The use of technology and preoperative education also reduces costs and
provides a positive experience.
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
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
clinics 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
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
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
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
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
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 elses 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
- Disclosure: Dr. Black has no financial interests to disclose.