Saturday November 25, 2006
Published in The Guardian
The adverts promise perfect vision "from £395 per eye". After wearing contact lenses for 20 years and watching the rise of high-street laser eye surgery over the past decade, I finally succumbed and went for a consultation. Would I at last be able to chuck away my glasses and, as one person I spoke to said, "laugh when I see my feet in the morning"?
Sadly, no. Laser eye surgery, I was told halfway into my appointment with Optical Express, one of the leading clinic chains, is priced on a sliding scale. With a "-7.0" prescription in both eyes (I'm fairly short-sighted) surgery would cost £2,590 or £3,390. Following that experience it seemed a good opportunity to take a closer look at the small print.
What is laser eye surgery?
The most popular form of laser eye surgery is "laser-assisted in-situ keratomileusis," or Lasik for short. More than 85% of laser eye surgery patients in Europe and the US opt for it.
The procedure involves rolling back a flap of tissue on the surface of the eye ("like cutting the top off a boiled egg and leaving the shell attached," says the Royal College of Ophthalmologists) and using a cold laser to modify the inner layers of your cornea - the transparent tissue on the very front of your eye. It takes a few minutes per eye and the aim is 20/20 vision.
A similar procedure, Lasek (laser epithelial keratomileusis), is an option for people not suitable for Lasik. It involves a longer healing time, of three to four days. Another technique, PRK, is an older procedure superseded by Lasik and Lasek.
Does it work?
Yes, for most people. It can correct short-sight (to -10 dioptres), long-sight (to +6.0 dioptres) and up to four cylinders of astigmatism. A review of 313,154 eyes by the government health watchdog Nice (National Institute for Health and Clinical Excellence) in 2005 concluded that 90% of patients come to within one dioptre of perfect sight. Bad outcomes are unusual.
Somewhat confusingly, there are different types of Lasik. Conventional Lasik uses a very sharp and precise mechanical blade called a keratome to cut the initial flap. IntraLase Lasik uses a laser to make the flap. Lasik with "wavefront" technology uses sophisticated software to map the eye very precisely before surgery.
And the cost?
There are two pricing models on the high street: charging by procedure or by prescription. If you are charged by procedure, you pay a flat rate. For example, Ultralase, one of the biggest clinic chains, charges £995 an eye for basic Lasik, rising to £1,795 an eye for wavefront IntraLase.
Under the prescription model, the worse your eyesight, the more the surgery will cost. For example, while Optical Express's attention-grabbing price of from £395 an eye is attractive, it is not available to those with medium or strong prescriptions.
A survey of 80 of the 95 clinics in Britain in the current issue of Optician magazine says that the average cost of standard Lasik is £925 an eye. Wavefront and IntraLase treatments add another £200-£300 each to the bill.
Where can I get it done?
Laser eye surgery is not available on the NHS, but is offered through many private clinics. Among the biggest providers is Optical Express, with 19 treatment centres including Birmingham, Bristol, Cheltenham, Bluewater in Kent, Leeds, London, Manchester, Newcastle, Oxford and Southampton.
Optimax is another major provider, with 18 clinics including Aberdeen, Belfast, Brighton, Hull, Ipswich, Leeds, London, Manchester and Peterborough. And then there's Ultralase, which has 14 locations including sites in Birmingham, Bristol, Cardiff, Glasgow, London, Manchester, Newcastle and St Albans.
Payment plans are available. Typical options include a deposit and a low- or no-interest payment plan. In my case, it would be £200 deposit and either £319 for 10 months or £132.19 for two years. By comparison, I spend £15 a month on contact lenses and solution.
How can I be sure who I'm dealing with?
Laser eye surgery clinics must be registered with the Healthcare Commission, which regularly inspects clinics and posts the reports on its website. Surgeons must be registered with the General Medical Council - the Royal College of Ophthalmologists recommends they should also be fully trained ophthalmologists. Consumer website lasik-eyes.co.uk features independent feedback from patients.
"Lasik is one of the best things I ever did"
"What was awful was the smell of burning," says Geraldine O'Neill, 53, an accountant from Bexleyheath in Kent. She had Lasik laser eye surgery in May 2004 and reckons it is one of the best things she ever did. "It's just wonderful!" she says.
Geraldine's optician told her she wouldn't be suitable for surgery - that she was too short-sighted with a prescription of nearly -9.0 in both eyes. But having worn contact lenses since 1973, she was finding them increasingly hard work. "As I got older my eyes got dryer. They were just getting uncomfortable."
She went to Boots in Bluewater, Kent, and paid a total of £2,200 for both eyes. "They were absolutely superb," she says. "Your eyes are clamped open - like that scene in A Clockwork Orange. They put drops in to anaesthetise them and it was fine - there was no pain at all." Just a smell like burning hair. "I wasn't prepared for that!" she says.
After wearing plastic goggles for 48 hours because "you mustn't touch your eye," Geraldine recalls: "The shields came off and I was delighted." However, it wasn't perfect. "I had to have one eye done again because I was so short-sighted," she explains. Since then, there have been no problems and she recommends it to friends. In fact, she reveals: "My son is going to have it done for his 21st birthday. It's our present to him."
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