While most companies are staking their claim as fierce competitors in either the femtosecond or mechanical microkeratome market, one company has a different approach to flap creation strategies: Two technologies are better than one. Ziemer Group AG (Port, Switzerland) has positioned itself uniquely in the market, offering the femtosecond laser and mechanical microkeratome to their customers as complementary rather than competitive technologies.
In April, Ziemer Group AG announced that it would take over worldwide marketing, sales, and support activities for the Amadeus II mechanical microkeratome, a product manufactured by SIS Surgical Instrument Systems, Ltd. (a Ziemer Group AG company) but distributed by Advanced Medical Optics, Inc. (AMO; Santa Ana, California). This agreement had existed since 1999, the original launch of the Amadeus. After AMO's acquisition of IntraLase (formerly IntraLase Corp., Irvine, California), however, the company indicated that it would instead focus its flap creation strategies solely on the femtosecond laser. One month after the announcement, Ziemer Group AG revived its distribution of the Amadeus microkeratome.
This arrangement afforded Ziemer an exclusive position in the refractive marketplace, as it is currently the only company to offer both a mechanical microkeratome and femtosecond laser. The company's marketing strategy is to show that both technologies are needed in today's refractive practices. It is suggesting that the femtosecond laser can be used in the majority of LASIK surgeries and the mechanical microkeratome used as a fallback alternative for those patients who are not LASIK candidates.
"We are selling the Amadeus II automated microkeratome and the Femto LDV because that means we can cater to the entire refractive market instead of limiting ourselves to just one technology at this stage," Anton C. Wirthlin, PhD, told Cataract & Refractive Surgery Today Europe in a telephone interview. Mr. Wirthlin is the Vice President of Marketing and Communications at Ziemer Ophthalmic Systems AG. "With the breadth of both product offerings, we are in a comfortable position, because we do not have to critically depend on how rapidly the market may be changing."
CONTINUED SUPPORT
In addition to supporting customer needs for the existing Amadeus II microkeratome, Ziemer has also recently added capabilities including the Epi-LASIK and lamellar keratoplasty kits. The goal, Mr. Wirthlin explained, is to continue to support and develop new accessories for the Amadeus microkeratome while encouraging use of the new Femto LDV.
Ziemer Group AG is more than aware that use of the femtosecond laser during LASIK and other refractive procedures is growing, and the company is continuing to further develop the Femto LDV to meet the current market demand. The company has sold approximately 50 units worldwide, and the sales are rising sharply, Mr. Wirthlin said.
Although the microkeratome business is generally sluggish—as Ziemer saw during the first 6 months of sales with the Amadeus II—the market is picking up again, and sales have returned to their previous level. "The microkeratome business has been slow, because those surgeons in the market for equipment are typically considering the femtosecond option at this time," he said. "Nevertheless, Amadeus sale volume is back up to previous levels, and it continues to be a quiet attractive option."
Many surgeons have already transitioned to the femtosecond laser, however, most still have a mechanical microkeratome on hand. For those who are contemplating the purchase of a femtosecond laser, patient volume, cost structure, and personal preference are among the deciding factors. Ziemer has a relaxed approach to help customers decide what technology is right for them.
"When an undecided customer is talking to us, he gets the comfortable feeling that we are not trying to push him in either direction," Mr. Wirthlin said. "We do not overstate the benefits of the microkeratome just because we do not have anything else to sell, and we do not try to talk a customer into a Femto LDV if that is not the right solution for him."
DEEPER CUTS IN THE CORNEA
Current clinical results with the Femto LDV are promising, and surgeons are creating deeper cuts in the cornea to use with corneal inlays as well as corneal rings. "These development projects will result in deliverable products on a fairly short time scale," Mr. Wirthlin said. In the distant future, he continued, the femtosecond laser will likely be used for new surgical applications beyond refractive surgery.
"I do not think I can say that the microkeratome will always have its place in the market, but I would say that the Amadeus and other microkeratomes will not disappear for quite some time," he said. "Sales of new units may ultimately decline, but there is also a large installed base of microkeratomes that will continue to be used for many years to come. That remains a viable business that Ziemer is certainly not going to neglect."
The consumables and service business for the Amadeus, Mr. Wirthlin continued, is profitable. The company's customers are receiving a more direct support network straight from the manufacturer, which has translated into faster service and higher satisfaction. That satisfaction, the company hopes, will translate into its customers wishing to buy the Femto LDV.
"Considering that we are a small newcomer [to the femtosecond market] taking on a well-established market leader, some people wonder how we sell any units at all. The reason is that the systems installed are delivering spectacular results, and that is spreading by word of mouth," Mr. Wirthlin said, adding that surgeons have reported a high cut quality with the latest model. The flap creation process is fast and easy, and the system itself is small, robust, and easy to maintain.
"It is being adopted enthusiastically by this group of customers for whom it is really the alternative," he continued. "If sales of the Amadeus eventually decline, our growth in the femtosecond market will more than compensate. If the shift toward femtosecond slows down—which is not what we predict to happen—we can respond to a more conservative market by offering a product that is proven and a popular platform for LASIK, surface ablation, and lamellar keratoplasty."
Ziemer Group AG is using the term z-LASIK to refer to the integrated and optimized femtosecond procedure. It may be used with any wavefront- or topography-guided excimer laser procedure. "With z-LASIK and the Amadeus, you might say we cover the refractive market from A to Z," Mr. Wirthlin said.
Anton C. Wirthlin, PhD, is Vice President, Marketing & Communications at Ziemer Ophthalmic Systems AG (a Ziemer Group Company). Dr. Wirthlin states that he is salaried by and owner or shareholder in Ziemer Group AG. He may be reached at +41 32 332 7052; anton.wirthlin@ziemergroup.com.
