I’m delighted to serve as the guest editor for this edition of Ophthalmology Management focusing on current trends in refractive surgery. This edition explores many of the topics of greatest clinical interest in both corneal refractive and lens-based surgery. Current forms of refractive surgery provide better outcomes to a wider array of candidates than ever before. 

In this context, it seems appropriate to ask whether we can understand some of the dramatic changes in refractive surgery volumes that have taken place in the United States over time. Why, for example, did we see roughly twice the volume of laser refractive surgery performed in the in the late 1990s compared to current levels according to MarketScope data? Why did volume spike in 2020-2021, only to fall back down in recent years? 

EXPLANATIONS FOR THE TRENDS 

The answers to these questions have been debated for years and are likely multifactorial; however, some generalizations apply. I have always viewed the early years of laser vision correction volumes as aberrational and representative of at least a decade of pent-up demand in early adopters who eagerly awaited the US approval of excimer lasers. It took years to work through this demand and reach a baseline titer of the true addressable market. Additionally, the early years of laser vision correction included the treatment of many hyperopes and older presbyopes who are typically treated today with lens-based surgery. Additional patients who we view today as non-candidates were also sometimes treated in the early days of laser vision correction.

Other factors enter into the equation as well. Our refractive surgical volumes comprise a tiny rounding error compared to the volume of spectacle sales, so subtle changes in the desirability of spectacles have dramatic effects on our industry. Several years ago, it became quite fashionable to wear spectacles, and it seemed that every celebrity sported a pair of chunky glasses. This trend seems to have abated of late. 

Another obvious factor is the rise in the importance of near vision in our society, a fact lamented by cubicle workers staring at screens all day and parents wishing their children would swap video games and phones for outdoor activities. Additionally, contact lens technology and comfort have improved, resulting in fewer patients becoming intolerant to their use.

OVERCOMING COST AND FEAR 

However, the two greatest obstacles to refractive surgery adoption have historically been described as cost and fear. Fortunately, the relative contributions of one of these obstacles have been modeled for us in a recent societal experiment. 

Imagine a scenario wherein the addressable market for refractive surgery was suddenly flush with lots of excess cash. This is precisely what happened in 2020-2021 when COVID-19 shut down most travel, dining and many other forms of spending. Simultaneously, $5 trillion in stimulus money was deposited into the accounts of individuals and businesses in the United States.¹ The Personal Savings Rate, defined by the Federal Reserve Bank of St. Louis as the percentage of the family’s monthly budget left over at the end of the month, typically averages 3-6%. As stimulus checks arrived, this shot up to an unprecedented 32% in April 2020.² Unsurprisingly, refractive surgery volumes spiked shortly thereafter. 

While understanding these macroeconomic changes is helpful, there isn’t much we can do about them. Similarly, many patients will harbor a certain degree of fear regarding any surgical procedure, no matter how great the results are. All we can do is strive to develop better and better technological advancements and adequately communicate the value proposition of these life-changing procedures to our patients.

I hope you enjoy this refractive surgery-themed edition of Ophthalmology Management. OM

References

1. Federal Reserve Bank of St. Louis. Personal Saving Rate (PSAVERT). https://fred.stlouisfed.org/series/PSAVERT. Accessed July 8, 2024.

2. Where $5 Trillion in Pandemic Stimulus Money Went. The New York Times. https://bit.ly/3zJMyuA. Accessed July 8, 2024.

Steven J. Dell, MD, is a cataract and refractive surgeon and the medical director at Dell Laser Consultants in Austin, Texas. He reports no relevant financial disclosures.