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IN CANADA, CUT-RATE EYE SURGERY LASER PROCEDURE DRAWING MANY FROM U.S.

Area residents who want to ditch their glasses and contact lenses are heading to Canada -- like thousands of other Americans -- for a phenomenally popular laser eye surgery nicknamed the "flap and zap."

They make the trip lured by a 15-minute procedure that can virtually sharpen vision overnight, and by cheaper prices -- $3,700 for two eyes here, vs. prices as low as $1,400 across the border.

The "wow factor" of LASIK has spawned cutthroat competition.

Canadian laser-surgery centers pitch special deals in newspaper ads and tout the capabilities of their high-tech devices to grab a piece of the potentially huge profits.

"It's pretty cool," said Joel Thompson, who recently drove nearly two hours to a clinic in Mississauga for the procedure. "I was waiting for the surgery to start when the doctor told me we were done."

Thompson, 20, a client-services representative for Ticketmaster in Buffalo, had worn glasses for nearsightedness since he was 12. Now his vision is perfect.

Laser vision correction began with surgeons using a cold beam of ultraviolet light from a laser to reshape the cornea, the transparent tissue covering the front of the eyeball.

The newest technology,LASIK, also uses a laser to correct nearsightedness, farsightedness and astigmatism. It has taken off in popularity in recent
years with advances in a device called a microkeratome.

The mechanized knife, similar to a carpenter's plane, delicately peels back a layer of the cornea about the thickness of a grape skin, leaving one end of the layer attached. This creates a corneal flap that, after the laser does its work, later adheres in its original position without stitches.

LASIK is not perfect, and it carries some risks. But compared to earlier procedures, the experience so far shows it results in quicker healing, less pain and almost instantaneous results.

Many of the 160 million Americans who wear glasses or contacts have noticed.

Since its approval in 1995, the number of laser procedures in the United States has grown from 215,000 in 1997 to 480,000 in 1998 and to a projected 980,000 this year, said David Harmon, an industry consultant in St. Louis and senior editor of the Market Scope vision-industry newsletter. It's expected to increase to 1.5 million procedures in 2000, most of them LASIK.

"This is not a niche service. The surgery applies to a high percentage of the market and it's basically brand-new," said Harmon.

Doctors in Western New York can offer LASIK. They just can't compete, at least for the moment.

"What we're seeing in Canada is the Wal-Mart model of medicine -- high volume, low price," said Dr. Claus M. Fichte, one of only a handful of LASIK providers in the area. "It's like a cattle train in some respects."

He noted that many of the companies that are opening laser eye surgery clinics in Canada, as well as in the United States, are publicly traded corporations in a position to forgo profits for a while to gain a large share of the market.

"Is the quality as good?" he asked. "There are good doctors in Canada, but do you create the potential for greater risk by running so many people through those clinics?"

At his peak, Fichte said, he was performing 100 surgeries a month. Canadian rivals like Image Laser Care have quickly cut that number in half.

Image Laser Care, one of about a dozen busy laser eye surgery centers in Ontario, expects to handle 375 cases this month at its Toronto clinic, half of them Americans.

The competition for American patients is intense. In preparation for the opening next month of another clinic in Niagara Falls, Ont., Image Laser Care dived with abandon into the price war by advertising a very low rate of $699 per eye -- the regular price is $999 -- to its first 1,000 customers.

"We don't want to be the cheapest in the market. That requires too much volume -- more than we would want -- to make a profit. But this does give us a way to create a referral base," said Michael Addley, president and chief executive officer.

Image Laser Care, which also operates a center in Scottsdale, Ariz., was incorporated in June. Like other companies rushing into the laser eye surgery business, it saw a good-sized niche in the United States for offering the procedure at a more affordable price.

Addley objects to critics who describe Canadian clinics as "revolving doors" because of their aggressive efforts to attract patients.

He argues that, in addition to cost, Canadian doctors enjoy an advantage from having more experience with more lasers than their American counterparts.

His company, as well as others, boasts about the subtle differences of their lasers just as computer makers compare the speed of their machines. But Harmon said there's little medical data yet that shows significant differences among the latest-generation lasers.

"We're not doing black magic here," Addley said. "The marketplace is very competitive and the procedure fairly standardized. Our doctors are working for a lower percentage than doctors in the states. We're Canadians, but we're doing this the American way."

American doctors, especially those in cities near Canada, can't do much to stop their patients from crossing the border.

"It's disappointing, but a reality that we can't compete on reputation alone," said Dr. Charles Niles, a Williamsville ophthalmologist. "The procedure is so good it has become a commodity."

The difference in price stems from more than fees.

Canadian doctors have enjoyed a few years' head start withLASIK because the federal Food and Drug Administration has taken more time to approve lasers and the range of vision problems for which they can be used.

In addition, the two dominant manufacturers of lasers available in the United States, Visx and Summit Technology, charge doctors a $250 royalty fee every time they use the devices on an eye, though rulings this month by the International Trade Commission may open the market to other lasers that don't require a fee. The fees are not applied in Canada.

Add in a favorable exchange rate, and it's not much of a contest.

A handful of physicians perform LASIK in Buffalo, most of them through a relationship with LCA Vision Laser Center in Amherst. LCA Vision is a national chain that buys the lasers -- the devices can cost more than $500,000 each -- and charges doctors a fee to use its facilities.

Fichte said he wants to break his connection with LCA in hopes of establishing a laser surgery center that can offer LASIK at a more competitive price. But it may not be easy.

"We all want to do that," said Niles. "But without the volume of patients, you can't afford to buy the best machine, not to mention the blades and their constant upgrades. And without the machine, you can't establish a reputation."

Addley and others said the price difference will narrow as more laser eye surgery centers open in the United States and more lasers from different companies become available.

Meanwhile, Niles said doctors have for the most part resigned themselves to the situation.

His key concern is that patients tell him about their plans for the surgery so that he can discuss the pros and cons. They usually don't, he noted.

"The most important determinant of success in LASIK is whether someone is a good candidate. People need to know that they may have to accept less than perfection," he said.

Side effects can range from light sensitivity to infection. Complications occur in about 5 percent of patients, although the rate drops to 1 percent for experienced surgeons, experts say.

Patients with severe vision problems may still need glasses afterward, though they may not have to be as thick. LASIK won't help people who use reading glasses.

"Will the rush in this business to lower prices and increase volume cloud people's judgment about who is a good candidate?" asked Niles. "You've got to wonder whether we'll one day see a backlash against this surgery as a critical mass of patients with not-so-good results grows."

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