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