Business with a Vision

April, 2002

Dwayne Myles, a Honolulu-based flight attendant for United Airlines, claims that on May 8, 2001, when he walked into the Laser Eye Center of Hawaii, he was as good as blind without his glasses. Badly nearsighted since the age of 10, he had 20/400 vision in each eye. An hour later, when he left the center after undergoing Laser-Assisted in-Situ Keratomileusis, a type of surgery better known as LASIK, his vision was corrected to a perfect 20/20 in one eye and 20/25 in the other. Says Myles: “I laughed. I cried. When I went home I could see the details of a butterfly in my yard for the first time. And since the operation, I’ve forgotten that I ever had to wear glasses.”

It appears to be a simple procedure, and everybody talks about it that way. LASIK, a specialized blade called a microkeratome, slices a flap of your cornea that surgeons claim is thinner than a grape skin. The flap is lifted and peeled back from the cornea with a tiny instrument. A clicking sound is heard as the surgeon applies a beam of cool ultraviolet light in pulses from a laser to vaporize a microscopic amount of tissue from the cornea, in effect, reshaping it. The flap is then returned to its original position. The relatively painless surgery lasts only seconds to up to 20 minutes for two eyes. All being well, it has a short recovery period; you’re back to work in a day.

In 2000, an estimated 4,000 persons in Hawaii elected to have refractive corneal surgery to correct astigmatism or nearsightedness, or to eliminate the wearing of contact lenses or eyeglasses, and leading practitioners believe that only 10 percent of the market here has been penetrated, making this a significant medical growth industry.

Yet, with all the success that the procedure has had (estimates are that 1.5 million Americans underwent LASIK surgery in 2001), prospective patients are urged to proceed with care and not to trivialize it. Side effects and complications can occur with both LASIK and PRK, an older procedure in which the outer protective layer of the cornea is directly sculpted and removed by the excimer laser.

“With either procedure there are three essential things you must consider,” says Dr. Dennis M. Kuwabara, president of the Laser Eye Center of Hawaii. “The qualifications of the surgeon, who should have done at least a thousand procedures; the quality of the center, which must have state-of-the-art equipment; and proper screening and preparation.”

In this complex medical field, a completely new subspecialty within the science of ophthalmology, many discount laser eye centers opened nationwide to grand fanfare in the ’90s, often competing on prices and false promises of perfection, then closed with a thud, contributing to vast misconceptions and considerable controversy within the profession. But Hawaii is still an uncluttered field, with only seven major centers now performing the procedure, all boasting high standards of care, technology and, apparently, strong codes of ethics. Three early Hawaii entrants — True Vision, St. Francis Hospital and Lasix Vision Corp. — left the field not long after they entered it (“One realized the learning curve was a little steeper than they had anticipated, the other two were only interested in the bottom line,” according to one eye surgeon). Six other facilities remain: Laser Eye Center of Hawaii (formerly the Laser Eye Institute of Hawaii), Eyesight Hawaii, Pan-Pacific, Hawaiian Eye, Queen’s Hospital, Kaiser Permanente and Aloha Laser Vision.

Clearly, the cost for laser eye surgery shouldn’t be your prime reason for evaluating a doctor or a center. (Nationwide costs for LASIX surgery at quality centers is about $1800-2400 per eye.)

“When the discount centers came into being, people thought the procedure was a matter of someone simply pushing a button,” says Dr. John Olkowski, chief surgeon at Eyesight Hawaii, who has been practicing corneal and refractive surgery in Hawaii for over 10 years and who last year performed LASIK surgery on his mother-in-law live on the Fox 2 morning news.

Olkowski, who has performed more than 4,000 operations, pointed to a study conducted by Harvard Medical Center’s Ophthalmology Department, which demonstrated that a surgeon’s complication rate for his first 600 eyes was about 3 percent, a figure which then diminishes to .01 percent for future procedures.

The trouble is that, because they often operate on normal eyes that see 20/20 with correction, laser surgeons acknowledge that controversy will continue to exist within their specialty. “The actual time the laser is functioning is usually less than one minute, but within that one minute a lot of things can go wrong,” said Dr. Tyrie Lee Jenkins, medical director and ophthalmic surgeon at Laser Eye Center of Hawaii, who performed Hawaii’s first LASIK surgery (and operated on Dwayne Miles).

Doctors involved in laser refractive surgery in Hawaii are encouraged by the new emphasis on the seriousness of the procedure. So far, the unwillingness of leading centers to cut corners to remain competitive is also a positive sign. Indeed, as any LASIK surgeon will tell you—with no pun intended—there’s much more to the operation than meets the eye.

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Author:

Tom Chapman