THE EFFICIENT OPHTHALMOLOGIST

LASIK: Will it need CPR or DNR?

Actually, that particular order is up to us.

By Steven M. Silverstein MD, FACS

Most studies in the last decade have demonstrated a gradual erosion of keratorefractive procedure volume throughout the country. These include both private physician- based as well as corporate sector programs. Since the roll out of RK, then PRK, and ultimately LASIK/epi-LASIK/LASEK, economic impact studies have continuously shadowed clinical safety and efficacy benchmarks. Despite significant improvements in technology, nomogram accuracy, and the introduction of femtosecond laser (bladeless) flaps, the volume of corneal-based refractive surgeries has continued to decline since its peak of 1.4 million procedures in 2007.¹ The anti-LASIK blogs reporting nighttime vision issues and symptoms of dry eyes have dwindled. The era of central islands has essentially disappeared.

Wavefront-guided technique has permitted equal or superior outcomes with greater tissue sparing, and a decline in surgically induced corneal ectasia. The range of correction (especially with hyperopia and astigmatism) has broadened over the last 15 years. So why are the numbers of procedures overall still in a slow tailspin?

LASIK surgery figures¹
Based on Market Scope Data

THE PARADIGM SHIFT

Without question, market fluctuation and the state of the economy overall play a significant role in the ebb and flow of liquidity-based luxury goods and services, including refractive surgery. The recession from 2008 through 2009 caused a precipitous drop in the GNP across the board, and certainly, cosmetic surgery and premium channel services were not spared.

Softer factors also influence the volume and timing of refractive surgery. The season of the year is a consistent variable, both good and bad. In the first quarter, patients’ FLEX accounts are accessible, so there is a bump in the number of procedures performed. Come spring, patients turn to thoughts of summer activities, and those who would enjoy freedom from contacts and eye glasses are more apt to undergo refractive procedures at this time. In addition, such procedures historically make great graduation gifts for students. During football and the holiday season, patients often wish to apply unused FLEX dollars for refractive surgery before they are lost. Vacation times are frequently sought after for healing time without missing work, making holidays throughout the year quite popular.

As for when a refractive surgery is an uncommon event: April 15th. You get the idea. If they are waiting for a tax refund, better vision will be postponed until that money is in their checking account.

CHANGING CHOICES

So what has changed? In our practice, we have noticed more baby boomers turning away from LASIK, instead pursuing premium lens implants that may afford them a more robust range of vision. Looking at this subset of patients in their 50s and early 60s who can better justify spending disposable income for any type of refractive surgery, they are opting for a more permanent solution for their vision needs. Marketing to this demographic can be quite effective, and because they are more active than ever before, they do not hesitate in seeking cosmetic and premium channel procedures that will help maintain, if not improve, their quality of life.

VALUE ADDED

Nearly all physicians agree that ophthalmologists who perform lens-based refractive surgery must either be able to address residual refractive error themselves, or have a relationship with another surgeon who does. In our practice, laser vision correction is provided at no charge for patients seeking sharper uncorrected clarity following a premium channel IOL as part of their package. We are all in the “20/happy” business, and it is our responsibility to use the tools available to us to help our patients achieve their best possible outcomes.

Corneal-based refractive surgery is a permanent, necessary element within the spectrum of services we provide. As ophthalmologists, we are fortunate in that two generations exist who are looking for this service. Younger patients seek freedom from contact lenses and glasses; our job is to better market to this exceptionally tech-savvy millennial generation who receive virtually all information via electronic and social media. As for the boomers, we must revisit successful methods for reaching them. These approaches include appropriately targeted marketing sources and offering seminars that cover all options for the refractive surgery patient, both corneal and lens based, and sometimes, a staged plan that features both. OM

REFERENCE

Steven M. Silverstein, MD, FACS, is a cornea-trained comprehensive ophthalmologist in practice at Silverstein Eye Centers in Kansas City, Mo. He invites comments. His e-mail is ssilverstein@silversteineyecenters.com.