Dominant Eye Surgery Chain LasikPlus Put Profits Over Patient Care, Some Doctors Say

Some said they were expected to perform so many procedures each day they worried they couldn’t keep up. “It felt like we were in a war zone all the time,” said

Therese Alban,

who quit LasikPlus two years ago after 15 years there, part of an exodus of about 20% of the chain’s then 40 or so doctors to a rival firm or private practice.

Dr. Alban said she was comfortable operating on 28 patients a day but was pushed to do 40 to 50. She would agree to boost her volume, she said, only to sometimes find an extra four or five patients added to her schedule without her permission. Some days, she operated from early morning until 9 p.m., she said.

More than a dozen former and current LasikPlus doctors and employees echoed such concerns. Some former surgeons said they felt pressure to approve clients for whom the standard vision-correction procedure might not be suitable and said the company discouraged them from recommending surgical alternatives that could be better for the patient.

Craig Joffe,

chief executive and owner of LasikPlus parent company LCA-Vision Inc., based in Cincinnati, said in an interview that ensuring “exceptional patient quality of care” is the company’s paramount goal.

He denied the firm pressured any physicians to change any medical practices and said the number of surgeries they performed in a day was up to them.

Mr. Joffe described the company as a kind of confederation, the firm providing administrative and management support while each location’s doctors manage the medical aspect. “All clinical decisions are made by the independent physicians, who are in 100% control of that patient,” he said.

LASIK (Laser-assisted in situ keratomileusis) involves using lasers to reshape the cornea, the clear outer part of the eye. In the hands of a skilled surgeon, it can be done in less than five minutes per eye.

After a pandemic-induced slump in 2020, the industry has surged this year, which executives say is partly because people grew tired of mask-fogged glasses. Patients typically pay out of pocket, from as little as $250 per eye at budget chains to $3,000 or more at high-end independent clinics.

LasikPlus was founded in the 1980s by Mr. Joffe’s father,

Stephen N. Joffe,

a physician who realized early the potential for lasers in many kinds of surgery. He narrowed its focus to vision-correction centers in the 1990s.

Son Craig Joffe is a Harvard Law School graduate who worked for a time as an executive of the chain. He bought the chain back in 2015 after it had slipped from his family’s control and had been sold to a firm that ran into financial problems.

LCA-Vision, with LasikPlus as its flagship brand, has since amassed an estimated one-third of the U.S. market, with four brands and 140 locations listed on its websites. The rest of the industry of about $2 billion in annual revenue is fragmented among much smaller chains and individual clinics.

Online reviews of LasikPlus locations are generally positive. “I can’t believe I put this freedom off for so long! Highly recommend this group of professionals!” read one

Facebook

posting late last year.

Sanjay Goel,

who was a surgeon at LasikPlus for 20 years and on its medical advisory board, quit in 2019 to start his own firm. He said he left in part over “unethical medical practices,” according to a lawsuit he filed in a dispute with the company over the terms of his departure.

His suit, filed in Circuit Court for Howard County, Md., alleged the company pressured its staff to have patients not return for a second preoperative evaluation, even when medically necessary, because this might dissuade some from having surgery. The suit also alleged the company pressured surgeons to meet unreasonable volume targets and even to join a “100 Eye Club”—100 procedures in a day.

Four other former LasikPlus surgeons said they recalled being encouraged by the company to join a 100 Eye Club. One hundred eye surgeries in a day typically would mean 55 to 60 patients, because some people have only one eye done.

Mark Lobanoff,

a private laser-vision surgeon in Minneapolis, said most private surgeons operate on 20 to 30 patients a day. Surgeons get tired, and “when you get tired, the risk of making a mistake goes up,” he said.

Mr. Joffe and two current LasikPlus doctors the company arranged to talk to The Wall Street Journal said they had never heard of a 100 Eye Club.

A lawyer for LCA-Vision said Dr. Goel raised issues about its practices for tactical reasons in the dispute over his departure terms. The parties have settled their litigation, which moved to Maryland federal court and which included a suit LasikPlus filed in Ohio federal court.

Some doctors at LasikPlus said they welcomed a faster surgical pace. “I’m going to give Craig [Joffe] a lot of credit,” said

Lewis Groden.

“He’s pushed me and other surgeons to do more, in the sense that you can do more.”

Dr. Groden said that after streamlining some procedures, he is comfortable operating on about 60 eyes in a day, up from about 40 to 44. Sixty eyes might equate to roughly 35 patients.

LasikPlus said its highest-volume surgeons have the fewest complications.

Stephen Whiteside,

a surgeon who left LasikPlus as part of the 2019 exodus, said he had grown concerned that management was pushing to relax or abandon some practices commonly followed in the industry and included in guidelines from the American Academy of Ophthalmology.

The academy, for example, recommends multiple postoperative visits. Some LasikPlus clinics have moved to seeing many patients just once within a day or so after surgery, relying on them to come back if they have problems.

Dr. Whiteside said complications often don’t show up for several days after surgery. “It’s one thing for a shoe company to cut corners,” he said. “It’s another for an eye surgery to cut corners.”

LasikPlus officials acknowledged that some of their doctors have deviated from voluntary guidelines such as on the number of postoperative visits. They said this was in part because technology has advanced since the guidelines were drawn up. They said some doctors concluded, based on their experience, they could safely relax the policies, depending on individual patients’ needs.

Mr. Joffe said there’s no uniform way of handling postoperative visits, certainly not one sponsored by the company.

Although various studies indicate the vast majority of patients are satisfied with their vision after LASIK, a Food and Drug Administration 2017 study of the broader industry found that, among patients reporting no prior visual symptoms, close to half reported some vision aberration after surgery, such as halos. These usually resolve over time, but a small minority of patients suffer from long-term eye problems.

Until last year, LasikPlus competed with a company called Vision Group Holdings, which controlled the only two other national chains. Many of the surgeons who quit LasikPlus in 2019 moved to Vision Group, in what the LCA-Vision lawyer, in a letter to the Journal, “corporate raid,” although most have since moved on again.

The lawyer,

Robert M.M. Shaffer,

said LasikPlus believes criticisms of its practices come in part from participants in the alleged raid and former LasikPlus doctors who now compete with the firm.

LasikPlus sued Vision Group in 2019 but dropped the suit after the rival filed for bankruptcy protection last year. That proved an opportunity for Mr. Joffe, who bought its two chains out of bankruptcy in August 2020, more than doubling the size of his own company.

The purchase triggered an antitrust probe by the Federal Trade Commission. Mr. Joffe said he is confident the FTC will conclude there is no competition issue. The agency declined to comment.

Eric Donnenfeld,

who runs a clinic for one of LCA-Vision’s recently acquired chains, said he has battled his new bosses to keep from implementing some of their preferred practices, such as pushing prospective clients to have surgery on the same day they come in or within a week. Dr. Donnenfeld said he prefers to give patients “all the time in the world” to consider the risks and benefits of surgery on their eyes.

“We still manage to take quality care of our patients, but that’s done despite LasikPlus,” said Dr. Donnenfeld. “I am concerned that LASIK, which is an extraordinary procedure, is being tarnished by a company that in my opinion is more interested in profits than patient care.” He added that he is trying to negotiate an exit from the company.

Mr. Joffe said the company doesn’t compromise patient care for money. LasikPlus, he said, is a long-term player in the industry, and taking any risks with patient care would come back to haunt it financially and reputationally.

Tired of wearing contact lenses,

Kelley Kuehm

decided to have vision-correction surgery at a LasikPlus location in New Jersey in 2019 after seeing that the company had positive online reviews.

The initial consultation “felt kind of car-salesy,” she said in an interview, with staff offering her a discount if she scheduled the procedure quickly.

She said she chose a surgeon based on the reviews, only to be switched to a different surgeon at the last minute.

The surgery left her with dry eyes and blurry vision, according to Ms. Kuehm, a 29-year-old dental hygienist. She said the surgeon kept dismissing her complaints, saying her symptoms didn’t make sense, and after six months she gave up returning to LasikPlus, never filing a formal complaint.

“They didn’t want to say there was an issue,” said Ms. Kuehm. LasikPlus, she said, seems “more concerned about pumping out procedures than the medical aspect.” She said two other eye doctors have since diagnosed her with severe dry-eye problems.

LCA-Vision’s Mr. Shaffer, citing privacy obligations, said it would be inappropriate to respond to inquiries about individuals and their health information.

Former LasikPlus surgeons said some changes that concerned them began after the younger Mr. Joffe took control in 2015. He started measuring performance at each location, focusing on the percentage of potential clients converted into paying patients and how quickly, according to the doctors and internal documents reviewed by the Journal. Mr. Joffe gave bonuses to the staff at clinics when they met financial targets.

One focus of his, surgeons said, was the percentage of potential clients accepted during an initial evaluation as being good candidates for surgery.

The company can’t legally tell doctors which people should be surgery candidates. Laws in many states prohibit non-doctors from owning medical practices and are designed to ensure that physicians can exercise their medical judgment without outside financial pressure.

Some former LasikPlus doctors said Mr. Joffe pushed them in memos and conference calls to boost the share of potential clients approved for surgery, known internally as their “candidacy rate.”

The American Academy of Ophthalmology says some people aren’t good candidates for LASIK surgery, such as those with severe dry eye, extreme prescriptions or thin corneas. Some independent eye surgeons said they accept 70% to 90% of people who inquire about the LASIK procedure.

LasikPlus clinics had an average candidacy rate of about 90% in both late 2017 and late 2018, according to internal memos reviewed by the Journal. The rate at some locations was above 95%.

Mr. Joffe at times pointed to more aggressive surgeons, asking doctors to learn from them, former LasikPlus doctors said. While they could resist the suggestions, some said, it was exhausting to keep battling the CEO. Doctors are paid a percentage of the revenue from patients they treat; some said they could earn $1 million or more a year.

Memos called out clinics with below-average candidacy rates as among “opportunity areas” to focus on: “Candidacy % below company average,” the memos would say.

“It was not taken too well if you had too many patients declared not to be candidates,” said

Jay Lustbader,

who quit LasikPlus in 2019 after 18 years. Dr. Lustbader now is chair of ophthalmology at Georgetown University Medical Center in Washington, D.C., and practices laser surgery privately.

The LasikPlus branch where he was had a candidacy rate close to 90% when he was there, internal memos show. In his private practice, he said, he accepts about 80% of potential clients as surgery candidates.

Olivia Webb

says she was operated on by LasikPlus but now believes she wasn’t a suitable candidate.

Ms. Webb, a graduate student in Texas, had her surgery done at a LasikPlus branch in San Antonio in early 2017. In medical-history forms she filled out beforehand, she said her eye doctor had diagnosed her with dry eyes and she used lubricating drops daily, according to a suit she later filed in Texas state court in Bexar County, Texas. The suit alleged that her LasikPlus surgeon dismissed her concerns the procedure might worsen her dry eyes.

The surgery left Ms. Webb with such severe dry eyes that for months she had to remain at home in complete darkness, her 2019 suit alleged. At the time, it stated, she was in constant pain, couldn’t leave home without a hat and special glasses, and at age 30 was “permanently disabled and unable to work.”

LasikPlus and the surgeon denied wrongdoing. The parties later settled on undisclosed terms, court records show.

Mr. Joffe denied the company pushed clinics to raise their candidacy rates. “Our independent physicians will never want to operate on a patient who is not a safe candidate for the procedure,” he said.

He said the companywide memos were to help doctors learn from each other, but the company no longer distributes them.

LCA-Vision’s lawyer, Mr. Shaffer, said the company has never taken adverse action against a doctor based on metrics such as candidacy rate. He said a wide disparity among doctors on such measures shows there was no undue influence on them.

Several suits were filed against LasikPlus involving 2018 surgeries that allegedly went awry. In one, a patient stated that a LasikPlus surgeon operated on the wrong person entirely.

Gregory Reinhart

was in the waiting room in Albany, N.Y., when a staffer called out “Greg,” according to Mr. Reinhart’s attorney. “Greg” was the last name of a different patient, and the LasikPlus staff did that other patient’s laser surgery on Mr. Reinhart, said his attorney,

Michael McDermott.

He said his client now suffers from loss of close vision, has recurrent headaches, sees floaters and flashes of light and has dry eyes.

LasikPlus and its surgeon denied the allegations, according to filings in New York state court in Albany, where a suit by Mr. Reinhart is pending. LasikPlus didn’t respond to questions about the case.

In a letter to the Journal, LasikPlus surgeons Dr. Groden in Tampa and

Dean Ellis,

who is in Kansas City, said that although treatment errors should never occur, the small number of errors should be compared with a “vast number of LASIK patients we have successfully treated and who are happy with the result achieved.”

—Elisa Cho and Jim Oberman contributed to this article.

Write to Mark Maremont at mark.maremont@wsj.com