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Cover Focus | Nov/Dec 2016

LASIK Volume Through the Years

By 2009, the worldwide economic downturn, often called The Great Recession, had done what many consider permanent damage to the LASIK market. In an exclusive interview with CRST Europe, James V. Mazzo, then chairman and CEO of Advanced Medical Optics (now Abbott), shared his thoughts on the decrease in LASIK volume. “There are three principal reasons people choose not to have LASIK. In order of importance, they are (1) fear, (2) awareness—not awareness of the existence of LASIK, but awareness that they are a candidate—and (3) cost. In the current crisis, I am sure that cost has risen in priority in that list, and it could currently be the No. 1 reason, but fear and awareness are still significant factors in people’s decisions.”1

Mr. Mazzo further stated: “It is thought that we have treated only approximately 2% to 3% of the eligible patients in the United States with refractive surgery. Why is that? It is because we have not been able to clearly communicate to resolve patients’ fear and awareness issues. Fear can be resolved. Your patient should know he is in the hands of the right physician; that is message No. 1. … In individual practices and in the industry in general, we must get better at educating the consumer on why this may be the right medium for him.”

The year 2010 was deemed “The European Year of LASIK” by the European Society of Cataract and Refractive Surgeons (ESCRS), and, in our July/August issue, CRST Europe featured an update on LASIK volume around the world with reports from nine surgeons.2 To combat the decline in LASIK volume, Karl G. Stonecipher, MD, said, his practice began gearing advertising toward millennials. “More of these patients are coming through the door,” he wrote, “but not enough to offset the decline of the aging population.”

At 400 to 500 procedures per month, John S.M. Chang, MD, said that his LASIK volume had taken a 10% hit. After a 30% plunge in LASIK cases in the 3 previous years, Francesc Duch, MD, said that his center had entered a plateau phase with a slow trend toward recovery. After a 23% decline the previous year, Michael A. Lawless, MBBS, FRANZCO, FRCOphth, anticipated another decline of about 12% for the following year. He said, however, that “the general decline in LASIK is easing, and individual premium providers offering a full range of refractive options tend to be affected less than those offering only LASIK.”

Echoing Dr. Lawless’ observation, Arthur B. Cummings, MB ChB, FCS(SA), MMed(Ophth), FRCS(Edin), said that his LASIK numbers had been stable since an initial dive 18 months before, and mostly older patients less affected by the credit crunch were now undergoing LASIK. Furthermore, Eric D. Donnenfeld, MD; Kjell U. Sandvig, MD, PhD; and Ronald R. Krueger, MD, all said that their practices had seen an increase in LASIK volume of about 10% with a return of younger patients with lower levels of refractive error in Dr. Donnenfeld’s practice, about 10% in Dr. Sandvig’s practice, and about 21% in Dr. Krueger’s practice.

In a 2014 article, Stephen Coleman, MD, tried to answer the question: What drives LASIK volume?3 “Naturally everyone has their own suggestions on how to increase business,” he wrote. “My feeling has always been that the key to maintaining or increasing LASIK volume is low enhancement rates. Give me a laser that results in the fewest enhancements, and I will show you a successful practice in which technology can truly be the foundation of ambitious marketing objectives.”

In April 2015, Sheraz M. Daya, MD, FACP, FACS, FRCS(Ed), FRCOphth, postulated that price wars and discounts on LASIK provided the public with a confusing message: that the procedure is not serious and is easily available at bargain-basement rates. Unfortunately, even though nearly 100% of eyes achieve 20/20 visual acuity, LASIK volume continued to taper almost worldwide, he said.4

CRST Europe took a closer look into LASIK volume in the cover focus of the 2016 July/August issue. Although the content from this cover focus is extremely recent, it is still beneficial to review. Perhaps the biggest take-home message in that issue came from Dr. Donnenfeld, who stated that LASIK is the safest, most successful, and most widely studied elective procedure in the world, with the highest patient satisfaction rate of any elective procedure. He credited the erosion of LASIK’s reputation to several myths that are still in circulation today: (1) that physicians would never have LASIK on their own eyes, (2) that contact lenses are safer than LASIK, (3) that LASIK significantly increases the risk of halos and glare, (4) that dry eye is extremely common after LASIK, (5) that the safety of LASIK has not improved, and (6) that complications are commonplace.

“To all the leaders of ophthalmology … our responsibilities must be to educate patients; to continue to improve patient satisfaction, with 100% of patients seeing the same or better than they did preoperatively; and, most important, to embrace patients who are dissatisfied with their vision following LASIK and never allow them to feel abandoned,” Dr. Donnenfeld wrote.5

Whatever the cause, it has been clear to many surgeons that actions must be taken to revive the market. In his editorial in April of this year, Dr. Cummings challenged CRST Europe readers to put eight points into practice: (1) Share current statistics with everyone who comes through your clinic doors; (2) educate your nonrefractive colleagues; (3) make contact with optometrists; (4) take the opportunity to speak about LASIK at a general ophthalmology meeting in your country; (5) if you offer new procedures, do so with grace and aplomb; (6) fight any attempts to commoditize LASIK; (7) make attempts to remove fear of the procedure; and (8) encourage industry to play its part.6

1. Will LASIK boom again? http://crstodayeurope.com/articles/2009-mar/0309_03-php/. Accessed November 14, 2016.

2. Chang JSM, Cummings AB, Dick HB, et al. LASIK volume around the globe. http://crstodayeurope.com/articles/2010-jul/lasik-volume-around-the-globe/. Accessed November 14, 2016.

3. Coleman C. What determines the success of a LASIK practice? http://crstodayeurope.com/articles/2014-apr/what-determines-the-success-of-a-lasik-practice/?single=true. Accessed November 15, 2016.

4. Daya SM. Whatever happened to LASIK volumes? http://crstodayeurope.com/articles/2015-apr/whatever-happened-to-lasik-volumes/. Accessed November 15, 2016.

5. Donnenfeld ED. Debunked: LASIK myths and misconceptions. http://crstodayeurope.com/articles/2016-julaug/debunked-lasik-myths-and-misconceptions/?single=true. Accessed November 16, 2016.

6. Cummings AB. LASIK: The uncrowned king. http://crstodayeurope.com/articles/2016-apr/chief-medical-editors-page-14/?toc=true. Accessed November 16, 2016.

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