Mining a New Refractive Market

BY DANIEL DURRIE, MD

Refractive surgery has been around for about 20 years now, and for almost that long it has been a procedure associated with 30-something professionals. Indeed, according to industry newsletter Market Scope, in 2005 the average LASIK patient was about 39 years old with an annual income of approximately $88,000. The procedure's initially high price has played a major role in keeping it a luxury for mature professionals, as did the need for a stabilized refraction.

However, a trend I have observed at my own practice has led me to conclude that it would often benefit patients if this “average” group became younger. While I would not generally advocate going below the age of 18, as current American Academy of Ophthalmology and FDA guidelines specify, refractive surgery for patients in the 18- to 24-year-old age group may provide them with a better quality of life, visually speaking. With the last census estimate counting 28.2 million 18- to 24-year-olds in the United States, this “Millennial Generation” are a demographic worth seeking out.

All in the Family

The idea to actively recruit college-age patients for LASIK came from their parents. My adult patients, those who are more the “typical” age for refractive surgery, always say the same thing following their procedure: “Boy, I wish I could have had this done 25 years ago.” Then, the parents watch their kids start having more problems with their contact lenses and see them sleeping in their contacts and sharing solutions with other kids at college, etc. And they start asking, “Could you have this procedure done earlier?” With LASIK being FDA-approved down to age 18, the answer is usually “yes.”

My patients' interest in having their offspring undergo refractive surgery at a much earlier age than they did led me to examine my own practice's statistics for our younger patients. I found that for the age group below age 25, potentially the 18- to 24-year-olds, had grown pretty dramatically over the last four years — from 4% to 14% of our refractive patients now. And remarkably, we haven't done anything to initiate that — it has happened on its own. That's pretty dramatic growth without target marketing, so we began to realize that there was a trend going in that direction.

Why Not?

So why not give our patients what they want? There have been essentially two arguments against performing refractive surgery on younger patients: the possibility that their eyes have not yet stabilized, and increased risk of keratoconus later on. I'll address each of these issues.

■ Not yet stable refractions may mean an increased likelihood of having to undergo (and pay for) enhancements later on in life. Curious about this, I reviewed my own practice's statistics. We divided our database of more than 5,000 patients into groups of five-year intervals by age at surgery and found that the enhancement rate went up every five years — that we actually had less enhancements the younger the group was. So the 25-30 group had less enhancements than the 30-35 group, etc. Thus, the enhancement rate is actually higher the older you are.

My daughter, Dr. Erin Durrie Stahl, presented a paper at the 2009 ASCRS meeting on teenage LASIK patients (Laser Refractive Surgery for Generation Y: 16- to 19-Year-Olds). It covered more than 100 patients that we had been following for the past three years. What we found was that the enhancement rate was quite low even in this group, because they were carefully selected and appropriate candidates for the surgery. Some of these patients were as young as 16. One adolescent patient was allergic to all metals and plastics, so he could not wear glasses or contact lenses — you can imagine how refractive surgery improved his quality of life.

■ The keratoconus risk. Because keratoconus is something that usually doesn't develop until a little later in life, there is the possibility that performing laser surgery might increase the likelihood of triggering keratoconus down the road. While this risk is real, I believe careful patient selection and a close examination of patients' topography can help surgeons meet this challenge.

The Orthodontic Model

Refractive surgery techniques and technologies have so improved over the brief period it has been an option that serious complications are rare and, for most people, there seem few reasons not to have the surgery performed.

I believe that, eventually, people's approach to refractive surgery will mirror that of orthodontics. If you think about how orthodontics has developed over the years, it's gotten to the point where you have your child get braces as soon as the dentist says it should be done. Theoretically, you could say that maybe 10 years from now people will wear glasses and contact lenses until their eyes stabilize, and then have surgery and don't wear glasses or contact lenses again.

Marketing LASIK surgery to a college-age demographic makes sense.

After all, when you look at it from the patient's perspective, if you're 22 years old and your eyes haven't changed in two years, and you're wearing glasses or contact lenses and dealing with contact lens solutions, you could potentially have better vision with the surgery. LASIK will provide better vision than soft contact lenses because of the correction of astigmatism. It's obviously more convenient and much more cost effective the younger you have it done. It doesn't cost any more if you have it done when you're young rather than when you're older, but you've bypassed years of costs for glasses and contacts.

Market dynamics have developed that are making it more cost effective, more convenient and potentially even safer to have refractive surgery rather than wearing extended-wear contact lenses. Those are pretty big driving factors that I think are going to have an effect over the next 10 years.

According to Market Scope's 2009 “Comprehensive Report on the Global Refractive Surgery Market,” global demand for laser refractive surgery is expected to start improving in 2010 and to subsequently return to previous levels after the protracted decline that began in 2007. I believe the dynamics mentioned above will play a role in driving that anticipated growth.

Who Pays?

Though this demographic is younger and hence has less disposable income than the typical, more mature refractive surgery patient, don't rule them out. In my practice we have seen parents not only encouraging their teenagers to have it done, but also paying for it. Just as they pay for the orthodontist, they pay for the eye surgery. And usually parents are not going to send their kids for the “2-for-1 special;” there's no mindset of, “I'll pay for it, but find the cheapest.” They want to make sure their children have the best equipment and go to a surgeon who has a good record.

Those who cannot persuade their parents or grandparents to fund the surgery are knowledgeable about and willing to obtain financing for what they regard as an important investment in their quality of life. So if you want to appeal to this patient base, you will need to offer financing programs. Longer-term financing programs may be particularly helpful for these younger patients.

Reaching the Younger Market

But the availability of financing is not the only thing you need to persuade the 18- to 24-year-olds to sign up for refractive surgery. While this age group typically does not harbor mistrust of the procedure — in fact, as a group, the fancy technology appeals to them — they are mistrustful of the hard sell. In my experience, the Millennial generation is suspicious of advertising and spokespersons. In order to reach them, be sure to provide them with a good educational experience about refractive surgery.

You can easily do this, of course, on your practice's Web site — which this Internet-savvy demographic will be checking. Be sure your site is up to date and provides the information they will be seeking in a very precise fashion. Avoid hype and provide them with facts as to why your practice is the right place to go for refractive surgery.

Additionally, you should be prepared to spend time addressing their concerns when they come in for a consultation. They do their homework on refractive surgery and they ask straightforward questions.

Your efforts to educate them with your Web site and to spend the time necessary to answer their questions will likely pay off. When I look at my practice's numbers for people who come in for consultations, my conversion rate is highest for this Millennial generation. After watching their parents and friends undergo refractive surgery, they come in already convinced that LASIK is safe and life-enhancing. OM

Dr. Durrie is in private practice at Durrie Vision in Overland Park, Kan., and is a consultant for Refractec. He can be reached by e-mail at ddurrie@durrievision.com.