Most LASIK practices are still running at about half of historic highs as the Great Recession, and high unemployment rates linger. Refractive surgery started as a low-barrier-to-entry, RK-based service with an even distribution of low-, medium- and high-volume surgeons. LASIK changed this with higher capital and marketing costs, and separated the committed from the less so, even after open access and roll-on, roll-off centers were developed. We are now in an era, perhaps a long-lingering one, in which a strong contraction in consumer credit (patients are less willing to borrow money for care) and a shifting demographic mean that high-volume, well-run LASIK centers will struggle and the diminishing number of low-volume private "boutiques" will return to the general, geriatric disease management segments of eye care. They don't give out prizes for going broke slowly. If your LASIK practice is losing money, fix the problem or withdraw sooner rather than later.