The True Economic Cost of LASIK Retreatments

Special section sponsored by Alcon

By James A. Davison, MD, FACS
Wolfe Eye Clinic
Marshalltown, Iowa

All vision correction programs aim to maximize the benefit to patients while minimizing the risks inherent in all surgical procedures. Our goal is to achieve the best vision performance and highest level of patient satisfaction for the least risk, inconvenience and expense. One inherent risk is that of imperfect refractive results, sometimes due to variations in tissue response of the individual patient. For LASIK and PRK, the survival of one keratocyte, which should have been ablated during treatment, can make a difference.

We can address imperfect results by performing retreatments, and although we appreciate this ability, imperfect results deprive patients of the joy that should be experienced after a successful procedure. Worse than the deprivation of that positive, the need for retreatment can contribute to substantial negatives: disappointment, dissatisfaction, guilt and up to 3 months of enduring perhaps significant visual disability. Furthermore, patients must undergo the operative and postoperative experience all over again. Retreatments also consume more tissue and reintroduce the risks of infection, flap trauma and epithelial in-growth.

Thus, we want to utilize an excimer laser platform, such as that offered with the Allegretto WAVE Eye-Q, which generates scientifically effective treatment profiles and is designed to reduce the induction of higher-order aberrations and perform ablations quickly.

Retreatments are expensive emotionally and financially. Deserved or not, the need for them implies an imperfection in the vision correction program and thus damages its reputation and diminishes its profitability. While the emotional costs borne by patients and providers cannot be measured, the financial costs for each can at least be estimated using reasonable assumptions.

From the patient's perspective, even though retreatment is provided at no charge, they may miss time at work because of additional surgical and office visits and they may incur travel costs. From the provider's perspective, there are two measurements that need to be applied when considering the financial impact of retreatments. The first is obvious — the incremental direct cost. The second is less recognized — the loss of potential revenue. That is, a provider cannot see new patients or perform new surgeries during the time it takes to perform retreatment evaluations and surgeries. It's important to realize that the expense and revenue sides of the balance sheet are affected.

While every provider's situation will be different, the use of my practice as an example demonstrates the total financial cost per retreatment is about $2,467 (Table 1 ).

In conclusion, for the sake of patients and providers, anything that can be done to maximize good initial outcomes and minimize the need for retreatments will be a substantial benefit to both parties.