Be Wary of the Lasik Vision Institute

Stephen Barrett, M.D.

The Lasik Vision Institute (LVI), which operates facilities in in many states, advertises $299-per-eye and $499-per-eye rates for Lasik surgery. But regulatory actions and media investigations suggest that this number is intended to lure patients into consultations at which much higher prices are quoted. LVI is subsidiary of Musa Holdings, Inc., of Lake Worth, Florida, which also operates Eyeglass World and has real estate investments [1]. The company is owned by three brothers: Max Musa (chief executive), Marco Musa (president); and Marc Andrea Musa (vice president). [2]

Eyeglass World operates a chain of retail outlets where customers can have their eyes examined by an allegedly independent, licensed optometrist and purchase eyeglasses and corrective lenses. The optometrists lease space in the company's outlets. In 2001, Eyeglass World's Web site stated that it operated 58 outlets in 22 states and that its affiliate company, the Lasik Vision Institute (LVI), operated 31 outpatient laser vision correction centers in 18 states [3]. At that time, LVI was called the Laser Vision Institute and the centers were serviced by a total of 11 ophthalmologists (eye surgeons). Most of the centers had same address as an Eyeglass World store. Today the Web sites list 59 Eyeglass World outlets in 24 states and more than 100 LVI centers.

In 2001, the Florida Attorney General announced that Eyeglass World would pay $500,000 and adopt an arms-length relationship with its affiliated optometrists to settle allegations of unlawful marketing practices [4]. According to the Attorney General's complaint:

• Optometrists leasing space in Eyeglass World outlets were pressured by the company to issue unnecessary prescriptions for glasses and contact lenses and limit time spent with each patient.
• The company's goal was to maximize the number of patients seen and ensure that every person who had an eye exam bought corrective lenses.
• State law prohibits a corporation that leases office space to an optometrist from interfering with their medical practice. In addition to violating that statute, Eyeglass World also:
  • Engaged in the sale of outdated, used and non-sterile contact lenses.
  • Sold diagnostic lenses and solution starter kits provided free of charge by the manufacturer.
  • Misrepresented itself as an approved provider for a certain health insurance plan.
  • Intentionally misquoted prices over the telephone, engaged in bait and switch advertising and failed to post its no-refund policy at the point of sale.
  • Failed to have a licensed optician on premises at all times and failed to have proper optical equipment or perform tests required by the FDA to determine product safety.

While admitting no wrongdoing, Eyeglass World agreed to:

• Provide for consumer restitution and pay the costs of the state's investigation.
• Revise its leases with optometrists to ensure that it does not exert improper influence over their medical practices.
• Implement a corporate ethics program that will include live instruction and creation of a corporate ethics manual.

In March 2003, LVI signed an FTC consent agreement to settle charges that the company failed to substantiate claims that its Lasik surgery services eliminate the need for glasses and contacts for life, eliminate the need for reading glasses, and eliminate the need for bifocals. The FTC's complaint also charged that LVI had falsely claimed that consumers would receive a free consultation to determine their candidacy for Lasik. Instead, after an initial meeting with an LVI representative during which the representative quoted a price for the procedure based on their preferred treatment, LVI required consumers to pay a $300 deposit before they were told of the risks associated with the surgery, or if they were eligible candidates for the Lasik procedure. According to the FTC, the $300 deposit was nonrefundable if, after the initial consultation, the consumers elected not to have the surgery. The FTC alleges that only $200 of the deposit was returned to consumers who elected to undergo the surgery but subsequently were rejected for medical reasons. The consent order prohibits unsubstantiated claims that Lasik surgery services or any other refractive surgery services: (a) eliminate the need for glasses and contacts for life; (b) eliminate the need for reading glasses; or c) eliminate the need for bifocals. The order also prohibits LVI from misrepresenting: (a) that consumers will receive a free consultation that determines their candidacy for Lasik or any other refractive surgery services; (b) the cost to consumers to have their candidacy for such refractive surgery services determined; or (c) the information consumers will receive during a consultation for refractive surgery services [5].

There is good reason to believe that the low fees advertised by LVI are difficult or impossible to get and that misrepresentations are common during LVI's "evaluation" process.

• In February 2002, KVBC-TV (Las Vegas) reported that (a) the commissions earned by LVI "patient counselors" depended on how many patients they signed up per week; (b) prospective patients were told that they are basically good candidates for the operation; (c) a nonrefundable $100 deposit was required to see an ophthalmologist for definitive advice; (d) a reporter with a degenerative eye disease (who did not meet standard criteria for lasik surgery) paid $300 for further evaluation by an optometrist who said she was suitable; and (e) a reporter who was an ideal candidate for lasik was told that if she paid more than $299 she would get better follow-up care [6].
• In October 2002, according to a South Florida Business Journal report, LVI's national operations director said that the $299 price included three months of postoperative care, but the average LVI customer paid close to $1,800 an eye, depending on his or her prescription and if any additional services are added [7].
• In July 2003, ABC Action News aired a three-part investigation during which they interviewed former patients and sent an investigator with a hidden camera to see what price is actually quoted. The reporter was told that had special problems and quoted $1,799 per eye by a "counselor" who had no medical background and did not examine his eyes. The reporter was also told he could not see the surgeon for a consultation unless he paid a $100 deposit. Neither the office manager nor Marco Musa would state how many people qualify for the $299 rate. The report included the story of six patients who developed serious eye infections after operations at the LVI in Tampa. Each of the patients had paid "thousands of dollars" for the procedure [8-9].
• In September 2003, an investigative team in Cincinnati aired a report describing how a producer visited a local LVI clinic with a hidden camera to see whether the $299 price was quoted. The report described how the producer was told that (a) the surgeon was out-of-town, (b) the price would be $899 per eye, and (c) a $100 deposit was required or the price would go away [10].
• Quackwatch has received a complaint from a man who was quoted $299 per eye at a Florida Eyeglass World store. He described how he paid a $100 deposit but was unable to get an appointment for the surgery as promised. When he asked for a refund, he was told that the deposit was nonrefundable because it paid for the eye exam [11].
• In August 2003, ABC Action News reported that a class action suit on behalf of patients who were injured or subjected to a bait-and-switch sales process. The lawyer handling the case says he has been unable to find anyone who was offered the $299 rate [12,13].
• In November 2003, ABC Action News reported that a former LVI national medical director has left in disgust because LVI was pushing its counselors to recommend punctal plugs to everyone who underwent the surgery. Such plugs, which prevent tears from being drained from the corner of the eye, should only be prescribed to patients who develop dry eyes after surgery, but LVI offered $500 bonuses to counselors who persuaded 50% or more of all patients having surgery to buy them. The report stated that the former medical director was so concerned that warned LVI officials last year that "the pre-operative insertion of punctal plugs in persons with normal eyes is fraudulent" and that operating on patients who have the plugs could cause a serious infection [14].
• In November 2003, WGAL-TV, Lancaster, Pennsylvania, broadcast a 2-part series that included comments by eye surgeon Steven Vale, M.D., who said he had performed about 15,000 procedures for LVI and knew of only one that was done for $299 [15,16].

The Better Business Bureau of West Florida reports that the Lasik Vision Institute of Tampa, Florida, has an "unsatisfactory record . . . due to unanswered complaints." [16] A small Yahoo group exists to share thoughts about Eyeglass World.

When done appropriately, refractive surgey can be very helpful. For further information on this topic, click here.

References

1. Action News exposes Lasik Institute president's lavish lifestyle. ABC Action News, July 23, 2003.
2. Borbely M. Lasik surgery sales tactics raise eyebrows. Washington Post, Sept 4, 2001.
3. Careers. Laser Institute Web site, accessed, Feb 12, 2001.
4. Butterworth B. Eyeglass World to pay $500,000, revise practices under agreement. Florida Attorney General news release, Feb 10, 2001.
5. Federal Trade Commission stops allegedly misleading representations for lasik eye surgery: Future claims of benefits, performance, efficacy, and safety must be substantiated. FTC news release, March 26, 2003.
6. Sight for sale. KVBC-TV, Feb 27-29, March 1, 2003.
7. Robertson K. Low-cost eye surgery back in town. American City Business Journals, Oct 21, 2002.
8. Action News investigates Lasik Vision Institute after complaints. ABC Action News, July 21, 2003.
9. Trying to get LVI's advertised rates for Lasik? Good luck. ABC Action News, July 22, 2003.
10. Target 5 finds flaws in ads for LASIK surgery: Few Customers appear to receive. WLWT-TV, Cincinnati, Sept 25, 2003.
11. Newberry A. Email to Stephen Barrett, M.D. Oct 16, 2003.
12. Class action lawsuit filed by injured Lasik eye surgery patients. ABC Action News, Aug 5, 2003
13. Majka et al v. The Laser Vision Institute, Case No: 03 7210 Div. H, Thirteenth Circuit, in and for Hillsborough County, Florida Civil Division.
14. Doctor blows the whistle on Lasik eye surgery chain. ABC Action News, Nov 10, 2003.
15. Low-cost LASIK surgery: Part I, Nov 6, 2003.
16. Low-cost LASIK surgery: Part II, Nov 10, 2003.
17. Better Business Bureau of West Florida. Accessed October 19, 2003.