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Up Front | Apr 2016

LASIK: The Uncrowned King

Arthur B. Cummings, MB ChB, FCS(SA), MMed(Ophth), FRCS(Edin)

For the past 14 years, I have attended the American-European Congress of Ophthalmic Surgery (AECOS) meetings, both in Europe—since the first meeting here 5 years ago—and in the United States. Among the reasons that I love the format of these symposia are the quality of the presentations and the group discussions on a range of topics that are totally relevant to my practice. Kerry D. Solomon, MD, gave an excellent talk on LASIK at the most recent AECOS meeting in Aspen, Colorado (where I am pleased to say that at least eight prominent European ophthalmologists were present). During his talk, Kerry asked the audience: What is preventing more of our peers from adopting LASIK, and why is there confusion in the marketplace?

Kerry, alongside Eric D. Donnenfeld, MD, and others, also recently addressed the FDA panel regarding LASIK. During their testimony, they explained that LASIK is the most studied elective procedure on the planet, with more than 1,000 articles in peer-reviewed literature and thousands, if not tens of thousands, of presentations at international meetings over the past 25 years.

why the FLAT MARKET?

Recent studies have shown improved night vision and contrast sensitivity and high patient satisfaction after LASIK. There is no procedure in all of medicine, let alone in ophthalmology, that enjoys the same ratings with regard to patient satisfaction and word-of-mouth recommendations to friends and family members.

High satisfaction rates also extend to ophthalmologists who have undergone LASIK. According to Kezirian et al, refractive surgeons have had LASIK four times more than the general population, and the majority (97%) believe they are better off for having had corneal laser refractive surgery.1 It is unprecedented that a group of professionals has had a procedure that they offer at a rate much higher than their patients.

With a procedure that is already so effective, how much better and safer can we make LASIK? Industry is spending time and money on the development of new laser treatments, such as Contoura Vision (Alcon) and small incision lenticule extraction (SMILE; Carl Zeiss Meditec), and on new excimer lasers coming to the fore. But, today, any improvements that are made are likely in the 1% incremental range.

So, in the wake of such positivity, why is the LASIK market flat? The global economic crisis over the past several years has played its part, affecting ophthalmology in general and those of us practicing refractive surgery specifically. There is also the commoditization of LASIK. Furthermore, advertising methods not traditionally applied to medical procedures, coupled with less-than-positive reviews, has led to a cynicism in many quarters.

COLLECTIVE RESOLVE

Incorporating these eight points into practice may help surgeons collectively revive the LASIK market.

No. 1: Share current statistics with everyone who comes through your clinic doors. Tell patients about the high satisfaction rate, and convey the facts that LASIK is the most studied procedure on earth and that refractive surgeons have it more than anyone else. Display these messages on the screens around your clinic, in your clinic newsletters, at the foot end of your emails to patients, and just about anywhere patients and their relatives are going to see it.

No. 2: Educate your non-refractive colleagues. Find at least one non-refractive ophthalmologist colleague each week for the next month and bring him or her up to date with just how good LASIK is. Let him or her know that the procedure provides the best vision possible and has a lower risk of serious side effects than contact lenses. That is four colleagues that each of us has the opportunity to educate in 1 month. (I find that, in Ireland, more than half of my colleagues have no idea about how good LASIK is or about the amazing results that we can achieve now with refractive surgery. Many patients have told me that their ophthalmologists have said, “I would not do it if I were you.”)

No. 3: Make contact with optometrists. Forward-thinking optometrists refer patients for refractive surgery when their patients request it or when patients are having problems with contact lenses or spectacles. (Optometrists are not the enemy. They work alongside ophthalmologists and others to provide our patients with the best care possible. Ignorance is the enemy.)

No. 4: Take the opportunity to speak about LASIK at a general ophthalmology meeting in your
country. This is a good way to further spread
the word to colleagues.

No. 5: If you offer new procedures such as Contoura Vision, SMILE, and trans-PRK, do so with grace and aplomb. Each procedure we offer, from routine PRK to advanced ablation profiles, has its place, and one is not better than the other. If you offer them all, provide the procedure that suits the patient best. Do not build your individual practice by killing the rest of the refractive market through bad-mouthing of LASIK or PRK and promoting only whatever you offer. (This is a case of a rising tide lifting all boats. You cannot lift your boat if all others are sinking. Let us work together to rebuild the LASIK market—and, better yet, the refractive surgery market.)

No. 6: Fight any attempts to commoditize LASIK. Due to very aggressive marketing tactics, the perceived value of LASIK has taken a knock. (This is one of the main reasons why the market is flat today.)

No. 7: Make attempts to remove fear of the procedure. Discuss the risks of LASIK in relative terms, for example compared with contact lens wear. Emphasize parts of the procedure that ease patient anxiety, using words such as noncutting and uses air-bubbles to create the flap.

No. 8: Encourage industry to play its part. When industry informs the end-user of how good its technology is, it can only help the market grow. (At the 2016 AECOS meeting in Aspen, four CEOs of the largest ophthalmic corporations participated in a panel discussion. They stated that they saw a LASIK era of working together and direct-to-consumer marketing ahead.)

RISE TO THE CHALLENGE

Is there anything that you and I can do to revive the LASIK market? I challenge you to put as many of the points I share in this editorial (see Collective Resolve on the following page) into practice in the coming weeks and months.

Thanks to incredible technology and 25 years of experience, LASIK has evolved into the most successful elective procedure in the history of medicine. Today, we know which patients are good candidates and which are not, and we have alternative procedures available so that no patient undergoes a surgery that he or she is not ideally suited for. If we cannot get this right collectively, how will we be remembered by future generations of ophthalmologists and patients?

We are skilled professionals, and LASIK has basically been perfected in our hands. Yet we may be blowing the opportunity to help more patients lead better quality lives with better quality vision. This is not the way that I want to be remembered, and I am sure that many of you feel the same.

I believe that, if only a small percentage of us put the points I mention into practice, we should see a difference in LASIK volume. I urge you to rise to the challenge, and let us see what we can do together.

— Arthur B. Cummings, MB ChB,
FCS(SA), MMed(Ophth), FRCS(Edin)

Associate Chief Medical Editor

1. Kezirian GM, Parkhurst GD, Brinton JP, et al. Prevalence of laser vision correction in ophthalmologists who perform refractive surgery. J Cataract Refract Surg. 2015;41:1826-1832.

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