Optometry

Sondra Black

At Crystal Clear Vision, we have drawn on our years of experience in the eye care industry to develop a new paradigm for laser vision correction service.

Jeff Machat, MD, chief executive officer of Crystal Clear Vision and co-founder of TLC, and I have set up a comprehensive three-pronged approach that focuses on the value of patient selection and outstanding visual results, as well as practice efficiency and profitability. The core philosophy at Crystal Clear Vision centers on precise patient selection, state-of-the-art technology and procedures, and a streamlined and efficient cloud-based technology system for patient processing. Our first clinic in Birmingham, Ala., opened within the last year, and patients report high satisfaction with their visual results and our practice procedures.

Over the years, results for laser vision correction (LVC) have significantly improved, especially as the technology has improved. However, the LVC climate is one in which there is a significant amount of patient confusion on several fronts, including price and technology. People tend to look at LASIK as a commodity and often they go where they think they can get the lowest price or “best deal.” They do not understand the differences between the technology, the procedures and results.

In addition, there has been no definitive information available on procedures and pricing. For example, if a consumer goes to any laser vision clinic’s website they often cannot find what technology is used, what the final price is or what the risks are. In addition, some people are still also confused because of the U.S. Food and Drug Administration hearings on LASIK. However, the majority of those problems occurred in cases in which older technology was used.

State-of-the art technology offered

At our center, managed practice patients receive custom, all-laser treatment with the iLASIK wavefront technology (Abbott Medical Optics, Santa Ana., Calif.). Only a femtosecond flap is used, and this combination increases the visual quality result. Through the years, we have worked with all the technologies, including every company in the early days of custom trials, and we have seen the best outcomes and results with the custom all-laser treatment.

When patients come to Crystal Clear Vision they are not given a confusing menu of LVC options from which to choose. Instead, custom, all-laser wavefront LASIK technology is available at an affordable price. The technology is explained to patients so they can understand the differences and the specifics of the treatment they will receive.

Patient selection critical

One of ways we are able to keep the cost down is that only patients who have the highest chance of success are treated by our surgeons. Patient selection is crucial. They must have no prior complications or previous eye surgeries, therefore reducing the potential need for retreatment and reducing overall costs.

Other patient exclusions include those who have autoimmune or immunosuppressive diseases or those who fall into the “gray zone” on topography. Although some of these patients are candidates for LASIK, their risk is slightly higher. Patients must have greater than 500 microns of preoperative pachymetry. In addition, our surgeons leave 300 microns in the bed postoperatively.

Through our previous experience with TLC, we recognized that high myopes and high hyperopes are the most time consuming patients. They are at the highest risk, they often need multiple procedures and they are frequently difficult to please. In the end, all the patients who come to a practice pay for those more difficult-to-treat patients. Instead, the practices we manage exclusively treat the patient base with a 98% chance of becoming less spectacle-dependent.

For example, even though custom wavefront LVC can be used to treat up to -12 D and up to 6 D of cylinder, our patient group is narrowed to include those in the range of +2 D to -7 D, with up to 3 D of cylinder. Patients who fall outside of the criteria are told they are not a LASIK candidate at our managed center.

In addition, a Crystal Clear Vision practice does not offer a “lifetime commitment,” which often results in higher costs for all patients. Instead, patients pay $250 an eye for enhancements, which are necessary in only about 2% of the patients in this range. That way, the average person is not paying for everyone else’s care.

Reducing costs with Internet technology

Another way overall costs have been reduced for the surgeon and patients alike is by going high-tech for patient education, explanation of services and billing. Our company uses a proprietary cloud-based Internet technology (IT) system that provides patients with information prior to their procedure and allows them to pay in advance for their procedure online. All referrals and post-ops also come in online.

Once a referral is received, the patient is assigned a LASIK advisor, who contacts the patient, provides counseling and guides the patient through the process. The LASIK advisor is available to answer any questions and often helps the patient overcome any fear he or she might have prior to surgery.

Through the patient portal, patients receive their instructions and FDA booklets. The website is transparent and includes exactly what type of technology is used and all the prices. Patients also watch a half-hour informed consent video that was developed with EyeMaginations (Baltimore). The video explains and shows what potential visual quality issues and complications, such as night glare, diffuse lamellar keratitis or epithelial ingrowth, look like. Animations of the technology and procedure are also available, so patients are well informed. As they go through the informed consent, they must answer test questions to ensure that they understand the information provided, and all the responses are documented in a web-based IT infrastructure.

The process is streamlined and all details are addressed completely prior to surgery. Having all the information upfront allows the patient to be calmer. Once the Pentacam (Oculus) and WaveScan (AMO) are performed on the surgery day, patients are ready for surgery. Much of the stress associated with a normal surgery day is eliminated.

Over the last year, we have been excited to offer patients a new philosophy in LVC treatment. Patients have indicated that they are pleased with the process and results. It is our goal to deliver this LVC experience to many patients who desire LASIK with the best technology at an affordable price.

• Sondra Black, OD, is vice president, clinical operations, at Crystal Clear Vision, Birmingham, Ala. She can be reached at Sondra.Black@crystalclearvision.com.
• Disclosure: Dr. Black has no financial interests to disclose.