Premium cataract options gain ground

“Survey says”: Slow and steady wins the race?

By Kristen Ingenito

Discussion of innovative new IOL options and other cataract surgery-related technologies have dominated ophthalmic meetings and journals. While this might excite cataract surgeons, not all of their patients have the desire or economic means to pay for these enhancements — nor do all cataract surgeons immediately embrace the latest and greatest. A recent Market Scope survey of U.S. ophthalmologists sheds some light on adoption rates and the economics associated with two game-changing innovations: premium IOL options and femtosecond laser cataract surgery. While both are beginning to fulfill their promise, adoption thus far isn’t what fans might expect.

Cataract volumes in the United States

In January 2015, Market Scope conducted surveys with 261 U.S. cataract surgeons or practices to better understand the market for premium cataract surgery. The data represented 493 cataract surgeons, as many of the surveys included data from group practices. This sample included roughly 7% of all U.S. cataract surgeons.

IOL procedures for Q4-2014 totaled 995,000, representing a five-year high as cataract surgery volume continues to grow, approaching 1 million procedures per quarter (Figure 1). Seasonal volume increases for cataract surgery are not unusual, particularly in the fourth quarter.

Figure 1.

Cataract procedure volume continues to show modest increases year to year, with 3.2% growth in cataract volume in 2014 over 2013. We expect this trend to continue as the baby boom population ages.

PC-IOL stats

During the fourth quarter of 2014, nearly 76% of surgeons who completed Market Scope surveys were offering presbyopia-correcting IOLs (PC-IOLs) in their practice. This is up slightly compared with 73% over the same quarter in 2013. Although most cataract surgeons offer these technologies, not all patients are good candidates for them or have the motivation and economic means required, and these facts show in the number of PC-IOLs actually implanted: Of the surgeons who offer these premium IOLs, more than 51% reported that they performed 10 or fewer PC-IOL procedures during the quarter (Figure 2).

Figure 2.

PC-IOLs’ share of the IOL market has remained relatively flat over the past five years, hovering between 4.5% and 5% of total IOL procedures. Toric IOLs, meanwhile, have seen modest growth in the same period and account for most of the premium IOL growth — they are 7.6% of IOL implantation in Q4-2014 (Figure 3). These rates still lag significantly behind the more popular monovision option, which accounts for almost 17% of IOL cases on average.

Figure 3.

Two new presbyopia-correcting surgical devices gained U.S. market approval in the first half of 2015 (Alcon’s AcrySof IQ ReSTOR toric multifocal IOL and AcuFocus’s KAMRA inlay), but these do not address a significant number of patients with astigmatism who are faced with a choice of toric or presbyopia correction. Outside the United States, patients who need a combination of toric-presbyopia-correcting IOLs can get them, as they are available in all vision ranges.

Overall, toric and presbyopia-correcting IOLs make up 12.8% of all cataract and refractive lens exchange procedures. While demand for these lenses may not be growing as quickly as some anticipated, PC-IOL numbers have remained steady, and toric IOL volume has seen modest growth as economic conditions begin to improve and the specialty embraces the patient-pay model.

Femto-assisted surgery surges — sort of

As expected, U.S. surgeons’ interest in offering femtosecond laser cataract surgery (FLCS) has increased since the technology’s introduction to the market in 2010.

Market Scope surveys indicate that the percentage of surgeons offering FLCS today has increased significantly, from 6% in Q2-2012 (when Market Scope first began asking about FLCS) to 31% in Q4-2014 (Figure 4).

Figure 4.

However, 58% of surgeons are still undecided or have no plans to implement the technology, and only 6.5% of IOL procedures performed in Q4-2014 used a femtosecond cataract platform, according to Market Scope surveys. While this percentage has steadily gained ground in the last two years, it still represents a small portion of the total IOL surgical volume (Figure 5).

Figure 5.

Opinions in the specialty remain divided, with some surgeons believing FLCS makes them faster, more accurate and safer, and others arguing the opposite (See Femtosecond laser-assisted cataract surgery: Point/counterpoint, page 58). This is not unusual, as other notable new equipment adoptions have encountered mixed reviews early on as well.

A financial leg up

Currently, Market Scope respondents report billing $786 more for FLCS procedures with toric IOLs than other cataract surgeons who implanted these same lenses, and respondents billed an additional $813 for FLCS procedures with PC-IOLs.

We expect improvements in technologies and economic conditions, along with demographic and social trends, such as longer careers and increased use of mobile devices, to increase patient demand for advanced technologies in the future. As long as ophthalmologists can differentiate and clearly explain these various options to patients who are able and willing to pay the premium price of these lenses, we see a plus-side future for all. OM

About the Author
	Kristen Ingenito is a market analyst and editor at Market Scope. Market Scope surveys U.S. ophthalmologists in the cataract, refractive, retina and glaucoma subspecialties about a wide range of practice of medicine and management issues (www.practice-scope.com). Kristen may be reached at (314) 835-0600 x 214, or kristen@marketscope.com.