Laser surgery, one of the biggest innovations in vision care in recent decades, hasn't made a lot of headway as a covered benefit.The operation, called Lasik, permanently changes the shape of the cornea, the clear covering of the front of the eye, using a laser. It has been available in the United States for almost 20 years, but few vision plans cover it. Most Lasik patients pay for it out of pocket.

Terri Wilson, vice president of strategic accounts for VSP, a Rancho Cordova, Calif.-based vision insurer, says she has not seen an increase in employers covering Lasik surgery, partly due to the bad economy. "I don't think the utilization is really there and [don't think] the value for the client or all of their members is there," she explains.

Don Yee, president of OptumHealth Vision Care, says, "You're not seeing more employers offer Lasik coverage. That's very much in the minority. That trend hasn't really changed much in the last two or three years."

The U.S. Army offers to pay for laser surgery for most of its soldiers. But some employers are reluctant to cover Lasik because they feel it would drive up the vision premium so much that employees would stop participating in the vision plan.

There's also a concern about adverse selection, meaning people would stop enrolling in the vision plan after having the surgery. "It's typically a once-in-a-lifetime benefit. So once they have their surgery, they would drop off the plan the next year, so that could impact the employer's utilization [trend]," Wilson notes.

Steve Holden, president of Davis Vision, says, "We're hearing more about funded Lasik programs. Davis has done that for quite some time." Nevertheless, he predicts fewer employers will cover Lasik in the next two years, due to cost concerns.

Instead of full coverage, some employers provide access to discounts on laser surgery within a specific network of doctors, or simply give employees a flat subsidy for Lasik costs. A typical subsidy is around $300 to $500 per person.

LCA-Vision Inc., a provider of laser vision correction services under the LasikPlus brand, recently announced its affiliation with National Vision Administrators, which will make laser vision correction less expensive for NVA's members nationwide. NVA members will have access to substantial discounts on laser surgery through LCA-Vision's National Lasik Network, comprised of 75 company-owned-and-operated vision centers.

About 1,145,500 U.S. residents had Lasik surgery in 2008, according to VisionWatch, a study conducted by Jobson Medical Information and the Vision Council of America. "More and more people are going out and getting laser surgery," Wilson says. "People are really curious about it. They would love to see that as a covered benefit, [but] it is cost-prohibitive." Some workers may be delaying or canceling their plans for Lasik surgery because of the economic recession.

"The procedures are down overall in the Lasik industry over the last 12 months," Yee notes. "It's a high-value, high-cost procedure. It's a larger-ticket item. It's certainly deferrable to the next year [for those who can't afford it now] ... There's still demand for it. It's very stable demand." Likewise, Holden notes, "It's an elective procedure. It's expensive."

Cost of vision problems

Vision disorders are the second-most prevalent health problem in the country, affecting more than 120 million people, according to a recent report from the Vision Council of America. An estimated 11 million Americans have uncorrected vision problems. For the United States, the annual financial burden of major adult vision disorders exceeds $50 billion.

On top of that, vision disorders alone account for more than $8 billion in lost productivity per year due to pain, discomfort or functional impairment. Nearly 90% of people who use a computer at least three hours a day suffer vision problems associated with computer eyestrain. In addition to computer-related vision problems, on-the-job eye injuries affect more than 800,000 American workers each year, and 90% of them are preventable, the report states.

Seventy-eight percent of employers offered vision benefits last year, up from 71% in 2004, according to the Society for Human Resource Management. Many workers still don't have coverage. About 43% of American adults are not covered by a managed vision care plan, the Vision Council of America reports. There's been a growing trend of employers offering vision on a voluntary basis, with employees bearing the full cost.

Likewise, more employers have been adopting a strategy of covering 100% of the eye exam for all employees, with the option for employees to purchase additional coverage for eyeglass frames and contact lenses, according to Wilson. "They want to provide good coverage, but they are trying to manage the company's expenses," Yee confirms. In addition to the trend toward voluntary coverage, there's been a trend toward bundling vision and dental plans, often to achieve lower costs, according to Holden. He expects that shift to continue in the next year or two.

BEFORE THE LASER

Before consumers undergo Lasik, they should consider:

LASIK Information Checklist

EXPECTATIONS

Identify at least one or two meaningful activities that will improve by being less dependent on glasses or contacts.

OCCUPATION

Ensure nothing in current occupation or planned future occupation would prevent Lasik from being an effective vision correction method.

RECREATIONAL ACTIVITIES

Ensure nothing about recreational activities would preclude being a successful Lasik candidate.

FEES AND COSTS

Understand all fees, including consultation, pretreatment diagnostic testing, the actual Lasik surgery and all follow-up care and enhancements. If using a payment plan, understand monthly costs, interest rate that and length of time to pay.

MEDICAL ISSUES

Identify all illnesses currently and previously treated, especially ones that may effect ability to heal properly.

EYE ISSUES

Identify all eye conditions that require treatment.

MEDICATIONS

Inform surgeon of all medications currently taking or have taken within the last year - prescription or over the counter - especially those medications which might effect healing or cause eyes to be dry.

PRESCRIPTION STABILITY

Give surgeon any old glasses or contact lenses, or copies of eyeglass or contact lens prescriptions.

PUPIL SIZE

Take careful measurements with a pupilometer and have had a wavefront refraction with an aberrometer to determine whether aberrations will need to be treated with custom Lasik.

CORNEAL THICKNESS

Measure corneal thickness with a pachymeter to determine if suitable for Lasik. If I corneal thickness is not adequate, discuss with surgeon other laser eye surgery options such as PRK, LASEK and Epi LASIK or not having surgery at all.

DRY EYES

Inform surgeon if ever treated for dry eyes, take medication or use eye drops for dry eyes.

OVER CORRECTION & UNDER CORRECTION

Patients may experience an overcorrection or undercorrection. Understand a second "enhancement" procedure to obtain desired result.

PRESBYOPIA

Understand that Lasik only corrects distance vision. Successful patients may still require reading glasses.

GLARE & HALOES

Some patients experience an increase in glare and haloes following Lasik.

REDUCED CONTRAST VISION

Some patients experience reduced vision in dim or dark lighting, making night driving difficult. Discuss with surgeon whether custom Lasik would minimize the possibility of reduced contrast vision.

LASIK SURGEON EXPERIENCE

Inquire about surgeon's length of experience and cumulative number of Lasik procedures (s)he has performed.

LASIK CARE CONTINUITY

Meet and speak with key staff members who will be part of care team, and feel confident that surgeon will be available and involved to answer questions or provide additional examinations.

Source: seewithlasik.com