good to have for peace of mind in case your eyes decides to change all of a sudden. Unfortunately for us, a small percentage of the population will need this enhancement down the road.

The doctor
Honestly, they all are well qualified and great doctors. Their license records are pristine. However, with the informed consent they require you to sign, you'd think that LASIK is the most horrible surgery in the world. Dry eyes, starburst, halos, blindness--yes blindness! One of the informed consent has that. Talk about covering your butt!

We both like Dr. Bindi. We went to see him a few years back when he turned my wife because we were told her eyes were not stable. I enjoyed communicating with him through Email. If our decision was based on the doctor and doctor alone, we would definitely pick Dr. Bindi. Referral: our aunt had LASIK with him. No issue.

Dr. Hyver was very nice when we spoke to him. However, we're not sure we would pick him based on his high volume, marketing-machine model. Plus, blindness as an informed consent? Come on, Dr. Hyver! Referral: my wife's friend had LASIK with him. No issue.

Dr. Furlong doesn't really market himself other than aligning himself with TLC. Also, he has only one business (that I know of) so you may actually catch him the entire week rather than two days a week. Did you know that Dr. Furlong actually performs more than refractive surgery, like real eye surgery and not the one where the machine does all the work? ;) He also performs cataract surgery and lens implant. He is the only surgeon who was able to detect cataract in my mother's eyes when she went for a LASIK consultation. Referral: our cousin had LASIK with him. No issue.

My aunt who is a nurse had her LASIK with Dr. Ellis (yes, the doctor with the malpractice suit). She isn't happy with the results because she has bad night vision with halos and starbursts which make it difficult for her to drive at night. She said she had custom LASIK with him. I assume that's with the 217z Zyoptix. He's lucky she doesn't exercise her God-given blogging rights as a consumer like me. Oops, too late, guilty by association. Bummer for him. She is the only person I know who claims to not be totally satisfied with her LASIK procedure. I asked her for a recommendation and she mentioned Dr. Furlong because the doctors from her hospital had it done with him. That's a nice endorsement!

The technology
This is the big one. Since we were happy with all three doctors, the real difference is the technology. The studies have shown that wavefront is superior to standard LASIK. I've discussed the technology in length in a previous post. The results were statistically insignificant between wavefront-optimized and wavefront-guided for patients with higher order aberrations below .3 RMS. However, my wife's eyes had .59 and .39 both above that magic number. Ultimately, we have to go with the tech with the higher probability no matter how small it is. With her high prescription and high HOA, the probability of achieving 20/15 is likely not that high. No matter, we have to strive for that level. If she only gets 20/20 then that's OK. However, we do not want to have regrets of not aiming for the 40% rather than the 20% target.

Side-Effects
My wife has come to terms with the side effects. There's always a small chance of something not working out such as dry eyes or halos and starbursts. She is willing to put up with dry eyes and starbursts if it means being able to see 5 feet in front of her and living without the use of contacts or glasses. Her bar is set fairly low. Her unaided visual acuity is somewhere around 20/500. If she can see 20/40 after surgery, she would consider the surgery a success. Of course, we're shooting for 20/15!

By the way, the doctor will prescribe you some brand name drug that cost over $120 for the antibiotics. Make sure you go back and demand they prescribe you an alternative generic like Ciproflaxin. Are the pharmaceutical companies offering them commissions for recommending these brand name drugs? These are not cancer treatment medicine. Get the cheapest antibiotics you can.

Oh yeah you probably want to find out who we chose...
I believe we would probably get great results with any of the three doctors. However, based on the studies, we will go with the doctor and technology that afford us the best probability and possibility for great results: Dr. Furlong.

Look for a future post of the actual surgery and recovery.

References
http://en.wikipedia.org/wiki/Presbyopia
http://forums.anandtech.com/showthread.php?s=3fad80c79cab1c7636affe52a6e55dff&t=78072
http://www.usaeyes.org/lasik/library/lasikplus-warranty.htm
http://www2.mbc.ca.gov/LicenseLookupSystem/PhysicianSurgeon/Lookup.aspx?licenseType=G&licenseNumber=19742
http://www.elliseye.com/san-francisco/lasik_technology_san_francisco/lasik-technology-san-francisco.htm

The Costs of LASIK

The average costs of LASIK in the San Francisco Bay Area is around 5K after "discount". In general they have a listed price of $5900 then discounts it from there via promotion or insurance. The most annoying aspect of the LASIK experience is the used car salesman aspect where you meet the sales consultant who starts the haggling of the price. Unfortunately, you can haggle with medical expenses and it's a fact of life. You can expect to shave around $1k or so give or take depending on the promotion, the referral, or the "study" special. The "real" price is around 5K give or take $300. In the UK, the practice is even worse where they start very high (£ 5000) and discount up to 50% off.

Breakdown of components of the cost of LASIK:

The surgeon
The doctor's reputation and experience probably make up 50% of the cost of LASIK. Although the machines actually perform the work, it is up to the doctor to program the nomograms based on your prescription. With experienced surgeons, they can use nonmograms to add or subtract from your prescription based on the machine to achieve better based on their experiences of past patients and/or your prescription/corneal/similar eye structure. This is why not all surgeons can give you the same results even though they may use the same technology.

Did you know your doctor's license is public information? Always use the California Medical Board License Lookup to research your doctor before you make a commitment. Malpractice suits should be a part of your consideration. Paradoxically, doctors with active malpractice suits may not be much cheaper because their malpractice insurance would go up exponentially.

The location
The San Francisco Bay Area in general cost about $1k more than the greater Los Angeles area. Within the LA area, there may be cheaper and more expensive areas. There's a Beverly Hills doctor who charges $6400 per procedure whereas there's another doctor in Koreatown who charges $1200(!!!) for the entire operation. The rent plays a huge factor into location The rent for an office in Koreatown is much less than a huge office in the Santa Clara or San Francisco area with mood lighting and a clean atmosphere.

Make sure you factor in the cost of travel if you are willing to go out of town for your surgery. Do you want the follow up exams? If you travel by plane, it cost at least $150 by plane round trip. By car, it could be half of that but you will lose about 6 hours. How much is your time worth to you? Don't forget to add in cost of hotels as well.

The staff: The more expensive surgeons have a full staff of professionals. Also, some of the more high volume doctors also hire optometrists who performs the follow up checks for them. If you want the surgeon to also be your follow up doctor, make sure you ask ahead of time. Not all surgeons have the time or willingness to actually see you. Interestingly enough, some of the low cost doctors may also be your follow up doctor because they cut back on costs for their staff. The result of these low cost surgeons is that they book more patients per day with less staff to accommodate them. It's not unheard of to wait 2-4 hours to see a Koreantown doctor. Once again, how much is your time worth?

Technology
After the the surgeon, technology should be the second highest priority than you should look at. The $1200 per eye doctor charges based on your prescription. The price goes up as your prescription goes up. Also, the surgeon most likely uses the NIDEK laser. This is an older technology that doesn't offer wavefront technology. It is tried and true but is very old (in terms of LASIK technology). These doctors have already paid back the cost of the LASER. Any new procedure is just gravy for them aside from the annual maintenance cost. The wavefront technology, both optimized and guided carry new costs with them. Also, the manufacturer often charges a per click price. Expect to pay twice as much as what the surgeon pays to the manufacturer per eye. Some surgeons may have the machine on consignment where the per click cost of LASIK is much higher than average.

The femtosecond flap technology can add $500 to $1000 to the LASIK procedure cost. Surprisingly, many patients chose this over the microkeretome. Apparently, a blade to the eye is just not a very popular option even when that option is frequently free. The low cost LASIK are almost always using the blade. The reason is probably that they are not willing to invest in a femtosecond laser if they are going for the low cost market. Did you know that you can go to Koreatown and get LASIK by a surgeon using the Allegretto machine with a microkeretome blade for only $2500?

Some surgeons have a "menu" of prices depending on the technology. For something as important as your eyes, why wouldn't they just offer you the best technology available? Well, some doctors do. One doctor in the Bay Area offers one price regardless of whether you are qualified for PRK or LASIK. He also uses the latest available rather than offer an older laser for a cheaper price.

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There's a pretty good chance that Patrick Willis or Tiger Woods did not pay for their LASIK procedure. Additionally, there's a pretty good chance that they got paid for the procedure as well. If you are going to pick a surgeon based on a celebrity, you should be aware that these celebrities probably did not pick the surgeon on their own and that they got paid for their endorsement of that doctor.

The rights for the official 49ers eye doctor? It's probably a paid endorsement deal. Patrick Willis's LASIK surgery? It's most likely PRK and not LASIK. Doctors do not recommend LASIK on individuals who participate in high contact sport. (Update 1/3/12: Apparently, football players can get LASIK if they wear a face mask! Thanks, Dr. Bindi!)

Conclusion
The cost of LASIK varies greatly between surgeons and regions. You should make a decision on LASIK based on the doctor, the technology, then the cost. The low cost surgeon may very well be a good surgeon and low cost doesn't automatically mean low quality. Although, with the lower cost, something has to give. Is it the rent? Is it the advertising budget? Is it the older laser technology? Is it the lack of femtosecond laser? Is it the long wait? Is it the staff who doesn't speak English? Or is it something else like a license censure?

If you are on a fixed income, or if the cost LASIK is beyond your budget, or if your prescription is on the low side, it may make sense to consider the low cost doctors. Keep in mind that 10 years ago, that same laser was performed on patients who are still perfectly happy with the results today.

However, never go into a LASIK procedure on a compromise. If you have doubts about your doctor or your procedure, you should stop. It may cost more down to road to fix a botched procedure than it does for the initial work. Ultimately, for us, it's more about the doctor and the technology. We are willing to pay more for the doctor we are most comfortable with the technology we want. We are still deciding but we will stay with a doctor in the Bay Area.

Disclaimer: I'm a not a doctor. Everything written here is my opinion only. None of what I wrote should be construed as medical advice.

References:
http://www.maloneyvision.com/resources/pdfs/Visx-wavescan-combined-nomogram-v2-regression.pdf
http://www.usaeyes.org/lasik/library/allegretto-lasik-datalink.htm
http://www.revophth.com/content/c/27712/
http://www.mbc.ca.gov/lookup.html
http://www.allaboutvision.com/visionsurgery/cost.htm