No Guarantees in LASIK vision correction of 20/20

Jon Dishler, MD

Article by
Denver Ophthalmologist

One thing is for sure about medical procedures, and that is, that nothing is for sure. On rare occasion even relatively trivial procedures can turn into disasters, and most often very complex surgery goes extremely well. Doctors are taught and ethics demands that we cannot promise any result since there are so many variables that such a promise is not reliable. What we can do is show our past experiences in similar cases and there is a good chance that your experience will follow others like you. This is where it is important to ask your doctor not for the experience of dozens of doctors from around the country who pool their numbers and experiences, but rather from your specific doctor in treating others with your specific problem.

We at Dishler LASIK have data based on our actual experience of treating prescriptions similar to that of our new patients. This is the most reliable way, over a wide range of corrections, for most patients to anticipate their likely excellent results. We also have data on our retreatment or enhancement rate, and again, our rates are among the best in the country. This means if you have LASIK, you will probably end up with clear vision and not be likely to need a second treatment. Furthermore, in the few percentage of patients who do need a "touch up" this is almost always done in the first year after the procedure and therefore is offered at no additional charge. We have been performing LASIK for almost 15 years, and with the modern laser equipment that we have been using, the number of enhancements we need to perform decreases every year.

Contrast this to the 20/20 guarantee which reads something like this: "If at ANY visit after surgery you are able to see 20/20 then (even if your vision deteriorates later) we have met our obligation in correcting you to 20/20 vision." It does not read exactly like that, but this is essentially what is promised.

In addition many older patients do NOT want to be corrected to 20/20 in both eyes because they want mono-vision with one eye left slightly nearsighted for reading. Some patients have higher prescriptions which are not candidates for the 20/20 guarantee. Some patients need PRK and also excluded. Most importantly you have to pay extra, a lot extra for this "insurance" so many patients elect not to have the "guarantee plan" but have already become comfortable with the center offering it and so decide to stay and have LASIK without the promise that attracted them in the first place.

The real psychology behind the 20/20 guarantee was a brilliant concept, that a new center could open and get instant credibility based not on referrals or statistics, but instead with a promise that they make. After all, it stands to reason that they must get amazing results (or how else could they afford to make this type of promise)? The answer is simple; most patients do get 20/20 vision after LASIK , the tough cases are excluded, and they have a secret weapon.

If you do not get 20/20 vision then they have the opportunity to do a no charge enhancement to make you 20/20 before the refund check comes. Sound familiar? That is right, it is the same enhancement that we give to the few patients who do not get the desired result after the first procedure, also at no charge, and virtually all of these people are 20/20 after their enhancement procedure. The only difference is that we do not charge for the "guarantee." Even if they do have to refund the money to a small number of patients, it is well covered by the higher costs charged to everyone else. So if this is such a great idea why don't we also do it?

Because, as I said in the beginning, medical doctors are not supposed to make guarantees. And even the appearance of impropriety is not what doctors are supposed to do. Vision correction that is perfomed in practices which are controlled by medical doctors (M.D.'s) will not likely participate in this strategy. But, many LASIK or laser vision centers are owned by others who employ medical doctors to perform the procedures. Let me say that again, many centers, and most corporate centers are owned by others than the doctors who actually perform the surgery. The doctors are employees or independent contractors who are paid by the procedure. These doctors do not set policy, and make medical decisions about the patients that they treat, but have little to do with the recruitment of those patients in the initial stages.