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Cover Focus | Jul/Aug 2016

Pearls for Keeping LASIK Volume Up

Communication, both with patients and with an optometric network, is key.

After LASIK volumes had been down pretty much universally in clinics around the world for nearly a decade, the past several years have seen, according to Market Scope, a stabilization of the market. However, many surgeons and practices are still reporting a lull in their procedure rates. This is confusing for many long-time refractive surgeons because, frankly, the surgery is better than ever: It is far more accurate, safer, and able to address a wider range of refractive conditions than in the past.


• It is important for optometrists to know that solutions are available for just about any refractive situation, including myopia, hyperopia, astigmatism, and presbyopia.

• In order to combat the outdated information on LASIK available on the Internet, surgeons must provide patients with data that is accurate and up to date.

• Having an age-appropriate counselor, especially for patients seeking presbyopia treatment, can help patients to feel comfortable talking about their vision problems.

• One strategy to increase not only LASIK volume but overall surgical volume is to consider emphasizing the whole suite of refractive surgery options with a high-quality approach.

And yet there is a gap between this reality and the public’s perception of LASIK. There is still the feeling among the public that the risks of this surgery are greater than they actually are. Part of the problem is that people do not know the capabilities of modern LASIK. Patients still ask, “Can you treat astigmatism?” when of course we have been treating astigmatism for many years.

Given the overall state of the market, our full-service refractive and cataract surgery center in Toronto, Canada, continues to do well. Anyone who has been around long enough to remember the heyday of LASIK in the 1990s, as we have, will never be satisfied with the current market, but Crystal Clear Vision remains busy with a range of refractive and premium cataract surgery offerings.

What techniques can practices use to maintain or increase surgical volume in a difficult market? There are probably as many answers to that question as there are successful surgical practices. For us, the one overarching strategy that seems to work best is communication. This takes several forms, including communication with patients, but also, importantly, communication with a network of optometrists in our area. This article discusses some of the ways we keep the lines of communication open to let patients and our optometric colleagues know about the benefits of the range of services we offer.

Figure 1. A recent Facebook posting by a patient who underwent LASIK at Crystal Clear Vision.


Perhaps the most important element in our continued success is the maintenance of our optometric network. This was a common practice in the early days of refractive surgery that has fallen out of favor with many practices. Refractive surgeons used to spend a lot of time with optometrists, educating them and engaging them. As the years went on, many drifted away from this practice. But if we do not educate optometrists about the procedures we offer, they are unlikely to bring these options up with their patients. Similarly, when patients come to the optometrists in our network with information on a new technology they have learned about on the Internet or through social media, these practitioners will be less well prepared to discuss the pros and cons—and less prone to recommend referral to a surgeon who offers the procedure.

To ensure that our community optometrists are well educated, therefore, we make a concerted effort to keep in touch and to keep them up to speed so they can broach these topics with their patients and feel comfortable discussing them. We have dinners with our local optometrists to maintain our relationships, and we hold informational and educational sessions to let them know the services we offer and the technologies we have available. By making sure our optometric network is educated about the latest refractive surgical options, we know they can then pass these messages on to their patients and educate them in turn.

It is important to let our colleagues know where refractive surgery is today and how safe it is. In our meetings with them, we explain what each procedure in our toolbox can do and how we do it. If all they know is LASIK, and they are not familiar with newer developments such as femtosecond lasers, wavefront aberration measurement, transepithelial PRK, phakic IOLs, corneal inlays, presbyopia-correcting IOLs, and all the other tools we now have available, we make sure to fill in the gaps.

It is important for optometrists to know, for example, that we now have solutions for just about any refractive situation, including myopia, hyperopia, astigmatism, and presbyopia. In the early days, when all we had to offer was LASIK and PRK, probably 25% to 30% of patients simply were not candidates for refractive surgery. Now it is rare that we do not have at least one procedure that is appropriate for a patient. If optometrists are still relying on old information, they may not be aware of this.

With the aging of the population, it is especially important to convey that we now have solutions for presbyopia. We make sure our colleagues understand that both of us are presbyopic, we each have had Kamra inlays (AcuFocus) implanted, and neither of us uses reading glasses. This personal note helps to convey the fact that we have options to offer for this population. In addition to the Kamra, the practice offers multifocal IOLs for refractive lens exchange or cataract surgery, as well as monovision LASIK and other options.


The other equally vital side of the communication issue is making sure that patients are well informed. There is a lot of old and inaccurate information available to all on the Internet. When patients search for LASIK in their browser, they may see outdated information, or, even worse, some decades-old complaint about a poor result from a procedure long abandoned and take this to be the state of the art. We need to combat this by providing data that is accurate and up to date.

For the current LASIK demographic—members of generation X and the millennials—obviously social media are a prime means of communication. We take advantage of these channels as much as possible. We have started taking photos of patients as they come off the LASIK bed and posting them on our practice’s Facebook page (Figure 1). Then patients can share them, and they are seen and liked by that person’s whole network of friends. As a result, now when we post practice news items or new videos on Facebook, they may get 1,000 views, instead of the handful they would have gotten before we started this practice. It has really boosted our traffic on the page dramatically in recent months.

When we underwent our own Kamra surgeries, we posted pictures and videos, and one of us (SB) wrote a blog about the experience. All of these things have helped to boost our social media presence.

We are also conscious that many patients rate or review their experiences on sites such as Yelp, and that this is an important part of how prospective patients make decisions today. We try to be proactive in making sure patients have positive things to say about us. We are always gratified when patients check in on Facebook or other media when they come to Crystal Clear Vision.

For the practice website, we use search engine optimization to try to be among the top results in Google searches for LASIK and other refractive surgery terms. Even if a prospective patient is searching for another practice, as long as we have a high rating for the key search words, we can appear in the search results. This is tremendously important for visibility of the practice.

In addition to LASIK, we also promote our presbyopia offerings. Many of our LASIK patients have aged into the presbyopic range (and yes, baby boomers use social media too), so it is vital to let them know we have good solutions for them, from monovision LASIK, to the Kamra inlay, to early cataract surgery or refractive lens exchange with a multifocal or extended depth of focus IOL. We want patients to understand that we offer a full range of refractive surgical options.

We no longer use print and TV advertising, or if we do it is a fraction of what we did in the past. Newspaper circulation has fallen dramatically, and many people now use digital video recorders and skip over the ads, so these media do not reach potential patients as they used to. Social media are now the way to go.


One strategy that we think has been successful is our use of age-appropriate patient counselors, especially for older patients who are interested in presbyopia surgery.

Nobody who is 50 years old wants to talk to a 25-year-old about his or her problems with reading vision. Both of us know what it was like when we hit a certain age and suddenly could not read without correction—it made us feel old. Patients who are going through that process want to talk to someone who understands what they are experiencing.

We now have six people in our practice who have had Kamra surgery, including both of us. The six of us who have experienced the procedure can talk to patients about what surgery is like, what recovery is like, and what the effect on our reading vision has been. This helps patients to make the decision about whether surgery is right for them.

The converse does not seem to be true. Overwhelmingly, 25-year-olds are comfortable talking to a 50-year-old with regard to the choices we have available. A lot of our staff members have been with us 15 years or more, and many of them have had LASIK or PRK over the years. Our receptionist, who is in her 20s, had PRK several months ago. So we have people at different stages of life who have had pretty much every procedure we offer, and they can share their own experiences.

Of course, this is a form of marketing in itself. If patients walk in and see the receptionist—or the surgeon, for that matter—wearing glasses, what are they to think?


Overall, our message for prospective patients is that refractive surgery is not just LASIK. It is not one procedure done only one way. It is actually a group or a family of procedures, whether we are using a femtosecond laser to create the flap or a microkeratome blade, whether we are doing a standard or a wavefront-optimized ablation, or whether we are using corneal inlays or performing an intraocular procedure. And our practice offers the full range of those surgeries, addressing virtually any refractive problem a patient may have.

For a long time, low-cost LASIK centers have promoted only LASIK, and the public came to treat LASIK as a commodity. This cost-cutting, bottom-line approach also reduced the trust factor. The public did not understand that refractive surgery can be done with different technologies in different ways, and that there are different costs involved. Our message has been to emphasize the whole suite of refractive surgery options with a high-quality approach, and we believe that that is why we have been successful and why we are where we are today.

Sondra Black, OD
• Director of Clinical Operations, Crystal Clear Vision, Toronto, Canada
• Financial disclosure: Consultant (Abbott Medical Optics, AcuFocus, Valeant)

Jeffery J. Machat, MD
• Chief Medical Officer, Crystal Clear Vision, Toronto, Canada, and NVision Eye Centers, United States
• Financial disclosure: Consultant (AcuFocus, Allergan, Abbott Medical Optics, Bausch + Lomb, ClerioVision, Ziemer, Schwind eye-tech-solutions)