In 2006, I was a senior surgeon and head of the glaucoma and anterior segment division in the University Clinic Hamburg, under the management of Gisbert Richard, MD. We were aware of the popularity of refractive surgery and the emergence of techniques including corneal laser surgery and refractive lens surgery. As a tertiary health care center serving mainly the state health insurance service, however, we could not afford the learning curve and cost of excimer and femtosecond laser platforms, nor did we have access to the marketing and standards of service common to refractive surgery centers.

In an attempt to take part in the growing refractive surgery market, we looked for a cooperative partner to help us become established in the field. We came upon Care Vision, which at that time was a newly emerging player in the German refractive surgery market—a market in which refractive surgery was performed mainly outside the academic environment. The few university hospitals that did have an excimer laser platform lacked the marketing and service standards of the independent local ophthalmologists and refractive surgery groups such as Optical Express that offered laser vision correction, and therefore they achieved only a small surgical volume and experience in this market.

Our clinic chose not to establish an independent refractive surgery unit, but rather to cooperate with Care Vision. This cooperation offered important advantages:

• No. 1: Vast experience in refractive surgery with more than 600,000 surgeries performed to date;
• No. 2: A Europe-wide network of more than 60 centers and hundreds of professionals;
• No. 3: Strict standardization of procedures and well-implemented quality management systems;
• No. 4: A training platform with hands-on experience and quality control;
• No. 5: Clearly defined borders between refractive surgery patients and university clinic patients, allowing us to avoid conflicts of interest;
• No. 6: Part-time, flexible work schedules, allowing our ophthalmologists to learn refractive surgery without neglecting our main specialties; and
• No. 7: Scientific research-oriented experts who take important roles in our university clinical research.

The professional clinic management provided by Care Vision has encouraged several experienced ophthalmic surgeons who had no previous refractive surgery experience to step in and join the Care Vision team. Since joining in 2006, Professor Richard and I have served on the advisory board to promote cooperation in the scientific aspects of our work.

After our first 2 years of successful cooperation, we extended our mutual commitment to the organization, and now, more than a decade later, the relationship is fruitful. Our clinic director, Martin Spitzer, MD, is our main point of contact with the central organization.

INTERNATIONAL SUPPORT AND TRAINING

As an international network, Care Vision is managed independently from its headquarters in Frankfurt and Madrid (the home of the parent organization, Grupo Baviera). Our university clinic benefits not only from the clinical work done at the Care Vision center in Hamburg but also from the research and development contributions of the entire network. For example, our researchers have access to the largest refractive surgery data bank in Europe.

Another means of support that we enjoy from Care Vision is that the business and marketing decisions for our refractive surgery center are not handled by the university clinic. I see this as an advantage, as each partner can focus on what he or she does best.

The training provided by Care Vision is much more extensive and shorter compared with the basic ophthalmology training we receive in medical school and residencies. With a local high-volume surgery center at our clinic and with support from experienced refractive surgeons on site, a seasoned anterior segment surgeon like me needs only several weeks to learn the refractive surgery techniques we offer and to understand the requirements for perisurgical evaluation and care.

MODEL OF CARE

The model of care in Care Vision is based on professional marketing and word-of-mouth recommendations. Our extensive pre- and postoperative care is all included in the treatment package, including touch-up surgery if needed. Most Care Vision refractive surgery centers are also affiliated with satellite centers in neighboring smaller cities, where clinicians can provide pre- and postoperative services.

The main refractive surgical procedures offered by Care Vision are microkeratome-assisted wavefront-optimized LASIK and clear lens exchange with trifocal IOLs. Other refractive surgery techniques, such as LASIK with femtosecond laser flap creation, intrastromal corneal inlays, laser-assisted cataract surgery (LACS), and small-incision lenticule extraction have been evaluated by Care Vision, and they are deliberately not offered because they did not demonstrate an evidence-based medical superiority over the procedures we offer. Our clinic does not have the resources for LACS and femtosecond corneal surgery, and we adhere to the noncompeting cooperation requirement of Care Vision.

GET ON BOARD

Every practicing ophthalmologist will in some way be acquainted with refractive surgery patients. Either interested patients will seek your advice, or post–refractive surgery patients will come to you with rarely occurring complications, or, more often, patients will need cataract surgery after a previous LASIK. My advice to any ophthalmologist who wants to stay current is to try to learn this developing field in ophthalmology with hands-on training. How you do so is up to you, but pairing with corporate ophthalmology, for me, has opened the door to: (1) thorough training in refractive surgery; (2) a well-known, high-volume, quality-oriented international network of colleagues; and (3) the ability to participate without giving up my main area of expertise and without investing huge amounts of money.