There is a wide variety of ophthalmic trends and practices in different European countries—as this issue illustrates—and although some views are more objective than others, we are provided with a flavor of what is happening in some of these countries. What I have found interesting is the varying number of refractive procedures, which overall seems low. The market is no doubt quite flat.

So much for the theories about product life cycles (Figure 1). Well, if the product cycle theories are correct, then I am at a loss to know what phase we are in right now. If there is little or no growth, then are we at or approaching the stage of maturity? If so, the market forecast gurus really got it wrong!

Refractive surgery has influences that are unlike conventional products. It is a highly elective surgical procedure, and the consumer has a perceived high risk (wrongly or not). Populations vary in their level of conservatism, and this is yet another variable that affects the product life cycle. Cost of surgery is another variable, however, I personally believe it is overrated. The reality is that laser refractive surgery is safer, more predictable, and accurate with the advent of sophisticated technologies that include femtosecond flap creation, iris registration tracking, and wavefront. Still, the number of refractive procedures are not increasing significantly. Advertising and models of care provision also have a definite impact. Physician-led centers and ophthalmology groups are probably the most sustainable models of long-term care, however, professional ethics, lack of know-how, and business acumen are growth-limiting factors. Take the United Kingdom, where the majority of refractive surgery is in the hands of corporations that use tactics including mass advertising, bait and switch, as well as models of care provision by surgeons who perform an essentially technical role with an almost nonexistent doctor/patient relationship. Presently, this model is flourishing because of the relative forgiveness of laser refractive surgery. This might not be the case for lens-based procedures, which carry a higher risk and more problems. Therefore, commercial groups are at a higher risk long-term.

Lens-based procedures are on the rise, as illustrated in several articles. Con Moshegov, MD, provides a good rationale for this technique. In some countries, the impact of lens-based surgery—in terms of overall numbers—will be more significant than in others. Patient expectations are managed better, and technologies and outcomes are improving.

Unlike laser eye surgery, a better doctor/patient relationship is vital to lens-based surgical success, and there is no doubt that the higher quality and commensurately priced model of care is an emerging trend in ophthalmology-based practices. Demographics, culture, and surgeon preference will influence this tremendously, as will revenues. I believe that ophthalmologists with a proprietary interest in a surgical center and access to laser refractive surgery are more likely to successfully adopt lens-based technologies. The future does look very interesting, as there is no doubt that what the consumer wants will influence how ophthalmologists develop their future strategy. The future is bright, and ophthalmologists are urged to find ways of working closely together as well as equip themselves to compete in the world of business by learning the necessary tools. We hope you enjoy this mixed bag of articles, articulating a number of viewpoints and trends peppered with the usual pearls of wisdom.