Almost 2 years ago, Ophthalmology Management reported on what was then a new phenomenon, the discounting of LASIK fees. It's time to revisit the issue because the situation continues to evolve.

The discounts being offered by the corporate laser chains are deeper than we anticipated. And while the chains concentrated first on large metropolitan areas, they're increasingly setting their sights on patients in the suburbs. They're extending their reach and bombarding patients with the message that LASIK is a commodity.

This month's cover story illustrates how the struggle has intensified for independent surgeons wrestling with what to do. Many feel they have no other choice but to lower their fees. Each practice must make its own decisions, but I maintain that we can stand our ground on fees and succeed. LASIK is the Rolls Royce of our practice. It costs more, but it's our premium product.

We're now seeing that to stay competitive we need to understand the type of patients we're trying to attract, learn the best ways to attract and retain them, and let the others shop on price if they're willing to take the associated risks. This will require smart marketing and patient communication in addition to the quality care we provide. But if we can rise to those challenges, the advantage will remain with the independent surgeon who knows his patients, invests in technology, hones his skills and considers quality surgery the bottom line.

Everybody loses

With the alternative, discounted LASIK, everybody loses. Individual practices lose because they'll be forced to increase volume while diminishing their bottom line. The industry suffers because doctors or discount centers that aren't profitable will not have funds to purchase the advanced technologies currently in the refractive pipeline. And ultimately, our patients stand to lose the most. They'll be denied access to the latest that LASIK and refractive surgery have to offer. Deep discounting a highly technical procedure like LASIK can only muddy the view we once had of a bright future with this new, exciting area of refractive surgery.