With some Canadian clinics offering laser surgery for about one-quarter the cost for the same operation in the United States -- a growing number of Americans are crossing the border to remedy their vision problems.

Many experts agree. More important than price, they say, are the surgeon's experience and skill with lasers. They suggest candidates interview several doctors and, if possible, some of their patients, before deciding who will perform their surgery. Then potential patients should make arrangements in advance for needed post-surgical care.

U.S. doctors will perform an estimated 980,000 laser eye operations this year, says the LASIK Institute, a Massachusetts-based nonprofit organization that educates patients about vision correction. About 18,000 Americans will have their surgery in Canada this year, more than twice as many as in 1996 when David Harmon began tracking the trend for St. Louis-based MarketScope, publisher of Refractive Market Perspectives.

"At first, people were going across because (laser treatment) for astigmatism wasn't approved in the United States, then because hyperopia (farsightedness) wasn't approved in the United States, and now because it's cheaper," says Harmon, who estimates that Canadian doctors will perform 120,000 laser operations this year, about 20,000 more than in 1998.

Of the two types of laser eye surgery, 85 percent are LASIK, short for laser in-situ keratomileusis. The surgeon uses a minute slicing device to cut through the cornea and peel back a thin flap, then uses the laser to reshape the cornea, depending on whether the patient is nearsighted, farsighted or has astigmatism. When the laser is finished, the flap is put back in place. The remaining 15 percent of patients have photorefractive keratectomy, or PRK surgery, in which the doctor removes the top epithelium layer to expose and reshape the cornea.

'Great Vision, Rave Reviews'
Cheryl Sample, a 52-year old teacher and speech therapist who lives near Spokane, Wash., made the 10-hour trip to LASIK Vision in Vancouver, B.C., last June after four friends returned with "great vision and rave reviews." Sample paid $1,350 for pre-testing, surgery and follow-up care -- $3,050 less than she was quoted in Washington to correct her nearsightedness.

"I used to reach for my glasses first thing in the morning, and I couldn't function at home or work without them," says Sample. "I noticed an improvement immediately after the procedure.'' Six months later, she has 20/20 vision in both eyes.

LASIK Vision Canada says its surgeons are more experienced with the procedure than their U.S. counterparts, and use safe, state-of-the-art equipment still awaiting federal approval in the United States. Laser eye surgery has been approved in Canada since the early 1990s, but only since 1995 in the United States.

What to Do
Check the doctor's professional records with licensing agencies where you are seeking surgery. The Canadian Ophthalmological Society can help you check certification and training in Canada.

Find out how many laser operations the doctor performs each month and how long he or she has been doing the surgery. It takes about three months, or 100 surgeries, to master the technique, says the LASIK Institute.

Inquire about outcomes and complication rates. Six months after surgery, 93 percent of patients have 20/40 vision and half have 20/20, the LASIK Institute reports. Several studies show a mostly minor complication rate after surgery of from 3 percent to 5 percent.

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