DR. JOSEPH DELLO RUSSO

A new website, www.eyetube.net, now offers access to hundreds of different videos, divided into categories such as Cataract, Cornea, Glaucoma, Laser Vision Correction, Ocuplastics, Refractive IOL, and Retina. Users can watch a few seconds of each video but need to register to the site in order to have free access to all videos.

After a health risk warning from Canadian authorities, Sandoz Canada (Quebec) has recalled its prescription timolol eye drop, regulatory agency Health Canada said on its Web site. The agency has warned consumers not to use Sandoz timolol ophthalmic solution in 0.25% and 0.5% strengths, noting some bottles may contain greater quantities of the active ingredient than is represented on the label. According to a local news report, potential adverse events include red eye, eye irritation, inflammation of the eyelids and/or cornea, drooping of the upper eyelid, double vision, dizziness, headache, abnormally slow heartbeat, abnormally low blood pressure, shortness of breath, difficulty breathing, and cardiac failure. Health Canada will continue to monitor the effectiveness of the recall being implemented by Sandoz, which plans to send a separate notification to doctors regarding the recall. To date, no adverse events have been recorded in Canada in association with Sandoz timolol, according to the news report.

Editor’s note: Timolol has been the most popular drop for glaucoma for about 30 years. This notice does not state whether this alert restricts usage in the US. It will certainly be available again, since a simple adjustment of the concentration would seem easy to correct.

Allergan will seek approval from the FDA to market an ointment that claims will lengthen eyelashes. Allergan announced on ASCRS Eyeworld’s website on June 16, 2008, that its use produced “significant growth” in recent trials.

Editor’s note: the first hurdle will be to prove to the FDA that this product does not harm the eye. The FDA will not easily approve its use since it’s simply for cosmetic use. It first must be shown to “do no harm”.

“EVER SINCE I STARTED TO WEAR GLASSES MY EYES GOT WORSE” – does not it sound familiar?

As Barbara Wright reported in Ophthalmology Times, May 15, 2008, people seem to think that wearing glasses when you are young makes your eyes worse, having to get stronger glasses from then on.
 
Dr. Dello Russo explains that nearsightedness is a progressive process. The average person who’s DNA determines that they are destined to become nearsighted will start to need them at around 8-9 years old. As the child grows so does the myopia which gets worse and hence the increasing need for ever-stronger glasses. This will continue until about the age of 20 when the prescription settles and becomes “stable.”
 
So, it is not the wearing of the glasses that makes one’s eyesight worse, but getting stronger glasses is just keeping up with the normal worsening of their myopic condition.

As reported at the ACVO annual meeting in Waikoloa, Hawaii, there has been an alarming rise in fungal infections among lens wearers. Causes may be related in part to lens solutions as well as poor hygienic care by patients. There is a large percentage of patients who suffer some loss of vision, nearly one third requiring a corneal replacement to restore sight.
 
The rise in fungus infections was noted first in 2005 by the CDC, and it is often associated with loss of sight.

 
Editor’s note: this report is consistent with a report issued by Dr Dello Russo in 2007.  

As reported in the December edition of Ophthalmology Times and by Dr. Talamo of Boston, patients now have choices in the type of lens implant that they can choose to replace their clowded lens (cataract).

They used to have no choice. Surgeons had only a choice between brand names, not types of implants. Over the past few years there is a whole stream of implants that have emerged on the market, designed to not only give good distance vision but some near vision ability as well. Every lens supplier has its own patented “multifocal” implant. Now the doctor can adjust the choice according to a person’s individual needs.

Editor’s note: expect new varieties to not only address far and near vision, but also astigmatism.

As reported in the December edition of Ophthalmology Times, there is a general consensus that the incidence of dry eye following Lasik is decreasing, according to Dr. Maldonado, since surgeons are eliminating candidates who demonstrate some degree of dryness during Lasik evaluation.

Editor’s note: it is necessary to treat any dryness that a potential Lasik patient may have before Lasik. Many techniques exist, such as lacrymal plugs, drops (both lubricating and curative), ointments, etc…

From a study that appeared in the Review of Optometry, February 15th, 2008.

Wine helps prevent cataracts? That is what a study by Dr.Paul Kopecki concluded after a five year study at Rekjavk Eye Center.
 
Researchers believe that regular consumption of red wine in moderation allows the French to counter-balance their fatty diets and live healthier lives, possibly living as much as ten years longer than others. The Rekjavk Study also indicated that moderate drinkers of red wine seem to be less prone to developing cataracts as well as retinal degeneration, which are both aging problems. Researchers believe that red wine contain antioxidents that are beneficial to a healthy diet.

From a study appearing in Eye Net , a Journal of the AAO, February 2008.

Many people who spend much time on computers especially daily at work may often experience eyestrain. The main cause of the discomfort is that the tear film of their eyes may not be healthy due to several reasons.

One cause is that some people do not blink enough to freshen and the tear distribution on the surface of their eyes. In essence, they tend to stare at the computer, blinking less than the average of twenty times per minute. A second reason for the poor tears is that many people simply develop a very mild but persistent inflammation of the lid tear glands which allows for less than normal tear production. Drying of the cornea is also worsened in some people who wear contact lenses, which tend to absorb some of the normal tears produced.

Editors note: If you suffer from computer eyestrain, try to make yourself conscious of blinking more often than you presently do and keep a bottle of wetting drops within reach of the monitor.

The following is a summary of a recent Aug. 31, 2007 NY Times article with Dr Dello Russo which discussed Lasik financing, as well as an evening news MSNBC article from Sept. 2, 2007.

Much has been written lately about the credit market but one area of credit is just beginning to prosper: financing medical as well as cosmetic surgery!

Cosmetic surgery like LASIK, which is used to get rid of glasses at about a rate of 1.5 million a year is increasingly being financed, sometimes at no interest penalty at all. Lasik is not covered by medical insurance so it demands a certain amount of discretionary income. Depending on a person’s credit rating, one may have lasik with Dr. Dello Russo of New York and New Jersey and not pay a penny for 12 months at which time the loan comes due and may to be paid without any interest at all. 

DR Dello Russo says that the patient arranges with the credit company to pay him and will then repay the lender according to their agreement either with no interest or heavy interest. The doctor himself plays no part in this arrangement, except to make the introduction of the patient to the lender and then allow them to work out their own particular agreement if any. 

Dr. Dello Russo says that  financing has allowed those who cannot pay in full at the time of surgery an opportunity to pay over a period of time. It has encouraged patients to undergo LASIK and all seem to benefit. Dello Russo says that it took him a while to get used to accepting independent financing in his office, but then again it took him longer to adapt to accepting checks and later longer yet to accept credit cards way back when.

Six years ago, Dr. Joseph Dello Russo founded online Lasik FAQs (Frequently Asked Questions) web site in order to provide answers to the most common questions that trouble Lasik patients and surgery candidates. It has since become one of the most popular Lasik information websites, currently serving 50,000 visitors each month — traffic has tripled since January 2007.

Dr. Dello Russo is one of the nation’s most well-known Lasik surgeons, one of the few who worked with FDA to approve the first Excimer Lasik technology. Following the Lasik approval in 1998, he noticed people’s confusion and received many phone calls and emails with questions from the public who was becoming aware of Lasik but knew little about the new surgery. “Patients complained that they could not find any reliable source online which can provide them with relevant, fresh information on Lasik-related issues,” he explains the reason he opened www.LasikFAQ.com in 2001. “I went online and found that there were no significant laser vision correction Q&A websites. Most Lasik message boards or chats were not managed by eye doctors. Someone had to take the initiative to educate the public.”

Dello Russo sought to provide a totally objective informational Lasik site, the content of which would reflect what questions were on the minds of the public who were considering Lasik: “I decided to choose a question and answer format, so people can browse through past questions and find information quickly.” The website is ad-free, hosted by Dello Russo Laser Vision centers. Dr. Dello Russo answers most of the questions himself: “sometimes it resembles a chat room when I have enough free time for act with questioners. I focus on a common problems and new developments”. On LasikFAQ.com, Dr. Dello Russo writes as an educated but independent advisor who answers questions from around the world. He normally avoids mentioning brand name products, if possible.

Traffic to LasikFAQ.com keeps surging, especially in the last few months, following an online campaign. Both Google and Yahoo link to the site’s answers for popular questions such as “how long does Lasik last?” and “how old do you have to be for a laser eye surgery?”. Dello Russo says that others choose to ask personal questions with a lot of detailed information, which has sometimes prefers to answer privately.

This is not the only online public service Dr. Joseph Dello Russo has developed. In October 2006, he opened a personal blog (www.drdellorusso.com) in which he refers to new laser eye surgery technologies, marketing practices and even recollections of the development of Lasik. Dello Russo recognized the opportunities in going online early on, and set up two practice sites back in the early internet days. Dr. Dello Russo reports that overall traffic to all of his websites has reached more than 100,000 visitors last month.

Dr. Dello Russo wished to emphasize that the information on LasikFAQ.com is delivered without any form of warranty expressed or implied, represents the opinions of Dello Russo Laser Vision and is not to be considered medical advice of any kind nor a substitute for a consultation with a medical doctor or health care professional. Dello Russo Laser Vision assumes no liability or responsibility for any claims, actions or damages resulting from information contained on www.lasikfaq.com.

The following reprint relates to an advertising offer often made by discount lasik centers (read more here).

Discount franchise centers have a poor financial history since they frequently go out of business by charging low prices for Lasik. So when you hear of a “lifetime guarantee”, I often wonder “whose life?” The doctor’s? The center’s? The patient’s? How good is an offer from a type of centers which historically go out of business quite frequently?

Also, why would a person need a lifetime guarantee? when Lasik is well done by a good surgeon on a good Lasik candidate, it is permanent. So, what is being guaranteed? Nothing is being offered.

Recently US News and World Report had published an article about the current state of Lasik: http://www.usnews.com/usnews/health/articles/070225/5laser.htm 

Featured in the article is Dr. James Salz who along with Dr. Joseph Dello Russo were selected by the FDA in 1990 to head the research into the clinical trials of the first laser to be considered in reshaping the cornea so as to rid people of glasses. Known as PRK and Lasik today.

Also members of the research team were Dr. J. Tennant, Dr. M. McDonald, Dr. Robert Maloney, all of whom have become some of the most innovative Lasik surgeons who have helped to develop the laser technology to nowadays advancements and safety levels, as has been reported here in other recent studies (see: “lasik surpasses contact lenses in safety” and ”PRK and lasik safe”).

The article is somewhat kind to those surgeons who still use blade (microkeratme) instead of the Intralase no-blade. In the real professional world of Lasik surgeons it is understood that the laser surpasses the blade. Dr. Dello Russo expects that the blade will eventually be discarded as these surgeons move up to Intralase in the near future. The main obstacle to Intralase among the remaining blade surgeons is the noteworthy extra costs to the surgeon.

Enjoy the article. If you have any questions about it you may direct questions to Dr. Dello Russo at http://www.lasikfaq.com. He will personally answer your questions if they are of educational value.

There is a low cost Lasik chain that states that they have performed 600,000 Lasiks. That sounds impressive, as they are trying to tell you that they are really experienced, but not so fast. Let’s analyze the claim of 600,000 Lasik surgeries by this chain of centers.

Remember that Lasik is not like a toaster that will cost less at Target store than at Bloomingdale’s. The quality of your surgery will depend heavily on the experience of the surgeon. If you go to that discount center and if they let you meet the surgeon who will perform your Lasik and you ask him if he has done 600,000 Lasiks, he will say no. So what does the number 600,000 mean and where did it come from? Does it have any meaning? Is it a deceptive marketing ploy to imply a lot of experience to insure you of a good Lasik result? Hmmm?

There are two important factors that influence the quality of Lasik performance. Experience of the surgeon performing your Lasik and the quality of the technology that he/she uses.

Lasik is the present laser darling. It is also very competitive, since success can be very profitable. In the current state of medical reimbursements, eye doctors are paid very poorly for devoting their lives to this great profession.

Lasik is not covered or regulated by insurance carriers or the government. It is an elective cosmetic surgery, therefore the competition for elective dollars. That’s capitalism, but not so fast. Can a surgery be made to conform to the characteristics of business? Advertising in newspapers, magazines, radio, TV and Internet is part of business and is required to promote Lasik practices.

Since its inception in 1990 laser eye surgery has improved dramatically in safety and quality of the visual result. Lasik is a professional surgical and medical service. There is an awful lot of advertising out there centering on low prices. As though low price also guarantees a good result. Fearful that the low priced ad will discourage confidence in their surgeons, this center says it has done 600,000 Lasiks.

An advertisement should give the buyer a reason to buy the service, so the ad must say something which shows that the surgeon/center is better in some way. As you may have suspected there is no monitoring of the content or the truthfulness of ads of any kind and that is why we may be doubtful about some ads like cancer cures, hair growth etc. Some are obviously untrue or even impossible.

When dealing with Lasik ads there is also some spinning possible. Pricing is the most common abuse. Deceptive low pricing is regularly being offered. Nobody pays $ 199 / eye. Nobody has ever paid the advertised $199 price.

If an athlete was operated on by a surgeon who has since passed on, is that athlete’s endorsement today valid and can the experience of the deceased surgeon be simply passed on to the experience of the latest hired doctor at that center owned not by any doctor but by a businessman/women, or a doctor’s wife? No. Experience is not automatically transferable or assumable from a doctor who operated on that golfer or the football player to the latest hired doctor.

What will really count for you is the experience of the doctor who will actually be doing your Lasik. Your surgeon gained no knowledge from a doctor in a different center who may operated on a football player. Even if the center is owned by the same businessman who also owns or owned a center in Canada ten years ago.

There is a claim out there for a franchise of Laser centers (no names , please) who are offering low discount prices. If you suspect that you get what you pay for they counter with the assertion that they have done some 600,000 Lasiks. Who? No single doctor has done 600,000. If that number could be true then you want that doctor who has done that number . Right? But the centers say that they – the centers – have done overall 600,000 procedures.

So let’s look at this 600,000 number. Where does it come from and how does it affect you? Does it imply competence at every one of the centers owned by that franchise and imply competence for every doctor hired by these centers? We can make some logical assumptions based on common knowledge in the industry at how this center arrived at this number. And in the end we will probably find that number is meaningless since experience from say a hundred (mostly bankrupt) centers across Canada and the US cannot imply experience for a surgeon hired to do your surgery. The numbers are not cumulative. Not assumable or transferable.

Let’s go back a bit to the very early days of laser surgery. The first laser was known as the Visx laser made in California. As any medical device it could not be used or sold in the USA without being approved by the FDA after years of clinical trials by specially selected surgeons like Dr. Joseph Dello Russo. From 1990 until 1996 this handful of surgeons did all the research to develop a laser that is currently used by 4,000 surgeons. These surgeons never asked or expected any thank yous. They just did what was necessary to prove or refute it at their own expense. All laser surgeons have benefited from their work.

Since the Visx laser was not sold in the US until 1996, the company sold it outside the country, mostly in Canada, where by 1992 businessmen quickly perceived a business opportunity and set up several different chains of franchise centers throughout Canada and prepared to enter the US following the 1996 approval.

The Canadian chains did well for a while but soon the supply of patients interested in Lasik was exhausted. A large number of centers went bankrupt, some merged with others to cut overhead costs, stuff that business people do. The pool of patients contracted and so did the number of centers, just enough to service the remaining pool.

When the chains merged they absorbed lasers, equipment, and name of franchises. As a marketing tool, the new company claimed that they had done the number of Lasiks they had actually done as well as the bankrupt companies that they had absorbed. Not a bad marketing tool but perhaps deceptive since it may imply that the new franchise had benefited in some mysterious ways from all the Lasik experience done somewhere else?

So the present franchise seems to be claiming responsibility of performing 600,000 Lasiks, in referring to all Lasiks performed by all those mostly failed centers across Canada and the US. The number 600,000 means 600,000 surgeries, which were done on 300,000 people. Divide that by 15 years and then by the amount of absorbed failed centers (maybe 100?) and we are talking about a handful for each center every year. Again none of the experience from these 300,000 patients can be put into the head of the surgeon who they hire today to perform your surgery.

So how much experience will that hired surgeon have? Not 600,000. Maybe none, maybe 50 , maybe 1,000, maybe 10,000. You just don’t know, but you can ask. That is the only number that counts. He will not bring 600,000 cases to the laser room with him when he does your surgery.

There are many well known surgeons who have done 20,000, 30,000 or even 50,000 Lasiks. These surgeons are all well known doctors. Their experience is known. We know that every year they will be there in their centers but with even more experience than the previous year. In fact they are so successful that they own their own centers. They are not up for hire to work at the latest low price franchise center. These surgeons don’t need to spin.

In general, if a surgeon doesn’t own his own center then one could conceivably infer that his success may be limited with limited experience, in general. Why would an experienced surgeon let himself be hired by a center? He wouldn’t!

Best advice? Look for true discernable experience of the doctor who you wants to do your Lasik, with no spins.

We understand that we can possibly get a sale on a product (a toaster, for example) at certain times of the year, or that we may be able to buy the same toaster at a Target store instead of at Bloomingdales and pay a lot less. You may be able to buy the same exact toaster for half price, because it’s a product.

Lasik is not a product. It is a service that is performed differently by each surgeon in every center in the world. There are different quality levels in this service depending on the surgeon. So how do you choose who to go to? How do you decide how much you should pay? You have the same problem when you are searching for a plumber or an attorney, or for any other service. You want the best but to either pay the least or not to overpay.

There are various factors that may influence your decision. Many decisions are probably made based on word of mouth. As more Lasik is being performed, more people can give you feedback on their experience with a particular center/doctor.

Most surgeons now offer very attractive financing (18 months interest-free), so all pricing issues seem to disappear when you consider your decision.

In the early days of Lasik, a lot of negative stories were posted online by under-achievers who profited from these negative postings.. These postings have diminished in part because of surgeons like Dr. Dello Russo (New York ) and Dr. Boothe (Texas) who took these deceptive and untruthful sites to the courtroom in order to remove them from search engines. Some have just disappeared naturally since the postings became old and people no longer believe websites that ramble on and on 100 % about complications that were supposed to have happened in the late 90’s. We all know happy lasik patients.

So how should you make your decision? Should you consider price as a primary factor? Some do, thinking think that Lasik is a product and that all doctors offer the same quality – so why overpay? Not unless you think that you are buying that toaster from that $199 per eye discount center that bases its advertisements on price alone. You may even know people who have paid only $2,700 to $3,000 for Lasik and are happy. Of course a percentage of these people will be successful with their surgery. That is not surprising, but it does not guarantee you safety. But everyone will be happy either.

You take a certain risk choosing any surgeon from any center. The risk sis minimized when the surgery is performed well by an experienced surgeon and his experienced staff using the safest lasers.

If you don’t use price as your only decision-making factor, you understand that it is less likely to have a problem in the hands of the more experienced (and somewhat pricier) surgeons. It would be ridiculous to predict that everyone goes blind if they don’t pay enough. By avoiding the discounters you are simply improving your chances of a safe result with better vision.

These are all generalizations about the whole field of Lasik. Prices for good Lasik surgery will vary regionally, but let’s explore the costs to the surgeon performing Lasik and how much he needs to charge you for the best Lasik he can do. The higher fees don’t simply depend on a surgeon’s ego. The pricier surgeon will have pricier costs that permit him to perform his quality lasik that you are paying for.

SURGEON /CENTER COSTS

- There are fixed costs such as overhead plus the higher costs of very highly trained laser technicians.

- Laser costs – two lasers are used, each will have the following costs to the surgeon:
1) $450,000 per machine plus about $200,000-$250,000 in lease financing.
2) Service costs of $3,000 to $6,500 per month.
3) Royalty fees of $150 per eye treated. That is correct. The surgeon must pay the laser company about $150 for each eye that he treats on the laser that he purchased from the laser company. Unbelievable but true.

Bladeless ( Intralase ) or all-laser Lasik requires a second laser as well. So you must double all of the laser expenses above.

It shortly becomes obvious that to treat each eye costs an awful lot of money for the surgeon. No truly experienced surgeon can perform quality Lasik for $199 when it costs him at least a $1,000 per eye. Nobody has ever paid $ 199 for lasik. When you see or hear of prices such as $199 per eye, you should know that you will actually pay a lot more and often the total cost of the procedure will be similar to costs for quality surgeons who don’t advertise discounted too-good-to-be-true prices.

Low balling is not new in sales. It is simply the bait-and-switch marketing tool so often used to get you in the door. But should it be used to get prospective Lasik patients in the door to simply up-charge so it will cost $3,500 to $5,000 anyway? One has to wonder about the ethics of a doctor/center using low-balling sales pitches. Can’t they simply count on word of mouth or advertise their qualifications, such as the doctor’s experience or the technology used? Experience and technology are the most relevant factors to consider since you are not buying that toaster but a very skilled medical/surgical performance that will affect your eyesight for the rest of your life.

One problem is that low-balling confuses the prospective Lasik patient. You may hear about $199 and then run into a person who had surgery with the bait and switchers center ( paid $ 3,500 to $ 4,500 ) and seems to see okay, which is a like testimonial for the low price center, so you feel that you shouldn’t be overpaying for your Lasik.

The best advice is to consider all aspects but especially the experience not of the center but of the surgeon who will be actually performing your surgery. If you do choose a pricier surgeon, remember that the difference in cost between low cost and pricey surgery is often $500 or so, but you will save that by not buying glasses within a year or two.

You can research the internet. There are about 17 million pages about Lasik on Google. Dr. Dello Russo himself has over 300,000 pages on Google. These numbers do not reflect the amount of advertising but the number of news articles and other sources of information. Regarding the net, some websites you should check out are www.lasiktruth.org and www.fda.gov/lasik.