Refractive Surgery: ’Net Results

Reaching the Internet-savvy vision-correction customer.

BY RENÉ LUTHE, SENIOR ASSOCIATE EDITOR

A fact that will come as no surprise to refractive surgeons is that the majority of their patients research vision correction procedures online. According to the Pew Internet and American Life Project, the largest age groups of U.S. adults online are those ages 18 to 29 and 30 to 49 — also prime demographics for refractive surgery — at a whopping 90% and 85%, respectively. This tendency makes refractive patients different from cataract patients; Pew reports that only 35% of Americans 65 and older use the Internet.

Daniel S. Durrie, M.D., medical director of Durrie Vision in Overland Park, Kan., and clinical professor of ophthalmology, University of Kansas Medical Center, Kansas City, Kan., points out that refractive surgery and Internet research have gone together from their beginnings in the 1990s. "It was actually leading a lot of the patient education online."

While online research has resulted in prospective refractive surgery patients armed with data, it has not necessarily led them to objective, reliable information. By helping them find that information, and learning how best to appeal to them, surgeons create both satisfied patients and future referrals.

Helping Patients

Uday Devgan, M.D., in private practice at the Maloney Vision Institute in Los Angeles and Chief of Ophthalmology at Olive View UCLA Medical Center, reports that his experience of online research among prospective patients is in line with what Pew reports; he estimates that approximately two-thirds of vision correction patients research procedures on the Internet, vs. only approximately one-third of cataract patients.

And he finds that most of the information that patients come to surgeons with is relatively accurate.

Dr. Devgan identifies the primary problem as something else: that patients find themselves in a sea of unvetted data. Evaluating claims is difficult for them. "Probably the most confusing thing to all patients is that on everyone's Web site, he or she is absolutely the world's best surgeon and is world famous and teaches the other surgeons — it's out of control," he says. He begins his consultations with the old adage of not believing everything one hears — and that pertains to his reputation, as well. He invites patients to put his name into Google. This is important, he feels, because it is crucial that patients feel comfortable with their surgeon. "You have to think, what if there's a problem?" he says. "Do I feel that this type of surgeon is really going to take care of it?"

He also advocates avoiding a "hard sell," whether it is on your Web site or in person. "I tell patients to shop around. The harder you sell a patient, the less inclined he is to book," he claims.

The Right Sites

A crucial part of avoiding a hard sell is directing patients to credible, objective online sources of information. Dr. Durrie's Web site features a page of patient education resources, with links to other sites. His links include www.usaeyes.org, the Web site for the Council of Refractive Surgery Quality Assurance, the FDA's Web site, www.fda.gov/cdrh/lasik/, and the sites for the American Academy of Ophthalmology (AAO) and the American Society of Cataract and Refractive Surgery (ASCRS).

Dr. Devgan is also a fan of the FDA site. "It is completely nonbiased," he says. "It gives you both sides of the story. It gives you a list of questions to ask a doctor. It gives you all the background information you need to know."

Andrew Iwach, M.D., associate clinical professor of ophthalmology at the University of California at San Francisco, faculty instructor at the California Pacific Medical Center Department of Ophthalmology and Secretary for Communications at the AAO, recommends www.medhelp.org, an independent group that lets consumers post questions to experts in given specialties. "There's a forum for ophthalmology and one of the three ophthalmologists who answer questions is a refractive surgeon," he explains.

The AAO's recent launch, www.geteyesmart.org, is another good resource to help clear up consumer confusion, he says, as the AAO has the ability to vet their information. "It's a huge priority for them," he says. The Foundation ofthe American Academy of Ophthalmology is behind www.eyecareamerica.org, a site designed to raise public awareness about eye disease and access to medical eye care. It has a page about LASIK, including a link to information on clinical trials. Sites such as these, and www.allaboutvision.com, often also have doctor locators.

Dr. Durrie says that www.trustedlasiksurgeons.com is another valuable resource. It provides descriptions of various refractive procedures vetted by experts, but also offers a twist. Cofounded by James J. Salz, M.D., the site states its mission is to help patients find refractive surgeons who are "the best and most trusted in the United States."

Surgeons are listed on the Web site after passing a screening process. Criteria include participation in FDA refractive vision correction studies; publication of an article about refractive surgery in an ophthalmic journal; presentation of a refractive surgery topic at a major ophthalmic meeting of ophthalmologists; and managing complications in patients who had previously been operated on by other surgeons. A listing on a site such as this helps surgeons stand out from the many others with Web sites, Dr. Durrie says.

Keeping Them Grounded

The sites listed above will help you avoid a major issue of Internet research: keeping patient expectations reasonable. Dr. Devgan reports that in his experience, corporate-sponsored Web sites tend to overpromise. "They will tell you, ‘You will see near and far and everything in between! You'll have seamless vision and no problems,’" he says. "That's not 100% realistic. I wish they would promise less. When I read these claims on the Web sites, I think, ‘Okay, I've got my work cut out for me!’"

Dr. Iwach also prefers the M.D.-sponsored Web sites. The ones he cites above, he says, "educate patients not only as to what the procedures are, but also what their limitations are. So patient expectations are in line with reality."

Finally, while today's online researchers come in "reasonably well informed," Dr. Devgan says, not all the information is positive. "They often come to you with these sensational news stories — ‘Having LASIK made me depressed!’" Dr. Devgan says.

However, even the "grievance" Web sites can be helpful. "I think those perform a service," Dr. Durrie says. "This is an elective surgery that no one has to do and I always approach it that way. If someone comes in with questions because they've read about halo and glare and dry eye, then they just come in with better questions. These Web sites stimulate discussions between patient and doctor."

Helping Surgeons

Practices can take steps to make their own Web sites more appealing to today's Internet-savvy prospective patient. Dr. Durrie warns that you have to be active with your site in order not to be overpowered by all the other information on laser vision correction that is available online. "Everyone and their brother is trying to sell you their brand of LASIK," he points out. Because there is so much competition, he recommends choosing a Web design company that is experienced with refractive surgery.

Keeping your content updated is also crucial. This is not always so simple, Dr. Iwach points out. "It takes a lot of work and discipline to keep it current," he says. Dr. Durrie agrees. "Don't let it get stale," he warns. "If you've got a page of Web news, like we do, make sure that the news isn't from 2007, or people are going to look at it and think, ‘Why do you have a news page when nothing is new?’"

The difficulty in upkeep of a Web site amidst the busy day-to-day of practice is another reason Dr. Iwach recommends featuring links to M.D.-sponsored sites such as the AAO's — those sites will be keeping their information current themselves.

Be sure to dedicate staff to keeping your site current, Dr. Durrie advises. "Someone in your office should be going to your Web page, approaching it like a prospective patient and checking to make sure everything works."

Keeping Them Interested

Because the demographic most likely to seek refractive surgery is also accustomed to innovation in Internet communication, practices must also work to keep their interest. Get used to thinking of upgrading as a continual process. "People are looking for a little pizzazz with some video or unique information," Dr. Durrie says. A recent addition to his Web site is the LVC Counselor Web tool, by Patient Educational Concepts. It simulates what myopic, hyperopic and astigmatic vision looks like on identical images, and how that image would appear with conventional laser vision correction, then custom correction. It is the sort of tool anyone could put on his or her Web site, Dr. Durrie points out.

A tool that allows patients to apply for financing online is another attractive service. "They can be preapproved before they come in to see you, so they don't have to be embarrassed if they don't qualify," Dr. Durrie says.

What Web Sites Can't Do

For all that a Web site can do to attract prospective patients, though, these surgeons agree that it is no substitute for a face-to-face consultation. "We use it as a vehicle to get people to come in and to let them know that we've been doing this for a while," Dr. Durrie says. As excited as the patient may be about having the procedure, it is only then that the surgeon can evaluate what procedure would be appropriate for him or her and whether the time is right.

"We take all this information from these aids and customize it to the particular patient," Dr. Iwach says. "We then help them understand not only what the risks are in the aggregate, but how those risks really apply to them. That's the important stuff. These aids have not replaced ophthalmologists yet." OM