Canadian eye surgery clinics are invading the Spokane market with advertisements aimed at luring across the U.S-Canada border patients who are seeking elective, laser vision-correction surgery.


In a bid for patients in an area of medicine thats volume driven, the Canadians are advertising prices that are hundreds or even thousands of dollars cheaper than what the surgery costs here, thanks partly to the weak Canadian dollar.


We dont think the hype is good, says Marlin Gimbel, director of professional relations at Pacific Cataract & Laser Institute, which operates one of two laser centers where vision-correction surgeries are performed in Spokane. We dont like to see people motivated by cut rates.


Spokane surgeons wont be cutting their prices to compete with the low prices offered in Canada, say several of the 11 local surgeons who do the procedure at Spokanes other laser eye-surgery center, ClearVision Laser Center.


My philosophy is Im not going to discount fees, for a profit motive, says Bruce Ellingsen, an ophthalmologist at Spokane Eye Clinic. He says doctors can earn the same amount of money providing standard eye exams as they can through surgical fees, and a high volume of surgeries must be done for laser vision corrections to be profitable for a clinic.


An average of 90 laser vision correction surgeries are performed each month in Spokane by Pacific Cataract & Laser Institute, a Chehalis, Wash.-based organization of eye surgeons that provides specialist services to patients referred by optometrists, Gimbel says. Robert Ford, founder of the institute and one of six member surgeons, does the laser vision corrections here, Gimbel says


The center charges $1,600 per eye for the surgery, and the patient must arrange for the necessary follow-up care with his or her primary-care optometrist, which usually brings the price of care up to between $2,000 and $2,200 per eye, Gimbel says.


The fee for surgery at Spokanes other laser-surgery center is $2,200 per eye and includes all pre- and post-operative care, the surgeons fee, and a charge for using the laser center, says Steve Kregstein, vice chairman and general counsel at ClearVision Laser Centers Inc.s Lakewood, Colo., headquarters. Spokane surgeons perform an average of 150 surgeries during the two weeks a month the portable laser equipment that serves Washington is here, says Kathy Arrington, ClearVisions director of practice development.


One Canadian clinic that has been marketing in Spokane, Kelowna Eye Care Surgicenter, in Kelowna, British Columbia, has been running newspaper ads here promoting surgery costs of just $1,150 per eye. Lasik Vision Canada, of Vancouver, with clinics across Canada, touts prices on its web site of just $675 per eye. London Place Eye Centre Inc., of New Westminster, British Columbia, has a listing in the Spokane Yellow Pages that advertises laser surgery, but doesnt list prices.


We market throughout the Pacific Northwest, says John Sharples, a director of promotions and public relations at Kelowna Eye Care. To bring in new patients, the Kelowna clinic hones in on areas in Washington, North Idaho, and parts of Oregon within easy travel range of Kelowna, either by road or through flight connections, he says.


In its advertising campaign, the Kelowna clinic reminds Americans that their U.S. money can buy more in Canada because of the current weakness of the Canadian dollar. The prices Americans pay in Kelowna are no cheaper than what Canadians pay, but Americans benefit from favorable currency-exchange rates, with the U.S. dollar worth about $1.52 Canadian, Sharples says.


Spokane surgeons say Canadas prices for laser vision corrections also are lower because of differences in the cost of operating a laser center in the two countries. They point to different licensing agreements that U.S. and Canadian clinics have with the few companies that make lasers approved for laser eye surgery.


Visx Inc., the Santa Clara, Calif., company that made the laser used at the ClearVision center here, charges a $260 licensing fee per procedure in the U.S., ClearVisions Kregstein says.


Susan Nablo, who like Sharples is a director of promotions and public relations at Kelowna Eye Care, acknowledges that the Kelowna clinic and others in Canada have different agreements with laser manufacturers and dont pay that fee per procedure. However, she says the fee is only a small percentage of the cost of the surgery in the U.S. and shouldnt be blamed for the entire price difference.


Reshaping the cornea


In laser vision correction, an elective surgery usually not covered by insurance, a laser is used to reshape a cornea that doesnt focus light correctly on the retina. For example, a nearsighted eye has a steeply curved cornea that causes images to focus in front of the retina so they appear blurry.


Several types of laser surgery are available to reshape the cornea so images will be focused correctly on the light-sensitive retina. Photorefractive keratectomy (PRK), performed on the surface of the eye, involves removing the top layer of cells from the cornea and then vaporizing thin layers of the cornea with a laser to sculpt it into the correct shape. In laser-assisted intrastromal keratomileusis (LASIK), a very thin layer of the eyes surface is cut and lifted to form a flap. Then a laser is used to shape the inner layers of the cornea, and the flap is replaced.


Before a surgery to reshape the cornea, a patient must undergo thorough eye exams to evaluate eye health, plus several tests to determine the curvature and thickness of the cornea. Healing is monitored with a series of post-operative exams. These exams typically are scheduled one day after surgery; one week later; and one, three, and six months after surgery, plus a year afterward, says Jodee Pavlin, laser coordinator at the practice of Michael Berg and Eric Sorensen, Spokane ophthalmologists who perform surgeries at the ClearVision center here.


It all comes down to good medical care, complete follow-up, and knowing the history of the patients and their eyes, Pavlin says.


Other doctors here also tout the added value of using locally-based surgeons, laser centers, and follow-up care, so patients can go through the entire process in their own community.


Vision is the most precious sense, says Frank Galizia, an optometrist at Empire Eye Clinic in the Spokane Valley, who has had the surgery himself. You dont want to take shortcuts; you want to know youre getting the best care money can buy.


Kelowna Eye Care does PRK, which has been approved in Canada for 10 years and done at the Kelowna clinic for five years, Sharples says.


It has been done in Spokane for only about three years, since the U.S. Food & Drug Administration approved lasers for corneal surgery in late 1995, and LASIK has been available in Spokane for about a year.


Because laser eye surgery has been done in Canada longer, the clinics there are more competitive, Nablo says. She says most clinics there include the post-operative care in their surgical fee, but, American patients might not want to travel to Canada for the frequent follow-up care, so theyre required to have an optometrist in their area monitor their healing.


Sharples says Kelowna Eye Care works with about 20 optometric offices in the Spokane and Tri-cities areas to provide post-operative care according to protocols from the Kelowna clinic. Patients must pay for the local follow-up care separately. That will probably cost between $500 and $600, say doctors here.


Sharples says the Kelowna clinic started marketing in Spokane in September, so it doesnt have conclusive information yet on the number of patients its treating from here, but interest seems high.


Gaining attention


However, Spokane doctors say interest is growing even without advertising as the procedure becomes more widely available and frequently done. The number of vision-correction surgeries done here could increase in the near future, because ClearVisions laser has been spending only two weeks a month here and also traveling to Tacoma, Yakima and Wenatchee to do vision-correction surgeries. A new laser has been ordered for Tacoma and when it arrives, the Spokane laser will make only short trips to Yakima and Wenatchee, Arrington says.


You dont see much advertising here, Galizia says. We rely on word-of-mouth.


Thats common practice here, say representatives of other local eye surgeons including the Berg and Sorensen practice and Spokane Eye Clinic PS.


Galizia says that for a life-changing surgery such as laser vision correction, patients trust friends or family members who have had the procedure, or primary eye-care doctors. Prospective patients often seek out the same surgeon who performed the procedure successfully on a friend or relative, which has brought patients to Empire Eye Clinic surgeon Mark Kontos from across the country and as far away as New Zealand. Most surgeries done in Spokane are on patients from Eastern Washington, North Idaho, and occasionally Montana, though, doctors here say.


Those patients mostly are brought in without advertising. Spokane Eye Clinic has advertised eye surgeries in the past, Ellingsen says, but found the ads brought in just enough new patients to pay for the marketing efforts.


Pacific Cataract & Laser Institute, which performs surgeries at 11 outpatient centers in Washington, Oregon, Idaho, and Alaska, shuns advertising even to the point of not buying space in the Yellow Pages, and treats only patients who come through referrals, Gimbel says.


The practice of ophthalmologists David Cohen and Chris Sturbaum is one of the few in Spokane that do run ads. Their advertisements dont push cheap surgeries, though.


They promote informational seminars the doctors offer for free to potential patients.


The ads are effective for us, Cohen says. People here have not been exposed to information on laser vision, and the seminars give them a chance to find out more.


He says he has offered seminars on procedures for about five years, initially on radial keratotomy, an earlier eye surgery that involved making cuts in the cornea to reshape it, and now on laser vision correction.


With the push of Canadian clinics into the Spokane market, Cohen says, doctors here must make patients aware of the services here.


He says his seminars address comparative shopping issues and the cost differences between the countries, but focus on the value-added service provided by local surgeons and follow-up doctors, and the quality of facilities and medications that can be found in Spokane.


Rather than a maturing market bringing prices lower as it has in Canada, the cost could rise here as surgeons skills increase with experience, Cohen says.