Ophthalmologists in the Roanoke Valley, seasoned specialists who can treat all manner of eye disorders, have a vision-correcting laser housed in Salem but don't use it every day.

"This is not a LASIK hotbed," said Dr. David Kinsler.

A big, national eye-care services chain is hoping to make it one, or at least heat up the market for LASIK, the widely accepted surgical treatment that can make eyeglasses and contact lenses unnecessary.

TLC Vision Corp., with nearly 80 branded LASIK centers nationwide, picked the Roanoke Valley as a site for one of the company's first "value-priced" LASIK facilities. Scheduled to open this month or early next month at 3800 Electric Road, the business has installed an advanced ophthalmic laser. In addition to that investment, which could have cost up to $300,000, it has recruited an eye surgeon from a prestigious Florida institute and will employ six or seven other personnel.

All to zap new life into what TLC thinks might be a LASIK-shy medical marketplace, but one whose consumers will seek LASIK care given the right combination of services, price and marketing. TLC is offering qualified patients interest-free financing at $59* a month. The asterisk refers to caveats about a credit check, among other qualifiers.

Its price for noncustom work is lower than the going rate and it plans to market its services directly to consumers, something the valley hasn't seen consistently. But two of the valley's doctors have publicly questioned whether the company, which hopes to sustain a comeback after years of losses, can deliver quality care here without cutting corners.

The sudden surge in LASIK competition illustrates an urgency within the medical community to respond to perceived opportunities in a rapidly changing marketplace. Although the competition among LASIK providers is fierce, at least they're relatively free of meddling from the managed-care bureaucracy. That's because few insurers pay for LASIK. Thus, the choice of LASIK as an alternative to contacts or glasses is often one of vanity, or at the least, an expensive convenience. Part of the overall strategy at work among providers is to mine the market before competition and perhaps technology pressure prices downward.

For the record, nobody interviewed for this article is questioning the safety of LASIK, a means of directing an ultraviolet laser to surgically reshape the cornea, or light-conducting surface of the eyeball. LASIK, which stands for Laser-Assisted In Situ Keratomileusis, cleared all Food and Drug Administration hurdles to be deemed safe and effective in 1988, though the technology had been used for years before that to etch computer chips. Though some caution that its too soon for LASIK'S long-term effects to be known, more than 1 million people in the United States have the procedure each year.

Concerns about TLC

TLC is a publicly traded Canadian company with a domestic headquarters in St. Louis. Describing itself as a diversified eye-care services company, it operates branded LASIK centers; furnishes access to LASIK and cataract surgery equipment; develops, manages and co-owns same-day surgery centers; owns an optometric franchising company; and holds a controlling stake in a company pursuing a cure for one type of macular degeneration. TLC had revenue of nearly $200 million during the first nine months of last year.

TLC's arrival on their turf did not go unnoticed by the Roanoke Valley's existing eye surgeons, whose sole proprietorships and small group practices might lose LASIK business to TLC, recognized as the LASIK industry leader. Some of them have dedicated many hours to charitable activities such as treating the poor and uninsured. They wonder, will the new LASIK center and its surgeon do the same? Will the surgeon live here or commute from elsewhere?

In addition, they are warning consumers to read the fine print about the company's prices and services, which has produced strain between TLC and some members of the Roanoke Valley medical community. TLC initially approached a number of valley doctors about the possibility of them or one of them working for TLC. The doctors declined. One, Carey Robinson of Roanoke County-based Eye Care & Surgery, placed an advertisement in The Roanoke Times and at Roanoke.com in which he wrote skeptically of TLC's planned new Roanoke Valley business.

Robinson asserted that TLC's advertised price would be rarely what patients actually pay, because TLC would tack on "up-charges" for correcting certain vision deficits.

More worrisome, the ad stated, TLC's LASIK surgeon "leaves town" after work and isn't around to help patients if "there are problems or surprises."

Mary Schoendorfer, manager of TLC's new Roanoke Valley center, revealed the depth of the company's anger in an interview.

"Somehow, he will answer to someone and explain," Schoendorfer said of Robinson, "because it's slander."

Five days later, Robinson said a TLC attorney has sent him a written warning to "cease and stop" making statements TLC considered misleading or face possible legal action. Robinson declined to be interviewed further.

William Leonard, president of refractive surgical services, TLC's largest division, said TLC offers a menu of services at various prices.

TLC's Roanoke Valley location, which will use the name LASIK Select, plans to charge $999 per eye for its standard treatment package, which appears to be a valleywide low. Customers who elect standard care can pay their bill, which would come to $1,998, in $59 installments "with credit approval."

As TLC's advertising points out, that's $1.96 daily or "less than a daily cup of joe."

Leonard said he didn't know what share of customers will end up paying that price, because "this is our first entree into the value-priced business."

That strategy, launching in Roanoke and a few other cities, is to charge moderate prices and advertise directly to consumers.

In other locations, TLC establishes relationships with a network of referring doctors, is more accustomed to getting LASIK business primarily through word of mouth, and charges what a press release calls "premium" prices. That's about $2,000 per eye, according to a filing with the U.S. Securities and Exchange Commission.

Leonard acknowledged that, at the Roanoke Valley location, customers could end up paying more than $999 for more complicated cases. It's similar to buying a car and adding "certain options," he said.

After dodging a request for the highest price to be charged in the Roanoke Valley, Leonard confirmed it will be $1,799 per eye. That's in the same ballpark as the price charged for customized LASIK by some eye surgeons already doing business here.

A doctor's impression

Roanoke eye surgeon Dr. Joseph Weisman said TLC called and tried unsuccessfully to interest him in the Roanoke Valley job, too. Asked for his impression of TLC, he said the company typically hires relatively young doctors to perform LASIK all day long and do little else, at fairly low pay. He said that after being in clinical practice for 18 years, a dozen of them in the valley, he prefers his wide-ranging general ophthalmology practice. He said he meets, treats and follows patients through the course of their illness, using LASIK and a variety of other procedures.

If TLC offers that kind of continuity of care with its LASIK, Weisman would place TLC on par with himself and his colleagues who form the core group of established local LASIK providers.

"But I don't think that's been the proven model with TLC in other markets," Weisman said. "The trade-off of the low cost is you don't get the personalized attention of a surgeon who knows you well and is going to be available to back up the work."

Weisman wondered aloud whether TLC's Roanoke Valley operation can attract enough business to meet some large patient-volume expectations a company representative shared with him. The one LASIK device in the valley, situated on Main Street in Salem and owned by a collection of doctors, draws a "consistent but fairly moderate demand," he said. But no providers of LASIK in Roanoke would disclose how many patients they currently treat.

Demand is probably as modest as that for plastic surgery in Roanoke compared with New York City, Weisman said. "The LASIK market really seems to take off in the larger cities where you just have a bigger population to draw from and, additionally, there tends to be more people with a lot of discretionary income that want elective surgery," he said.

TLC's response

TLC division president Leonard said the new TLC location is positioned to draw from a geographical area of 300,000 people, which would be about equal to the population of the Roanoke Valley and some adjacent communities. He declined to give volume targets. But the company believes the potential market is nearly four in 10 U.S. residents, or 110 million people -- only a small fraction of whom have had the procedure -- suggesting plenty of room for industry growth, according to a filing with Securities and Exchange Commission less than a year ago.

Leonard said concerns about continuity of care at TLC are unfounded. TLC's surgeon will meet potential patients when they visit the Roanoke Valley site for consultation, treat them and perform follow-up care, all at that address.

Dr. Michael Tracy, the Florida eye surgeon TLC hired, "will be involved in the overall care of the patient, from beginning to end," Leonard said. "He will be living in Roanoke."

Asked whether Tracy will join Project Access, a Roanoke-based network of nearly 500 physicians providing free care to the uninsured, Leonard said, "hopefully he'll be involved in some community activities. More important, we hope, is providing great patient care to the people who come in and use LASIK Select."

Leonard declined to make Tracy available for an interview, but TLC's Web site, and public records, painted this profile: Tracy finished medical school in 1999, his residency in 2004 and the last step of his training, a fellowship in cornea and external diseases at Bascom Palmer Eye Institute, last year. U.S. News & World Report ranked Bascom Palmer, part of the University of Miami Miller School of Medicine, the best hospital in the country for ophthalmic care in 2005 by reputation.

Despite being a new doctor with at most about a year of active clinical practice, Leonard said that Tracy is highly qualified for his new position, having performed more than 1,000 LASIK procedures.

Tracy is also "board certified," Leonard said.

However, a spokeswoman for the American Board of Ophthalmology said that Tracy has not taken a required examination to become a board-certified diplomate, which means certified as a medical specialist by the relevant medical specialty board.

On the other hand, Leonard appears correct in his claims about TLC offering advanced technology in the Roanoke Valley. TLC's valley location will offer a form of LASIK that prepares the cornea for laser-ablation using a laser rather than a small blade.

At the valley's longstanding LASIK center in Salem, doctors still open the cornea with a blade.

It's a trade-off that patients who want to stick with the familiar will have to be willing to make.