MOH concerned over misleading Lasik ad claims

Salma Khalik
Thu, Nov 22, 2007

The Straits Times

THE Ministry of Health (MOH), concerned over misleading advertisements by some Lasik clinics, wants to meet eye surgeons tomorrow to discuss what can or cannot go into their ads.

A letter from MOH to all ophthalmologists doing Lasik said it has received feedback that some print and online advertisements have given the public 'unrealistic expectations' about what the procedure can fix.

Results are oversold, while the risks and possible side-effects are downplayed.And some ads cite success rates for Lasik done elsewhere, said an MOH spokesman.

Several ophthalmologists in private practice told The Straits Times that they felt the ministry's warning was a matter of time in coming.

After all, the market for the surgical treatment of myopia or near-sightedness is red hot. Thousands of people from here and overseas have been flocking to eye surgeons for the procedure.

With Lasik surgery being 'cosmetic', these patients do not get government subsidies; neither can they draw down on their Medisave funds for the operation, so people often go to ophthalmologists in private practice.

But even so, public sector hospitals have done more than 6,000 Lasik operations in the past year.

Private clinics and hospitals do not reveal their patient numbers, but one private clinic claims to do 1,600 Lasik procedures every month.

Competition is so stiff that some clinics offer 'discounts' to patients who sign up immediately or who are willing to do both eyes at the same time.

Some in medical circles are concerned that, in the race for the patient's dollar, proper 'before' and 'after' care may be compromised, or that patients are not briefed on the risk of post-surgery complications. Worse, they fear some surgeons are taking on patients not suited for the treatment.

Dr Jerry Tan, an ophthalmologist in private practice, has been seeing more patients from other clinics who need 'repair jobs' - five to six such patients a week, up from three to four a year ago.

'Most come because of poor night vision and over- or under-correction,' he said. Some have more serious complications, like the one patient he has seen whose sight in one eye has been permanently damaged.

Dr Gerard Chuah, another private practitioner, says that on average, he tends to three complaints a month, mainly related to the side effects of Lasik.

Women in their 40s and up, for example, have a higher risk of getting permanently dry eyes.

One patient Dr Chuah came across now sees four of everything - the result of his previous surgeon not letting a badly-cut cornea flap heal first before going ahead with the Lasik procedure proper.

While doctors agree that Lasik is generally a very safe procedure, patients should know there are risks.

Precision is key in Lasik, he said, adding: 'The distance between a good outcome and a mediocre or disastrous one is a fraction of a millimetre.'

The Singapore National Eye Centre has seen at least one patient who needed a corneal transplant after a botched Lasik job.

Dr Lee Hung Ming, the medical director of Parkway Eye Centre, had this piece of advice for patients: 'Avoid the centre that hard-sells you the procedure or the surgeon who does not have time to see you for your most important pre-operative and post-operative consultations.'

Article from: http://www.asiaone.com/Health/News/Story/A1Story20071122-37967.html

Thinking of Lasik surgery? Don't rely on ads alone

Jessica Jaganathan
Fri, Dec 07, 2007

The Straits Times

(Dec 5) The competition has heated up so much among private clinics and hospitals providing Lasik surgery that some have even run advertisements offering patients 'discounts' for signing up immediately or for doing both eyes at once.

The 'market' for Lasik is certainly sizzling with many hoping to correct myopia this way and dump their spectacles.

But clear vision has not been the result for some who have had the operation. They've complained instead of shoddy service, even worse eyesight and inadequate before and after care.

One patient last month filed a report with the Singapore Medical Council against the doctor who operated on her. She regretted choosing a clinic based on its price and claimed that it was clinic assistants who had pronounced her fit for surgery, and that the doctor did only a summary examination before the procedure.

The Ministry of Health (MOH) has warned eye specialists about using misleading Lasik advertisements to attract customers. On Nov 23, it announced three taboo areas for eye surgery ads - no celebrity endorsements, no mention of the number of operations done and no highlighting of success stories.

Mind Your Body spoke to eye surgeons for their opinion on what you should ask your doctor if you are considering Lasik surgery.

Before surgery

Be mentally prepared for Lasik, say surgeons. And decide if you really need it. Lasik is appropriate for those with myopia, astigmatism and far-sightedness.

You are not suitable for Lasik if you are:
- Below 18 years old because you are still growing and eye power is not stable yet

- Pregnant- Have a pre-existing eye condition like cataract and glaucoma

- Have extremely thin corneas or high myopia (more than 1,500 degrees).

Scour the Internet for information and ask friends who have already undergone Lasik for their feedback before you choose your doctor.

'Another good thing is to ask your family doctor,' said Dr Lee Hung Ming, medical director of Parkway Eye Centre. 'The most important thing though is to not base your decision just on advertisements.'

To be thoroughly prepared, jot down all questions you plan to ask the surgeon during the pre-surgery consultation.

Pre-surgery consultation

Doctors should spend adequate time explaining the procedure to patients. Ask your doctor how many cases he handles per week.

'If the doctor says 1,000 cases a week, you think to yourself, how many seconds does he have for the patient? One case a week is also too little. So there needs to be a balance,' said Dr Jerry Tan, an ophthalmologist in private practice.

Enquire about the doctor's background and whether he has had any appropriate training in Lasik. Ask the doctor for his results. According to an MOH study released last year, which was based on four centres offering Lasik surgery, 98 per cent of patients achieved 6/12 vision or better. But Dr Tan warned that some may mislead patients by showing other people's results.

Ask for the doctor's enhancement rate. This is used to determine how many people return to the doctor to correct the procedure because of unhappiness with their results. Doctors interviewed showed an average of a 2per cent enhancement rate.

Find out about the characteristics of your eyes from the surgeon and ask why the particular type of Lasik procedure recommended is appropriate for you.

A pre-surgery consultation would take three to four hours during which a series of tests is done to check your eye power and cornea thickness. Eye drops are used to dilate the pupils in order to check the retina. There should be a gap of at least 24 hours between consultation and surgery, to allow for the natural constriction of the eye as the effect of the eye drops wears off.

Surgery

It takes about 15 to 20 minutes, depending on the technique used.

Doctors are divided on the practice of doing Lasik surgery on both eyes at the same time.

Dr Jerry Tan cautioned that some centres might be tempted to use the same blade for both eyes which, in turn, made the second cut more blunt.

But Dr Lee said he had not seen any discernible difference in doing one eye at a time and both eyes at the same time.

Post-surgery

There are usually at least four consultations with the doctor: One day after surgery, one week later, one month later and three months after.

Avoid strenuous sports, swimming, vigorous rubbing of eyes and eye make-up for up to one month.

Complications that could arise from Lasik surgery include dry eyes and night-vision problems like halos and glares. But these usually disappear within three to six months of surgery, said Dr Lee.

More severe problems involve the flap which can be irregularly cut or cut off totally, resulting in scarring of the cornea. But this is rare if the procedure is done using a bladeless laser technique.

In the most extreme case, infection could set in, causing blurred vision.

There are a variety of Lasik procedures available, so ask your doctor to recommend the type which is most suitable for your eyes. It depends on individual characteristics.

'It's not like buying the cheapest stereo or television, so it's important to do your homework,' said Dr Chan Wing Kwong, head of refractive surgery service at the Singapore National Eye Centre.

Article from: http://www.asiaone.com/Health/News/Story/A1Story20071207-40084.html

Lasik surgery price war breaks out

The Straits Times
AUG 22, 2004 SUN
By Salma Khalik

THE cost of Lasik surgery, which corrects short-sightedness, is tumbling at both public and private institutions.

After two public hospitals cut the cost by 20 per cent on Monday, the Singapore National Eye Centre (SNEC), which does the bulk of Lasik treatments here, announced yesterday that it had slashed rates by up to 30 per cent.

Not to be left out, two Parkway Group Healthcare hospitals - Mount Elizabeth and Gleneagles - have cut prices by 10 to 20 per cent. Depending on the specialist, it will cost between $1,596 and $1,796 from today.

The SNEC, reversing its stand that it can command a premium because of its branding, has gone from being the most expensive to being the cheapest, at $1,320 for normal Lasik by a consultant.

For the more advanced wavefront Lasik, the $1,520 its consultants now charge is cheaper than at other hospitals. Its senior consultants charge $1,520 for normal Lasik and $2,050 for wavefront Lasik.

The price war started last week when two National Healthcare Group hospitals - National University Hospital and Tan Tock Seng Hospital - cut charges to $1,590 for conventional Lasik and $1,780 for wavefront Lasik.

Dr Lee Hung Ming, who heads the Eye Institute at these hospitals, said they had received triple the number of inquiries this week as a result of the price cut.

Lasik is considered cosmetic so there is no subsidy for it, nor can Medisave funds be used. Both public and private sectors compete for the same group of paying patients. Some even go to Bangkok for the procedure, paying about $1,000.

The number of Lasik operations at the two hospitals has doubled from 100 a month last year to 200 a month this year. The SNEC has also seen higher demand, with Lasik operations up from 300 a month last year to 400 a month this year.

SNEC director Ang Chong Lye said its 'competitive' rates were deliberate as it was also aiming to attract more foreign patients.

'We have already seen an increasing number of patients from Indonesia and Malaysia,' he said.

When told of the SNEC cuts, the other hospitals said they would keep their rates.

Consultant Ronald Yeoh, who did about 500 Lasik operations last year at Gleneagles, said the earlier cuts took the price to about as low as it could go in the private sector. 'If the price goes ridiculously low, it can be dangerous.'

He said some centres in the region used the same US$100 (S$172) blade for about 10 eyes, instead of just one per eye, which is the practice here.

But Dr Ang said: 'With the competitive pricing, we believe we can chalk up even more volume that will only mean better economies of scale...without compromise to quality, safety and standards.'

So prices may keep falling.

Article from: http://singaporeforums.com/forum/showthread.php?t=307

Lasik prices expected to fall further when pte sector publishes bill sizes

By Julia Ng, Channel NewsAsia Posted: 08 February 2008 1755 hrs

SINGAPORE: Inflation and healthcare costs may be on the rise but the cost of Lasik surgeries has bucked the trend.

Eye doctors expect rates to fall further when the private sector joins the public sector in its current practice of publishing the size of their medical bills.

Singapore has one of the highest rates of myopia in the world, so there is a ready pool of people eager to do away with glasses and contact lenses through Lasik surgery.

Some four years ago, it used to cost about S$2,300 to 'Lasik' one eye. Now, prices have tumbled 40 percent to about S$1,300.

The price war started in late 2003 when the Health Ministry required all public hospitals to publish their bill sizes.

Apart from cost competitiveness, doctors said increased cost efficiency in equipment and medical products has also allowed doctors to adjust prices.

Dr Chan Wing Kwong, Senior Consultant Ophthalmologist, Head of Refractive Surgery Services, Singapore National Eye Centre, said: "In the earlier years when Lasik was relatively more expensive, there was a market for some patients who are budget conscious to go overseas to have their surgery. (But) I think many Singaporeans would rather have their surgery done in Singapore by a Singapore facility.

"The moment the cost competiveness becomes better, I think many Singaporeans who were going to take the overseas route would decide to do it here. So basically the number of people who go overseas for Lasik is very negligible now."

Prices are set to come down further as Health Minister Khaw Boon Wan has said he wants all private hospitals and centres to post their bill sizes online. With greater transparency and competition, prices could only head southwards.

But patients need to realise that price is not everything.

Dr Lee Hung Ming, Medical Director, Senior Consultant Ophthalmic Surgeon, Parkway Eye Centre, said: "It's good to have bill sizes published for the public because transparency is very important. But patients should not just look at the price alone. More importantly, the surgeon's experience and his expertise is a critical factor.

"The second important factor should be technology and then price should be the third factor. I don't think that the price should spiral all the way because ultimately, if the price really spirals down, then there're bound to be some centres that are cutting costs and also cutting corners, and that may eventually affect the outcome of Lasik."

Technological advances have made Lasik not only cheaper, but also safer.
Good surgical outcomes and reputation of Singapore doctors have also helped to draw in foreign patients like Ronald Butterfield.

The 63-year-old Canadian wants to correct his vision through Lasik. In the last seven years, he has consulted doctors back home and in Hong Kong, but no one wants to operate on him as he also suffers from cataract. So he came to Singapore for a second opinion.

Although he was told to wait till his cataract 'ripens' before having a Lasik surgery, Ronald walked away impressed.

He said: "The kind of brutal honesty was there and I felt that I've come to a medical centre that was concerned with my health, opposed to going to a business. If I were to go down the street to a Lasik centre, they could have done the Lasik tomorrow. He was supposed to have come from a medical point of view and I sensed that, and I trust him and I will come back!"

The Singapore National Eye Centre said it has been seeing 5 to 10 percent more foreign patients every year, most of them from Asia and even Middle East.

Article from: http://www.channelnewsasia.com/stories/singaporelocalnews/view/327682/1/.html

Lasik clinic's hard sell left her confused and fuming

Sun, Dec 07, 2008

The Straits Times

I refer to last Sunday's article, 'Lasik price wars'.

I almost fell prey to a Lasik clinic's hard-sell tactics.

At first, I was impressed by the many sophisticated machine tests at the clinic that lasted for three hours, and the hour-long counselling by its good-looking staff.

But later, I was left feeling confused and fuming.

An optometrist there informed me that my left eye was my dominant eye, instead of my right one.

She claimed I had been wrongly diagnosed by my personal optometrist of five years.

I was asked to place a full payment before leaving the clinic, in order to enjoy the promotional rates.

But I left the clinic, insisting that I should try wearing contact lenses to test if I was really left-eye-dominant first before making any decision.

The clinic followed up with calls to ask about my condition, although I had not yet tried the lenses. The staff said I should secure the promotional rates by making an appointment.

After checking the prices for the standard Lasik procedure, I withdrew $3,100 from my savings, and went to make payment.

When I arrived, I was told I had 'steep corneas', which would require a bladeless procedure that would cost me $3,888 before goods and services tax.

I saw red upon hearing this.

The senior surgeon had not informed me I had 'steep corneas' during my evaluation, and had given me the impression that I could have a standard procedure.

The clinic then slashed the price by $200, but I still refused to sign.

Later, I was informed that I could opt for a standard procedure for one eye, and a bladeless procedure for the other eye, which would save me another $200 - but I had to have the operations done by end-October.

I stomped out of the clinic fuming.

I found such conduct unprofessional - the clinic was out to make money, not to help me see better.

I have since visited another clinic, which does not advertise or engage in a price war and has been very patient.

And guess what? I am actually right-eye-dominant.

Connie Loh (Ms)

Article from: http://www.asiaone.com/News/the%2BStraits%2BTimes/Story/A1Story20081207-106087.html