Refractive surgery is a procedure that can be considered for the correction of many visual defects. The prices charged are high and the support very low. Update on a surgery that is (very) expensive for those who have it.
Around 100,000 people each year in France use refractive surgery to correct their vision. The operation involves changing the topography of the cornea using an “excimer” laser after removing the top layer. The total duration of the operation is approximately 30 minutes and does not require hospitalization.
Most visual defects can now be corrected by this intervention, whether it is myopia (defect of far vision), astigmatism (visual blur from far and near), hyperopia (defect of vision) near vision) and even, more recently, presbyopia (difficulty of accommodation in near vision).
Each intervention technique has its price
There are three different techniques. It is up to the ophthalmologist to suggest the one that is best suited to the patient and his visual defect:
Refractive Photokeractectomy (PKR)
It is the oldest. It involves reshaping the cornea with a laser after having removed the epithelium mechanically using a micro-brush. It is used in about 25% of interventions. PKR causes postoperative pain for 4-6 days. The visual recovery time lasts one to two weeks. Its average cost is around € 2,000 for both eyes.
The procedure begins with the cutting of a thin layer of cornea using an automated plane (microkeratome) with the help of basic eye surgery instrument set. The surgeon then lifts this coverslip to apply the laser treatment. The corneal flap is finally rested and reattaches without suturing. This method is used in 15% of interventions. It is painless and allows rapid visual recovery. Its cost is a little higher than the PKR.
This technique is identical in principle to that of Lasik, except that the cutting of the cornea is carried out using a more precise laser, of the femtosecond type. Today, it is the most widely used procedure in France (around 60% of cases) and elsewhere in the world. It is painless and presents very little risk of complications..
No coverage by Health Insurance
Refractive surgery is indicated for patients between the ages of 18 and 55 whose visual impairment has not changed for 2 years and who do not suffer from any eye disease (glaucoma, retinal disease, etc.). This intervention is intended for people with a slight to moderate visual defect (myopia up to – 8 diopters; hyperopia up to +6 diopters and astigmatism up to + or – 4 diopters).
In the eyes of Social Security, refractive surgery is an act outside the nomenclature regardless of the technique used. In other words, she does not pay back a penny. On the other hand, 6 out of 10 complementary health contracts take part of it, according to a study by the Ministry of Health published last August and on the most frequently subscribed contracts.
Among individual contracts, those offered by mutuals display a guarantee for refractive surgery in 69% of cases, against 52% for contracts managed by insurers. As for collective contracts, taken out by companies on behalf of their employees, this guarantee is less frequent in contracts managed by provident institutions (38%), compared to those of insurers who offer it in 62% of cases. and in 82% for mutuals. The amount covered varies from one contract to another (up to 700 euros per eye). However, it is rare for the operation to be fully covered, as the prices charged are high.
Ways to reduce the bill
First reflex for those who wish to pay less: find out carefully before choosing the surgeon and especially ask for quotes. The price differences for the same technique can be significant from one establishment to another, within the same city. Good to know: some clinics and hospitals display their prices on the Internet.
Several health supplements also offer their members the benefit of more attractive prices than those on the market. As they do with opticians or hearing-aid acousticians, they can also form partnerships with centers specializing in refractive surgery. Professionals who adhere to it agree to limit their prices in the hope that the influx of new customers will offset the decline in their margins. Check with your complementary organization.
Another avenue, still little exploited by French patients: the foreign sector (Turkey, Tunisia, Thailand). Just like expensive dental care (prostheses, bridges, implants) or esthetics, refractive surgery is seeing more and more centers developing outside our borders and offering far lower prices than those charged by French practitioners.
Be careful though for potential exile candidates not to leave with their eyes closed. Among the precautions to be taken: make sure of the surgeon’s experience (yes, the question arises!), the level of equipment used or the guarantees offered and in particular the conditions for resuming care in the event of complications.
After 60 years or in the event of a strong visual defect
Refractive surgery is not recommended when you are in your 60s or if you have severe visual defects. It is even rather contraindicated in many cases. Surgeons can then use eye implants, synthetic lenses installed inside the eye, either by keeping the lens if it is healthy, or by replacing it in the event of cataracts.
The procedure does not require hospitalization and is usually performed in two sessions, one for each eye. Like refractive surgery, the placement of eye implants to correct a defect is not reimbursed by Social Security. As for the complementary, they are still few to take care of it.
The side effects in question
The Dangers of Lasik Association paints a bleak picture of the adverse effects that one might fear following refractive laser surgery. The association reports high complication rates based on a study by the Food and Drug Administration, the US equivalent of our National Medicines Safety Agency (NMSA).
This study, carried out in two groups of approximately 240 and 300 patients who have undergone refractive surgery, shows that 4% of them experience “very” or “extremely” troublesome visual difficulties three months after the procedure. Halo, glare, dry eyes… For 1% of patients participating in this study, these difficulties were such that they prevented any resumption of activity.
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