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
Would you mind sharing a bit more about why you (seemingly) didn't really consider Dr. Manche? You mention him briefly in a positive way in your first post and then it sounds like you don't really consider him after that. Is his technology not that much better for the cost and location inconvenience? Or was there something else that turned you off to him? Thanks! (Your research and info has been immensely helpful in my own LASIK research - thanks!)
ReplyDeleteHi Liv,
ReplyDeleteWhen we started going to see doctors, we chose the ones closest to us first. My wife liked every doctor she went to (she's not a difficult person). So none of the doctor's personality or credential had anything to do with our decision.
The reasons:
(1) my wife did not want to drive to Palo Alto which is out of the way for us.
(2) The technology we preferred (iLASIK) was used by both Dr. Manche and Dr. Furlong. (Dr. Manche did have the slightly newer flap laser, but we decided it was not that big of a deal; slightly faster with an inverted cut)
(3) Dr. Furlong offered us a discount off the total price; Dr. Manche did not
(4) Dr. Manche wanted to charge us around $200 for the wavescan regardless if we chose him or not; Dr. Furlong's is free
(5) My wife did not want to go to see another doctor even though I insisted that she should at least see Dr. Manche (we've seen three)
(6) With Dr. Furlong, my wife gets to go to her regular optometrist who she likes for the post-op checkups which is just a few miles from our house
We would have chosen Dr. Manche but for the fact that he wanted to charge for the wavescan and did not budge off his set price. We have no problem with paying for the best if there was a real and concrete beneficial reason for it. His teaching at Stanford was not that compelling to us for the increased distance and cost. In the end, we went with the Dr. Furlong for the lower price, distance, and flexibility
I'm glad this blog is of help. If you're just thinking of getting LASIK, it can be a very difficult decision due to so many conflicting information. The actual surgery itself is not that bad, the research and anticipation is probably the hardest part. In terms of scariness in surgery, LASIK is probably a 2-3 on a scale of 10.
Having gone through it without any complications (she's very lucky for having no dry-eye symptoms after a week), it's a no-brainer decision in hindsight. However, your situation may be different based on your eye's particular characteristics. Good luck!
Thanks so much for the reply! I'm actually not worried about the procedure itself, but it's good to know it's low on the scary level. :)
ReplyDelete