Same reason medical care is so expensive in the US: Insurance and the art of the upsell. The provider gets to charge high prices because the bulk of the cost is covered by insurance and thus "hidden" from consumers. The insurance company gets a non-trivial cut of the pie, which pads the bill further. And in my experience, when you go in with something wrong with you, most doctors will recommend (or perform without as…
That said, I'm currently getting cataracts removed and IOL implants and insurance is like "correcting your astigmatism isn't needed so we won't cover the IOL that does that, just your distance vision". If correcting my vision isn't necessary then why cover any IOL at all??? :-/