The Rewards of Laser Surgery

The Lure of Laser Surgery" [Cover Story, October 12] provided readers with an excellent overview of the risks and benefits of Lasik surgery.

However, I think readers may be misled by the portrayal of refractive surgeons as slick operators doing this to make money. I believe that ophthalmologists are excited about laser surgery primarily because it gives them another opportunity to help patients see clearly again--a truly gratifying experience, as ophthalmologist Gerald D. Horn pointed out in the story.

Doctors should be fairly compensated for Lasik--both because it is a wonderful procedure and because it is quite expensive to perform. Though the surgery itself may take only a few minutes, one must factor in the cost of expensive equipment, administrative costs, marketing and training, and the patent royalties due every time the laser is used.

It is also misleading to say that the "frenzy" over laser surgery surpasses cataract surgery in its heyday. I'm pleased to say that the heyday of cataract surgery continues. It's just that the surgery is so reliable and effective that the media frenzy over it has dissipated. More than 1.3 million Americans have cataract surgery every year, and that number will continue to increase as our population ages.

Robert M. Sinskey, MD

President

American Society of Cataract and Refractive Surgery

American Society of Ophthalmic Administrators

Fairfax

* The value of the article is in reminding people that laser vision correction is indeed surgery. In the end, this is elective surgery on healthy tissue, which is currently functioning perfectly with glasses or contacts. As you state, not all people are good candidates. Some of my patients come in telling me that they were at a "mall laser screening" and were told that they were perfect candidates for the procedure. The reality of it was that they were terrible candidates. Their vision was not stable (increasing nearsightedness yearly), they were not told they would need reading glasses after the procedure, or their pupils were too large.

Your article was very thorough and was a balanced assessment of the industry and the procedure, except for one important point. I want to clarify that optometrists (and ophthalmologists) that refer for this procedure are paid based on services rendered only. Sometimes the use of the term "referral fees" is mentioned by particular groups to further an agenda and are by no means based on fact. I saw this term first used in an article on laser vision correction in a mall. The owner/ophthalmic surgeon stated that their fees are lower because they don't have to pay optometrists for referral fees. This inaccuracy is purely a marketing ploy and not based on fact.

As in many surgical procedures, the patient is always best served if their primary care provider (optometrist or ophthalmologist) is involved in the decision to consult a surgeon for a particular procedure and then the patient is referred back to the doctor for post-operative care. This care is provided on a fee-for-service basis, not on a fee-for-referral basis.

Michael Berenhaus, OD

Bethesda

Correction

An October 19 story on the renaissance in barbershop music misstated the workings of the diaphragm, the muscle in the chest that controls breathing. When inhaling, the diaphragm contracts. When exhaling, the diaphragm relaxes.

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