2026-08-11T08:40:28-0400 / KFF健康新闻
纽约退休营养师塔米·查拉拉对自己的白内障手术效果非常满意，术后视力接近20/20。
她说，去年她选择让医生使用激光辅助手术，双眼手术自付费用近4000美元。
现年69岁的查拉拉在网上查阅资料并咨询医生后，选择了激光手术而非传统手术刀手术，她认为这能带来最佳效果。“这看起来是更好的选择，”她说。
白内障手术是医疗保险覆盖的最常见手术之一，通常参保人只需自付数百美元。部分患者会在手术过程中额外付费矫正视力。
但和查拉拉一样，越来越多的患者仅仅因为同意医生使用激光而非手术刀手术，自付费用变得更高。
两种手术方式都很安全，都能大幅减少或消除患者佩戴眼镜的需求。
不过，许多医生表示，激光手术比手术刀切割更精准。他们表示，激光手术为患者提供了更多选择，同时也能弥补医疗保险逐步削减白内障手术费用给医生带来的收入损失。
另一些人，比如约翰·霍普金斯医学中心的眼科医生奥利弗·沙因，则指出使用激光存在强烈的经济动机，因为一套激光设备可能让诊所花费高达50万美元。
沙因表示，他的同事在激光手术问世几年后就开始使用，但并未发现其优于传统白内障手术的地方。不过，激光手术并无危害，也能为患者带来不错的效果。
“这对外科医生来说是极具吸引力的组合，”沙因说。但他补充道，最终大多数患者都认为多花钱就能获得更好的效果。
医疗保险为标准白内障手术向医生支付约520美元，过去十年间下降了约20%。该费用包含术前和术后随访。
虽然医疗保险通常禁止医生向患者收取高于医保支付标准的费用，但当使用激光仅为改善视力时，医生可以向患者额外收费，因为大多数视力矫正项目不在传统医疗保险覆盖范围内。
具体而言，当医生使用激光植入高端人工晶状体或矫正散光时，可以向患者收费。通常，激光手术每只眼睛的收费在1000至3000美元之间。
医疗保险参保人还需自付购买高端人工晶状体的费用，这类晶状体可以让患者无需佩戴阅读或远视眼镜，费用从1000至4000美元不等。
包括医疗保险优势计划在内的私人保险公司通常遵循医疗保险福利规则。
研究表明，对于标准白内障手术，激光手术并不比手术刀手术效果更好。
全球最大的眼科医生和外科医生组织——美国眼科学会在其网站上表示：“研究并未显示激光手术的并发症更少，也未发现激光手术的效果更佳。”
总部位于圣路易斯的眼科市场数据公司Market Scope称，全美每年开展的500万例白内障手术中，近12%为激光辅助手术，且这一比例一直在增长。
“这对患者和医生来说是双赢，”加州大学洛杉矶分校眼科教授凯文·米勒说。“医生在医保报销之外多赚一点钱；行业获得资金开发新技术；社会也受益，因为这些患者不再需要眼镜了。”
到80岁时，超过一半的美国人都曾患过白内障——这种疾病会导致视力模糊和夜间视力变差。随着年龄增长，眼睛晶状体中的蛋白质和纤维分解并结块，大多数白内障都会缓慢发展。
几十年来，医生一直使用手术刀进行白内障手术，即摘除白内障并将浑浊的天然晶状体替换为透明的人工晶状体。
71岁的芭芭拉·科布齐是一名拥有传统医疗保险的医疗账单顾问，去年她需要接受白内障手术。当她新泽西的眼科医生推荐她使用激光手术，每只眼睛收费1500美元时，她寻求了第二诊疗意见。“我觉得他想骗我。”
科布齐说，第二位医生为她进行了无激光手术，她对效果很满意，包括不再需要佩戴远视眼镜。
“医生把激光当作赚钱工具，”她说。
曾担任美国白内障与屈光手术协会主席的眼科医生万斯·汤普森表示，一些患者选择激光手术是因为它提供了更精准的手术方式，另一些患者则是为了避免佩戴眼镜。
他说，他会向患者讲解激光手术的优势，让他们自行决定哪种方式更适合自己。“他们有权了解所有可选方案，”汤普森说。
他表示，在他南达科他州苏福尔斯的诊所中，约有一半患者选择激光手术，而十年前这一比例仅为10%左右。
不过，激光手术并非适用于所有患者，比如那些有角膜瘢痕或瞳孔过小的患者，汤普森说。
多伦多接受过美国培训的眼科医生巴雷特·尤班克斯表示，要证明激光手术的益处颇具挑战性，因为传统白内障手术本身已经安全有效，感染率很低。
他说，与传统方法相比，他发现激光手术更容易植入高端人工晶状体或摘除某些类型的白内障。这是因为激光可以按照编程进行精准切割，而人手无法做到这一点。
加州大学洛杉矶分校的眼科医生米勒表示，随着医保报销持续减少，激光手术有助于为他的诊所增加收入。“眼科领域的一个问题是，每个人都在拼命维持运营，”他说。
米勒说，他的诊所开展激光白内障手术已经有好几年了。他将这种选择比作购买丰田凯美瑞或雷克萨斯。“两者都能带你去想去的地方，但其中一个能让你体验更豪华，配备真皮座椅，”他说。
他说，患者都知道可以选择不使用激光的手术。“我们不会强迫任何人做任何事，”米勒说。
在洛杉矶一个富裕地区的诊所中，他表示80%的患者选择激光白内障手术。“你为激光支付的费用换来的是精准性和可重复性，每一次激光切割都完全一致，”他说。“它不会让视力变得更好。”
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Medicare’s paying less for cataract surgery. Eye doctors are turning to moneymaking lasers.
2026-08-11T08:40:28-0400 / KFF Health News
Tammy Chalala, a retired dietitian in New York, was thrilled with the results of her cataract surgeries, which left her with close to 20/20 vision.
She said she paid nearly $4,000 out-of-pocket for her two surgeries last year because she opted to have her doctor use a laser to assist with the procedure.
Chalala, 69, chose that method over the traditional scalpel after doing research online and consulting with her doctors, believing it would give her the best outcome. “It seemed like the better option,” she said.
Cataract surgery — one of the most common operations paid for by Medicare — typically leaves enrollees owing a few hundred dollars. Some patients pay more to have their vision corrected during the procedure.
But, like Chalala, a growing number of those patients are paying even more out-of-pocket simply because they agree to have their doctor use a laser rather than the scalpel method.
Both methods are safe and can significantly reduce or eliminate the need for patients to wear glasses.
However, many doctors say the laser helps make more precise cuts than the scalpel. The laser method gives patients more options, they say, and recoups more revenue as Medicare has gradually cut what it pays doctors for cataract surgery.
Others, such as Oliver Schein, an ophthalmologist at Johns Hopkins Medicine, point out the strong financial incentive to use the laser, as the equipment can cost a practice up to $500,000.
Schein said his colleagues used the laser a few years after it came out but did not see any benefit over traditional cataract surgery. Still, the laser doesn’t cause harm and provides patients with good results.
“That’s a powerful combination for a surgeon,” Schein said. But in the end, he added, most patients believe paying more will yield a better result.
Medicare pays doctors about $520 for a standard cataract procedure, down about 20% in the past decade. The fee includes pre- and postoperative visits.
While Medicare generally prohibits doctors from billing patients above what the government program pays, doctors are allowed to bill patients extra when using the laser only when it is used to improve vision, because most vision correction is not covered by traditional Medicare.
Specifically, doctors may bill patients when using the laser to insert premium lenses or fix astigmatism. Doctors typically charge $1,000 to $3,000 per eye for use of the laser.
Medicare enrollees also pay out-of-pocket for the premium lenses that can eliminate their need for reading or distance glasses, with charges ranging from $1,000 to $4,000.
Private insurers, including those operating Medicare Advantage plans, typically follow Medicare benefit rules.
Research shows the laser does not provide better outcomes than the scalpel for a standard cataract procedure.
The American Academy of Ophthalmology, the world’s largest organization of eye physicians and surgeons, says on its website: “Studies do not show that laser surgery results in fewer complications. Also, studies haven’t found that laser surgery provides better outcomes.”
Nearly 12% of the 5 million annual cataract surgeries performed nationally are laser-assisted, and that number has been growing, according to the St. Louis-based ophthalmic market data company Market Scope.
“It’s a win-win for patient and doctor,” said Kevin Miller, a UCLA ophthalmology professor. “Doctor makes a little more money on top of the Medicare reimbursement; the industry gets money to develop new technology; and society benefits because these patients are not going for eyeglasses anymore.”
By age 80, more than half of Americans have had cataracts, a condition that causes blurred vision and poor night vision. Most cataracts develop slowly as part of the aging process when proteins and fibers in the eye’s lens break down and clump together.
Doctors for decades have used scalpels to perform cataract surgery, which involves removing the cataract and replacing the cloudy natural lens with a clear artificial one.
Barbara Cobuzzi, 71, a medical billing consultant with traditional Medicare coverage, needed cataract surgery last year. When her eye doctor in New Jersey recommended she get the surgery using a laser at a cost to her of $1,500 per eye, she went looking for a second opinion. “I felt like he was trying to pull a fast one.”
Cobuzzi said the second doctor performed her procedure without a laser, and she was happy with the results, including no longer needing glasses for distance vision.
“Doctors are using the laser as a moneymaker,” she said.
Vance Thompson, an ophthalmologist who is a past president of the American Society of Cataract and Refractive Surgery, said some patients want the laser because it provides a more precise way of doing the surger,y while others choose it to avoid the need for glasses.
He said he talks to patients about the advantages of the laser and lets them decide which method is right for them. “They deserve to be educated on all their options,” Thompson said.
He said about half his patients at his Sioux Falls, South Dakota, practice choose the laser, up from about 10% a decade ago.
The laser is not suitable for all patients, though, including those who have corneal scarring or a small pupil, Thompson said.
It’s challenging to illustrate the benefit of the laser because traditional cataract surgery is already safe and effective, with low infection rates, said Barrett Eubanks, a U.S.-trained ophthalmologist in Toronto.
He said he’s found that, compared with the older method, using the laser makes it easier to implant premium lenses or remove certain types of cataracts. That’s because the laser can make the exact cut it’s programmed to make, unlike the human hand.
Miller, the UCLA ophthalmologist, said the laser helps bring money to his practice as Medicare reimbursement continues to decline. “One of the problems with ophthalmology is everybody is scrambling to keep the lights on,” he said.
Miller said his practice has offered laser cataract surgery for several years. He compares the choice to buying a Toyota Camry or buying a Lexus. “Both will get you where you want to go, but one will get you there with a premium feel and leather seats,” he said.
He said his patients know they can choose the surgery without a laser. “We do not pressure anybody to do anything,” Miller said.
At his practice in an affluent part of Los Angeles, he said, 80% of patients opt for laser cataract surgery. “What you buy with a laser is precision and reproducibility, as every laser cut looks exactly the same,” he said. “It does not make vision better.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
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