In The Big Short, in a chapter ironically entitled “In the Land of the Blind,” best-selling author Michael Lewis describes how doctors respond to bad incentives. He explains “The evolution of eye surgery is another great example.” He writes that LASIK was born when Medicare reimbursements for $1,200 cataract procedures were slashed to $450. Quoting a Vanderbilt trained neurologist, Michael Bury, M.D., “the incentive was to maintain their high [seven figure] incomes, and the justification followed.”
In the news, Morris Waxler, Ph.D., calling on the FDA to pull the plug. He worked for the FDA when the lasers were initially approved. In short, Dr. Waxler says if he knew then what he knows now, he never would have recommended that the FDA approve LASIK.
Responding en masse, the LASIK-Industrial Complex is calling on its titans to trumpet the safety of the current generation of LASIK technology in the hands of skillful surgeons. They say LASIK is the safest surgical procedure known, with patient satisfaction rates ranging from 95 to 98 %.
For the LASIK consumer, the challenge is to find the right surgeon and the right technology. As recently as 2007, Alcon’s LADARVision 6000 surgical laser was quietly recalled by the FDA after hundreds of patients were injured by the product defect. Problems with creating surgical flaps have been reduced by Intralase lasers, which have replaced the prior generation microkerotomes, or miniature meat slicers. Yet, doctors still use microkerotomes. And, while the LASIK industry says the current generation of technology is terrific, where were the warnings for those unwitting “guinea pig” patients who were injured by the prior technology?
In selecting a surgeon, competence and experience help. But what matters more is the surgeon’s business model. Even terrific LASIK surgeons have failed their patients in high volume LASIK factories.
In short, I have three impressions about the current debate between Morris Waxler and the LASIK industry:
1. I do not support Dr. Waxlerr’s petition to cease LASIK. I know too many honest, intelligent LASIK surgeons, “who eat their own cooking,” to say the surgery is inherently flawed.
2. Knowing the true risks and consequences of this elective surgery, I choose to stick with my glasses and contact lenses.
3. For LASIK surgery customers to make their own truly informed decision about the risks, benefits and alternatives to this popular surgery they deserve an independent patient satisfaction study that is free of the influence of the LASIK Industrial Complex.
 Michael Lewis, The Big Short (2010), pp. 43-44.
 Doyle Stulting article