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Cover Focus | Sep 2016

The Pros and Cons Pros of Early Adoption

Follow your instincts, but do your due diligence when making value decisions.

In 2004, the acquisition of a femtosecond laser was one of our biggest decisions. At that time, the IntraLase femtosecond laser (then IntraLase, now Abbott Medical Optics) cost US$450,000 and the technology was just being introduced into Europe. A second platform, the Femtec femtosecond laser (then 20/10 Perfect Vision, now marketed as Victus; Technolas Perfect Vision, a Bausch + Lomb company), had not yet received the CE Mark, although the company was close.

At a Glance

• When deciding to purchase a new technology, follow your instinct, and never be concerned about naysayers.

• Go see the technology in action.

• If the technology is safer for patients than what you previously used, it will succeed.

• Price increases can generate increased revenue and profitability.

I had been interested in femtosecond laser technology for many years, and, at each conference, I would visit both the 20/10 Perfect Vision and IntraLase booths to see what the lasers were capable of. In 2002, I had seen that the lasers were proficient at creating great flaps—albeit slowly—and I felt that this technology was the future. At that time, however, IntraLase was only focused on delivery to the US market and was not pursuing distribution in Europe or other markets. That changed in 2004 with the introduction of the company’s 15-kHz laser.

Several events conspired to make me consider purchase of an IntraLase laser at that time. First, sterilization laws in the United Kingdom were changing, and we were being compelled to have four procedure rooms to meet the standards for sterilization even for LASIK. This was not going to be easy to achieve in our existing facility. Also, in 1 week, I had experienced two flap complications (a buttonhole and a microkeratome jam) with two different Hansatome (Bausch + Lomb) keratomes. On average, I used to get about one problem per year (1:1,000); two in 1 week seemed like more than just bad luck. As a high-end provider, I felt this level of unreliability was unacceptable for the trusting patients who came to us expecting us to deliver good quality, safe results.


As the only alternative to a mechanical microkeratome at that time was the IntraLase, my wife Marcela, also an ophthalmologist, and I decided we should think seriously about purchasing one. The price tag was a problem, but our gut feeling was that this was the way to go. We would obviously have to increase our fees, and we would need to figure out a pricing strategy that would work.

We did the usual due diligence—contacting users who had experience with IntraLase—and we were impressed with their enthusiasm for the laser. There were, however, many naysayers who, in their capacity as key opinion leaders, were uncharacteristically vocal in terms of opposition to this technology. These included my own fellowship mentor, who spoke at conferences about why he was not an IntraLase user.


We weighed the positive and negative feedback we had heard from our colleagues and peers and decided to place an order. In the meantime, we went on holiday to Puerto Rico, where we had an opportunity to see our friend, Miguel Santiago-Garcia, MD, use the device on 56 eyes in 1 day. The procedures were highly reproducible, and there was no reduction in volume in his practice. Based on what we saw at his facility, we felt there was no question that, in terms of patient safety, we had made the right decision. As far as the economics, that would be something we would have to deal with.


We calculated that the incremental price for use of the IntraLase technology should be £400 per eye. This represented a 26% price increase over our fee for LASIK with a mechanical microkeratome. We continued to offer surgery with a microkeratome at a lower price, but no one wanted this option. Three months later, after a patient informed us that we were daft to offer a substandard procedure, we put all our microkeratomes away. What that patient said resonated with our values, and it is something I have never forgotten. There are many truths in his statement:

“Doctor, I come to you in trust,” he said. “I own a Ferrari, and I take the car to the dealership for service. I am never presented with options based on price. It is an expensive car, and it needs whatever is necessary to ensure that it runs well. Do you think I would take more chances with my eyes than my car? I trust you to do the best for my eyes, and it worries me that you are offering something that is not as safe. Don’t do that; just provide what you think is the best for your patients no matter what it costs.”


So what happened? Well, being the first practice in the United Kingdom and among the first in Europe to adopt femtosecond laser technology helped us in terms of attention and was a no-brainer in terms of public relations.

After we incorporated femtosecond laser technonlogy, our LASIK volume increased by 15%, and our revenue increased by 35%, with an increase in profit of 25%. We recovered the cost of the laser quickly, and cash flow, which was initially a major worry, was not a problem.

Since then, as we all know, femtosecond laser flaps have become the gold standard for LASIK. n

Sheraz M. Daya, MD, FACP, FACS, FRCS(Ed), FRCOphth
• Director and Consultant Surgeon, Centre for Sight, East Grinstead, United Kingdom
• Chief Medical Editor, CRST Europe
• Financial disclosure: Consultant (Bausch + Lomb Technolas)