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Cover Focus | June 2021

Is Postquarantine Refractive Surgery Volume Still High(er)?

Wearing masks continues to influence patients’ choices about their eye care.

Riding the ‘COVID High’

Kendall E. Donaldson, MD

COVID-19 has been devastating globally, affecting so many aspects of professional and personal lives. The financial impact on many industries has been dramatic, and changes in the ways in which people interact with each other and how people view the world are pervasive and long-lasting. This pandemic has caused most people to examine what they value most in their lives. Many have responded by investing in their homes, their families, and themselves. Various forms of self-improvement have been considered and pursued.

Television commercials provide a window into how society’s priorities have changed. It seems to me that more than half of commercials are currently for bed sheets; mattresses; towels; chairs for the home office; vitamins; and youth-enhancing medications, creams, and cosmetic procedures. A patient of mine recently shared with me a photograph from her 70th birthday party. A group of ladies in their 70s were pictured, and I commented on their youthful appearances. She laughed and told me they all got facelifts during the pandemic after canceling their travel plans.

A SURGE IN VOLUME

In ophthalmology, a similar impulse has increased the volume of corneal refractive surgery and premium lens upgrades with cataract surgery. According to Market Scope and other sources, national surgical volume was low in March and April 2020, but numbers rose quickly during the following 3 months to above-average volumes.1,2 In my practice, overall volume is approximately 110% to 120% at present compared with the same time in previous years. We have been offering a post-COVID discount program for LASIK that has helped us to maintain high volumes for corneal refractive surgery. I also find that more patients are electing premium lens upgrades. They seem to value freedom from glasses more since experiencing life with face masks. Further, when I explain that potential side effects of a multifocal lens include glare and halos, most patients provide a response similar to this: “I rarely drive at night anymore because there is nowhere to go since COVID-19.” These visual phenomena are therefore not a major deterrent at the present time.

I cannot overstate the influence that wearing masks is exerting on my patients’ choices about their eye care. I consistently hear them complain about foggy spectacle lenses, difficulty breathing, dry eyes, blepharitis, chalazion, and dermatologic symptoms. Patients sitting in my exam chair often have fogged, dirty glasses perched awkwardly on the ledge of their crooked masks. Many of my patients who wear contact lenses have reevaluated the potential risks of touching their eyes and face. Others no longer wish to bother putting in their contact lenses to work at home—a sort of extension of their exchanging button-down shirts, ties, and dresses for more casual attire. Many of my patients are also noticing an increase in dry eye symptoms associated with long hours of screen usage and mask wear. These experiences and observations are driving increased interest in corneal refractive surgery and premium IOLs.

As my patients receive their COVID-19 vaccinations, they are becoming more comfortable with venturing outside their homes, including to the clinic. Many patients whose last visit was in 2019 have returned in the past 3 months. A lot of them present with cataracts that have matured during their absence from medical care, medical conditions that have become more severe, and consequences from less rigorous adherence to prescribed medical therapy. This recent influx of patients has boosted the pool of potential candidates for corneal refractive surgery and premium IOLs.

CONCLUSION

During this COVID high, as I call it, special discounts and word-of-mouth referrals are helping to maintain and grow surgical volume for the long term at my practice. Telehealth is a wonderful tool for educating and screening patients who are interested in refractive surgery. It increases office efficiency by educating patients in advance of their clinic visits and helps us to limit clinic volume so that we can maintain adequate physical distancing.

COVID-19 has been devastating, but it has also offered lessons that can be used to change lives and strengthen medical practices as we move forward.

1. Refractive Surgery Council reports nearly 30% rise in laser vision correction procedures year over year. Refractive Surgery Council. April 30, 2021. Accessed May 10, 2021. https://eyewire.news/articles/refractive-surgery-council-reports-nearly-30-rise-in-laser-vision-correction-procedures-year-over-year

2. Shruti Aggarwal, Jain P, Jain A. COVID-19 and cataract surgery backlog in Medicare beneficiaries. J Cataract Refract Surg. doi:10.1097/j.jcrs.0000000000000337


Patient Confidence Is Booming

By Barbara Leyssens, MD

The following question was posted to an online forum for physicians: “Who knows what to use for fogging glasses with face masks? It makes our daily work impossible.” I saw answers listing all kinds of spectacle sprays. My response was: refractive surgery.

The COVID-19 pandemic has brought awareness of vision correction to many people. Patients wearing a face mask and foggy glasses regularly sit in my chair and tell me that they would like to be free of the inconvenience as soon as possible. The pandemic is also increasing people’s awareness of their appearance. Many people who work from home these days have traded their contact lenses for the ease of their spectacles much as they traded business clothes for casual wear. Thanks to virtual meetings conducted on Zoom, Microsoft Teams, and similar platforms, we have never looked at ourselves as much as we do now.

Limitations on travel and social activities have also left a lot of people with more discretionary income and a desire to spend it on self-care products and services. The time investment is also easier because most people are involved in fewer activities and the time for recovery is not interrupted.

A life free from spectacle and contact lenses can be transformative.

PROCEDURAL GROWTH

With all of this in mind, it is not surprising that the number of people interested in elective refractive surgery has risen in our private clinic. Growth in the volume of refractive surgery from 2019 to 2020 has been enormous (Figure 1). Procedural volume increased by 30% for refractive lens exchange, 41% for laser vision correction (LASEK, transepithelial PRK, femtosecond LASIK, SMILE), and 58% for the implantation of a phakic IOL (EVO ICL, STAAR Surgical). Procedural growth was observed among patients of all ages but was greatest in those younger than 45 years of age.

Figure 1. A comparison of refractive surgery volume in 2019 versus 2020 at Dr. Leyssen's private clinic. Abbreviations: RLE, refractive lens exchange; LVC, laser vision correction; ICL, EVO ICL

Courtesy of Barbara Leyssens, MD

The increase in refractive surgery volume continued in the first quarter of 2021 (Figure 2). Compared to numbers for January through March 2020, volume rose 201% for refractive lens exchange, 140% for laser vision correction, and 147% for phakic IOL implantation. Growth was observed among patients of all ages and was greatest in those over the age of 50 years. My experience is not unique. According to the Refractive Surgery Council, laser vision correction volume is up in other parts of the world (see Refractive Surgery Volume on the Rise).

Figure 2. A comparison of refractive surgery volume at Dr. Leyssen's private clinic from January through March 2020 versus the same months in 2021. Abbreviations: RLE, refractive lens exchange; LVC, laser vision correction; ICL, EVO ICL

Courtesy of Barbara Leyssens, MD

This COVID-19 period with boundaries has been the start of an era of visual freedom for many of my patients.

REFRACTIVE SURGERY VOLUME ON THE RISE

The volume of laser vision correction procedures has increased by 29.7% year over year (Figure), according to the Refractive Surgery Council.1 The analysis considered the utilization of technologies from the industry’s leading manufacturers of laser vision correction equipment to determine that more than 220,000 LASIK, SMILE, and PRK procedures were performed in the United States in the first quarter of 2021.

Figure. Year-over-year growth of laser vision correction procedures.

Kendall E. Donaldson, MD, MS
  • Professor of Clinical Ophthalmology, Cornea/External Disease/Refractive Surgery, and Medical Director, Bascom Palmer Eye Institute, Plantation, Florida
  • Member, CRST Editorial Advisory Board
  • kdonaldson@med.miami.edu
  • Financial disclosure: Consultant (Alcon, Allergan, Bausch + Lomb, Carl Zeiss Meditec, Eyevance Pharmaceuticals, Johnson & Johnson Vision, Kala Pharmaceuticals, Lumenis, Novartis, Omeros, Quidel, Science Based Health, Shire, Sun Pharma)
Barbara Leyssens, MD
  • Refractive surgeon, FYEO, the Netherlands
  • Cataract surgeon and cataract surgery instructor, Maxima Medical Center, Eindhoven, the Netherlands
  • Member, CRST Europe Editorial Advisory Board
  • barbara@fyeo.nl
  • Financial disclosure: None

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