Add  to Your Bottom Line with CK
The NearVision procedure attracts patients who have previously avoided refractive surgery.
BY ROBERT TAYLOR III, M.D.

Conductive keratoplasty (NearVision CK) effectively improves vision in presbyopic eyes and I believe it can provide incremental revenue to your practice in a relatively short time. As you know, the ViewPoint CK System from Refractec uses radio frequency wave energy applied through a probe tip to reshape the cornea. The procedure is indicated for hyperopic corrections up to +3D and for improvement of reading vision after age 40.

In this article, I'll explain how our practice has attracted new patients and increased our bottom line with CK -- without having to make major adjustments to staffing or office routines.

Who's a Candidate?

Our ideal patient is a 40- to 60-year-old presbyopic hyperope who needs glasses for distance and near. NearVision CK is my procedure of choice for all patients with refractive errors of plano to +3D with less than 1.25D of cylinder correction, both for monovision correction and for distance-only corrections in low hyperopes who don't like or tolerate monovision well. Our results with this approach have been very positive. (See "Tracking Our CK Results" on page 84.)

Patients who have been successful monovision contact lens wearers are very good NearVision CK candidates. We find that patients subjectively have better quality of vision with conductive keratoplasty and find it easier to adapt to than traditional monovision.

For the distance-only corrections, LASIK is certainly an option. However, we prefer CK over LASIK as long as the astigmatism is low because the margin of safety is much better. Also, these patients often have a very significant improvement in near vision, as well, and many are much less dependent on reading glasses after the procedure. If they become more dependent on near-vision glasses down the road, I may go back and add additional CK treatment spots to the nondominant eye.

I treat both eyes when patients are hyperopic to a level of +0.75D or have uncorrected distance vision in the dominant eye of 20/30 or worse. Patients must have very good distance vision in the dominant eye to be happy with "blended vision" CK.

Obviously, for those with more astigmatism, or hyperopia of more than +3D, we would consider LASIK or clear lens extraction.

Conductive keratoplasty has brought a new patient demographic into our practice. For example, I now readily perform CK on patients with very low hyperopia (¾ +1D). Previously, I would have hesitated to cut a flap and perform LASIK on a patient with such a small refractive error.

In addition, many patients who are coming in for presbyopic correction were themselves reluctant to have LASIK or clear lens extraction because of the invasiveness of these procedures. They're not as fearful of conductive keratoplasty. Positive marketing on both the national and local level has helped explain the NearVision CK procedure and its high degree of safety to patients.

Training Staff for CK is Easy

The impact on the practice in terms of patient flow, staff training, and additional staff hired has been minimal. The technicians who perform our refractive screening for PRK and LASIK are now trained to do the conductive keratoplasty screenings, as well.

We conduct a complete eye exam with several additional elements, including central and peripheral pachymetry and Orbscan topography. We also perform a monovision trial with a loose lens and a contact lens monovision trial prior to surgery.

Screening patients for NearVision CK is very similar to screening patients for LASIK and other refractive surgery procedures, in terms of the actual process. However, the procedure needs to be carefully explained to ensure that patients' expectations are appropriate.

For instance, LASIK patients typically experience the full improvement in vision within the first 24 hours after surgery -- the well-known "wow factor." Conductive keratoplasty patients do get some immediate improvement at both near and distance, but they have a longer adjustment period prior to visual stabilization. This occurs both because of the monovision or blended vision effect and also because there is some fluctuation in the refraction over the first 1 to 3 months. Once this is properly explained, patients know what to expect and are more satisfied with the results.

CK Builds the Bottom Line

Financially, adding NearVision CK to a refractive surgery practice makes tremendous sense. It took only about 5 months for procedure revenues to break even with the advertising, equipment depreciation, supplies, and other startup costs. Within the first year, it's already a very profitable part of our practice offerings. (See "CK Start-Up" chart on page 83.)

We hired no additional staff. The hours for some existing staff increased, but the cost to the practice is minimal at about $200 per month.

The majority of our CK advertising dollars were spent early on, when we launched the procedure. This strategy was effective in helping us educate potential patients about a new procedure and in quickly building enough volume to generate a return on the investment and future referrals.

We now charge $1,750 per eye and $3,500 bilaterally for CK surgery. This is the same price we charge for conventional LASIK; wavefront LASIK is $2,250 per eye. Our CK fee includes post-op care for 1 year. Enhancements are free except for key cards/probe tips which cost patients $100. I also extend the post-op period for 1 year from the date of retreatment if retreatment is necessary. Our enhancement rate is approximately 6%, which may seem higher than some surgeons, but I have a very low threshold for enhancements for astigmatism or undercorrections.

Today, our NearVision CK volume is 40 cases per month, and we believe that's likely to increase. Demand is primarily driven by referrals from patients who've already had the procedure. Thanks to these word-of-mouth referrals, our CK advertising expenditure is now relatively small at about $2,300 per month. It still makes up about 90% of our refractive advertising because we do very little LASIK advertising.

In fact, I would characterize Shepherd Eye Center as primarily a general ophthalmology and cataract practice. Our advertising is mostly geared towards promoting public awareness of our comprehensive practice, rather than marketing any specific procedure.

Refractec's national marketing and advertising has been very helpful in raising awareness about NearVision CK. Then, when people see our ads locally and realize we perform the procedure they heard about, they come in to the practice for an evaluation.

Overall, NearVision CK has boosted our refractive surgery practice volume by bringing in a new patient demographic and additional revenue without significantly increasing staff or marketing budgets. Even more importantly, it's enabled us to offer our presbyopic patients a safe and effective option for improved vision.

Dr. Taylor is in private practice at Shepherd Eye Center in Las Vegas, Nev. He has no financial interest in Refractec or NearVision CK. Contact him at (702) 731-2088 or rbt3@cox.net.