As I See It
Can You Afford to Ignore LASEK?

Robert D. Watson

Ask any ophthalmologist if LASEK at this stage of the game is simply a glorified PRK, and the majority will answer yes. Ask ophthalmologists who are doing LASEK if they think LASEK will be better than PRK in the near future, and the majority will say they do. So the jury is still out, but my ophthalmologist-clients are ordering LASEK educational materials nonetheless.

Their interest is driven by the fact that patients are asking about LASEK. Where there's demand, there's opportunity. One high-volume refractive surgeon reported that 27 of the last 50 laser vision procedures he performed were LASEK. When asked if he was promoting LASEK or doing a study to generate so many cases, he said, "No, I cover PRK, LASIK and LASEK at seminars and simply say that LASEK is very similar to LASIK but without the risk of complications from the microkeratome, and that it's a much better procedure than LASIK for those with thin corneas or pupils that dilate larger than the treatment zone. Whether they have these contraindications or not, they like the fact that LASEK is a newer procedure that avoids some of the potential complications they have heard about with LASIK."

WHAT PATIENTS ARE THINKING

Patients think of LASEK as an advancement over PRK. Most have read on every LASIK surgeon's Web site that LASIK is much more patient-friendly than PRK, doesn't cause haze and causes little if any discomfort. They simply don't want to have an older procedure that was once abandoned due to its drawbacks. But when they learn that LASEK combines elements of both PRK and LASIK, they perceive it to be better than PRK.

It turns out that if you offer a safer alternative with results as good as LASIK, a considerable number of patients are willing to put up with slower recovery and discomfort to gain an additional margin of safety. When you offer LASEK to patients who have seen negative news stories or know someone who had a bad experience with LASIK, they start to think that they can have laser vision correction after all -- with fewer risks.

LASIK, on the other hand, has received enough negative publicity in recent times to help drive patients who were thinking about having surgery to the sidelines. Although the discounters have started closing their doors, the public is learning that discounters are not the sole reason some patients have bad results. The key to educating patients about the differences in PRK, LASIK and LASEK is to tell them the truth: LASEK may have some advantages.

THE PROCEDURE WILL IMPROVE

Consumers are becoming smarter, and the early refractive surgery adapters have already come and gone. Refractive surgery is going to be a much harder sell from here on out, and LASIK-only practices are going to lose patients to practices that offer a safer alternative packaged in the new and advanced form of LASEK. It would benefit you to get tuned into LASEK by attending the upcoming first International LASEK Congress in Houston (March 22 to 23) and LASEK courses at the ASCRS and AAO, and then begin presenting LASEK to patients for whom you think it has advantages.

Once the number of doctors performing LASEK reaches some level of critical mass, LASEK will become a better procedure than PRK and perhaps even better than LASIK. Think of it like the early days of phacoemulsification. At first, only a few ophthalmologists did phaco the way Dr. Charles Kelman taught them. But after hundreds of the best minds in ophthalmology started doing it, they developed new phaco techniques that continue to make the procedure better and better.

Already LASEK surgeons are experimenting with improvements in technique, including loosening and separating the epithelium in hopes of keeping the flap alive. Will this contribute to faster visual recovery and postoperative discomfort more similar to that of LASIK? If it does, everyone wins!

Robert D. Watson is the president of Patient Education Concepts, Inc. You can reach him at (800) 436-9126 or robertw@patientedconcepts.com.