Pumping up the premium IOL option

The category is stuck in neutral. Here are ideas to help attract more patients.

By Jerry Helzner, Senior Editor

As president of Elective Medical Marketing in Boulder, Colo., Kay Coulson's goal is to assist ophthalmology practices in improving their results through practice development and patient education strategies. One of her most challenging tasks is helping practices increase the percentage of patients choosing what are commonly called “premium IOLs” but that she pointedly chooses to call “lifestyle IOLs.”

“The category is stagnant,” she asserts. “The overall adoption rate has been stuck at 10% for the last three years, according to (the industry newsletter) MarketScope, for presbyopic and toric lenses combined. In the practices we advise, we are achieving conversion rates that now range from 27% to 87%, including rural and depressed areas. The problem for many practices is that they don't have a strategic plan for growing the category, and that includes the name itself.”

Ms. Coulson contends that the phrase “premium lens” primarily conveys “it's going to cost more.” She prefers the term “lifestyle” because her goal is to put the patient's focus on the significant vision benefit these lenses can deliver.

Getting patients to view these lenses as an investment in an improved lifestyle is an important first step, says Ms. Coulson, but it is then up to the practice to make the commitment to satisfy these patients with the best possible outcomes. This article will deal with attracting more patients to this category.

Still investigational in the United States, the Calhoun LAL is seen as a potential solution for post-refractive cataract surgery patients.

Predictability appeals to patients

One thing that consultants and cataract surgeons agree on is that patients paying out of pocket do not like the idea of having to come back for an enhancement procedure. Surgeons do not like enhancements, either, because they cost the practice time, money and even reputation if the need for an enhancement comes as a surprise to the patient.

“Cataract surgeons don't like to do LASIK enhancements, but if you want to do lifestyle lenses the right way, you have to be able to do enhancements in the patients who need them,” Ms. Coulson says.

“Even if you are using the best technology, you can have 10% to 12% of these patients who will need an enhancement,” says Daniel Durrie, MD, of Durrie Vision in Overland Park, Kan. “You need to be prepared to do them. We do not charge extra if an enhancement is needed.”

In recent years, surgeons who have succeeded with “lifestyle IOLs” have found ways to reduce the number of patients who require enhancements. Ms. Coulson points to rigorous surgical preparation using planning software and a dedicated staff person as ways to achieve superior outcomes.

“Most practices don't have a staff person who focuses on surgical planning,” Ms. Coulson says, “but when you have the methods in place to produce superior outcomes you can use those results — along with patient satisfaction surveys — in your marketing to potential new patients.”

Intraoperative measurements and predictability

WaveTec ORA (Aliso Viejo, Calif.) is an intraoperative wavefront measurement technology that provides streaming information to increase the precision of cataract surgery. Ideally, using ORA System during surgery will produce a higher percentage of on-target outcomes that do not require enhancement.

WaveTec recently released its own data indicating that practices using ORA System have been able to increase the percentage of patients opting for premium lenses by 27%. The company also reported that surgeons using ORA System have achieved a 47% drop in overall enhancement rates.

“We keep a global database of outcomes using ORA System and practices can show the data to potential patients,” says WaveTec CEO Tom Frinzi. “With our recent VerifEye upgrade, surgeons can confirm that the eye is stable prior to the measurement by providing streaming refractions in the preview screen. Surgeons see this as a tremendous benefit in adding refractive predictability.”

Mr. Frinzi also notes that many cataract surgeons report ORA System to have excellent synergism with femtosecond laser-assisted cataract surgery, providing even more precise and consistent outcomes than they were previously able to achieve.

POST-REFRACTIVE CATARACT PATENTS

The Calhoun Light-Adjustable Lens

One growing patient cohort who are good candidates for premium lenses are patients who previously had enough interest in superior vision that they underwent a refractive laser procedure and are now presenting for cataract surgery.

With these patients it is especially difficult to achieve an accurate measurement through traditional formulas because of structural changes to the cornea the previous procedure may have caused,

As Lawrence Brierley, MD, of Victoria, B. C., stated in his recent and much-discussed study of post-refractive patients undergoing cataract surgery, “Laser-based ophthalmic procedures change the natural spatial relationship between the anterior and posterior corneal surfaces, negating much of the value of the keratometric index of refraction.” ¹

Some patients who opt for premium IOLs find that a laser “touch-up” is required to achieve an optimum result.
PHOTO COURTESY OF JAY BANSAL, MD.

In his study, Dr. Brierley found the Calhoun Light-Adjustable-Lens (Calhoun Vision, Pasadena, Calif.), now completing late-stage US clinical trials, could be a useful solution for post-refractive patients. That's because it can be precisely and non-invasively adjusted once it is in the eye to provide the patient with the desired visual outcome.

In the 34 post-refractive eyes he implanted with the Calhoun lens, Dr. Brierley began the adjustment process two weeks after the initial lens implantation, with patients receiving one, two or three adjustments to achieve target final manifest refraction spherical equivalent. The adjustments were done using ultraviolet light of a specific wavelength that interacted with biocompatible materials in the lens to change the shape of the lens.

In the final measurement, 74% of eyes were within 0.25 D of target refraction and 97% of eyes were within 0.5 D. Mean absolute error at final measurement was 0.19 D, with 65% of the eyes achieving 20/20 vision.¹

ORA System

Tom Frinzi of WaveTec believes the difficult-to-measure post-refractive cataract patients represent a “gateway application” for ORA System.

“Cataract surgeons are starting to see these post-LASIK patients,” Mr. Frinzi says. “We believe the capabilities of ORA System can be very helpful in achieving better and more predictable outcomes for this group.”

Clarity Medical Systems has announced the launch of its Holos IntraOp intraoperative aberrometer, which will also provide intraoperative refractive guidance.

“We welcome the competition,” says Mr. Frinzi. “It will raise awareness of intraoperative measurement and the value of these instruments.”

Expand your premium patient base

From a marketing standpoint, Dr. Durrie believes that many cataract surgeons are missing out on a large group of potential patients he has reached successfully: presbyopes in their 40s and 50s who are not yet candidates for cataract surgery.

“Our practice is exclusively self-pay, but I see no reason why cataract surgeons can't put more of a priority on providing premium lenses to presbyopes instead of waiting for someone to show up with a billable cataract,” he says. “Some call this procedure refractive lens exchange but I prefer to say it is a solution for dysfunctional lens syndrome.”

The 50s are a crucial age for presbyopes as their loss of visual acuity becomes more noticeable. “If we can give 50-year-old patients excellent vision for the rest of their lives while preventing them ever having to deal with cataracts, that represents extreme value to the patients and they will pay for that huge benefit if it is presented to them properly,” Dr. Durrie says.

Unlike some surgeons, Dr. Durrie believes that the currently available premium IOLs are “not a limiting factor” in achieving excellent results.

“We still do a small percentage of enhancements, which are included in the global surgical fee,” he says. “But I believe we should continue to pursue technologies that will further reduce enhancements, including the ORA System, the Calhoun lens and the HD Analyzer (Alphaeon, Newport Beach, Calif.), a device for the early detection of cataracts.”

Commitment is key

Although ideas for increasing the percentage of patients choosing premium IOLs may vary, practices must make a significant commitment to these lenses if they are to succeed. This commitment should encompass the elements of patient education, rigorous surgical planning, appropriate technology and thoughtful marketing strategies.

Practice location, demographics and income levels will always play a role in achieving premium conversions, but practices that make premium lenses a priority have proved they can create a profitable niche no matter where they are located. OM

REFERENCE

1. Brierley L. Refractive results after implantation of a light-adjustable intraocular lens in post-refractive-surgery cataract patients. Ophthalmology. 2013;120:1968-1972.