Marianne Dixon wouldn't have known her best friend without contact lenses until two 20-second laser treatments gave her perfect vision.
The 32-year-old attorney, who describes herself as "no risk-taker," said the experimental procedure beat the hassle and health risks of a lifetime of wearing contact lenses. "I haven't seen the downside yet," Dixon said.
Millions of other nearsighted Americans are expected to feel similarly-and to pay out of pocket about $2,000 per eye for the quick outpatient surgery.
The potential of laser vision correction is giving rise to a new industry. Dozens of companies reportedly are building chains of laser clinics, and at least one company plans to help hospitals snag a piece of the pie.
About 60 million Americans are nearsighted. Because of the shape of their eyeballs, light focuses too soon and objects look blurry. With glasses or contacts, light focuses on the back wall of their eyes, as it should, and they see clearly.
In laser vision correction, computer-guided pulses of ultraviolet light vaporize a thin layer of corneal tissue. The flatter cornea, like glasses, delays the focusing of light. About 90% of patients won't need corrective lenses afterward, according to one laser manufacturer.
The procedure looks more seductive because of its simplicity. It takes 20 minutes from preparation through post-operative dressing. The entire patient visit lasts at most a few hours, and pain usually disappears within a day or so.
"This is going to revolutionize eye care," said Thomas Deutsch, M.D., a professor of ophthalmology at 817-bed Rush-Presbyterian-St. Luke's Medical Center in Chicago.
The Food and Drug Administration is expected to give its go-ahead by year-end to a laser made by Waltham, Mass.-based Summit Technology. The same equipment already is sold to treat corneal scars. It will need new software for laser vision correction, clinically known as photorefractive keratectomy.
Other companies, such as Orlando, Fla.-based LaserSight and Santa Clara, Calif.-based Visx, are developing similar lasers, but they won't win FDA marketing approval as soon, analysts said.
Sales of the $485,000 Summit laser won't be the company's biggest return. It will divide royalties estimated at $250 per laser procedure with Visx under a 1992 patent settlement. That could be a real windfall if lasers are used to treat 1 million to 2 million eyes by 2000, as Summit has predicted.
The company intends to capitalize on the breakthrough with its own chain of up to 30 laser clinics, many of which will be joint ventures with teaching hospitals. So far, Rush-Presbyterian in Chicago and 400-bed George Washington University Medical Center in Washington have signed on, said David Applegate, vice president of marketing for Summit Vision Centers.
The company plans a $100 million stock offering to finance its efforts and a multimillion-dollar television campaign to publicize the procedure once FDA approval is received.
Summit isn't alone in tying its centers to hospitals.
Cincinnati-based LCA-Vision is setting up joint ventures with hospitals in eight cities. They include 305-bed Baptist Medical Center in Montgomery, Ala., and 665-bed St. Francis Medical Center in Pittsburgh.
The 9-year-old company, formerly Laser Centers of America, runs programs for minimally invasive surgery at 45 hospitals. It's training U.S. physicians in laser vision correction at its Toronto center, which has reshaped 3,000 eyes with the technology since 1992.
"I think this is a phenomenal opportunity for hospitals to reclaim a lot of eye business," said Stephen Joffe, M.D., LCA-Vision president.
But it's not for every hospital. The service won't be profitable in markets with populations of fewer than 500,000, Joffe said. He estimates first-year demand at one procedure per 5,000 population. Average first-year costs for equipment, training and salaries will hit $1 million to $2 million.
Deutsch of Rush-Presbyterian voiced another warning: Laser vision correction could be a hard sell for hospitals that aren't known as eye-care centers. Ophthalmology groups likely will nab the biggest chunk of business, he said.
Hospital involvement, however, could ward off the troubles that plagued an earlier technology, Joffe argued.
Radial keratotomy also repairs nearsighted eyes. In that procedure, a scalpel is used to make tiny cuts in the periphery of the cornea, flattening its surface. Mixed outcomes and poor follow-up care stalled consumer acceptance.
Laser vision correction could stumble too, Joffe said. "If we do not bring this technology to market with correct education and correct quality assurance, it's not going to take off," he said.
Summit vows to provide thorough training and the marketing that will jump-start demand. Rush-Presbyterian is one of its training centers.
Knowing which patients can't be helped with laser vision correction is key, Deutsch said. Initially, the FDA isn't likely to approve its use to treat severe nearsightedness, about 10% of the field, he said.
Meanwhile, the process doesn't repair astigmatism, and performing it on people with eye disease is dangerous, he said.
Full healing takes several months. During that time, physicians must watch for scarring and infections, rare events that can be cured with medication, Deutsch said. Usually, the eyes are treated three to six months apart.
There is a catch. Most patients will foot the bill for laser vision correction without help from their health plans. And some clinicians have questioned the wisdom of altering the eye's surface.
That didn't stop Dixon, who underwent one procedure in June 1994 and another last February after methodical research. For the first time in 17 years, Dixon can swim without fearing for her contacts.
Fluorescent lights give off a bit of a glare and images appear more distant, but Dixon said she would recommend the procedure to friends. The whole world looks different, she said.