A Patient-Focused Economic Model

If I had been asked to describe my economic model for laser vision correction 5 to 10 years ago, my answer would have been more complex than it is today. Back then, I was a high-volume refractive surgeon who adopted new techniques and technologies frequently; now, I am a lower-volume refractive surgeon who has not adopted anything new for the past few years. I am simply no longer as hungry for financial success and international recognition in the ophthalmic community, and I consider myself no more than a simple guy from the countryside.

I started to do refractive surgery in 1994 with the first-generation, broad-beam Excimed excimer laser (Summit Technology; no longer available) and was among the first surgeons in Norway to perform LASIK. In 1996, I switched to the EC-5000 excimer laser (Nidek). Over the years, I upgraded the laser’s software approximately 15 times to incorporate all of the latest ablative advancements, including the Final Fit custom ablation treatment, in order to treat as many patients as possible successfully. I switched to the Navex Quest some years ago but still use my Nidek MK1000 microkeratome instead of a femtosecond laser in the few cases of LASIK I do.

I currently prefer surface ablation for patients with up to -8.00 D of myopia and the Visian ICL (STAAR Surgical) for those with high myopia or hyperopia. I consider the latter the best option for quality of vision, as most patients gain multiple lines of acuity. I implanted the first commercially available Visian ICL Toric in Europe in 2002 and, 3 years later, was the eighth surgeon in the world to join the ICL 500 Club. Since then, I have implanted 500 more of these lenses. I also implanted the first commercially available AcrySof Restor IOL (Alcon) in Northern Europe in 2003.

These achievements used to mean a lot to me, but now I consider my biggest triumphs to be patient happiness and giving back in the forms of humanitarian work and participation in clinical studies. I no longer think of myself as a moneymaker; I simply do the best for my patients for the least amount of money.

NO INCREASE IN PRICING

I started charging NOK12,000 (about €1,500) per eye for PRK in 1994 and did not increase my pricing until 2010, when I raised it to NOK14,000 (about €1,700). Since 1997, I have performed thousands of limbal relaxing incisions (LRIs) in combination with cataract surgery, but I have never charged a penny for them. Most times, I do not even tell patients about the LRI; all they know is that they are pleased with their good postoperative UCVA.

My goal with LRI placement is not to eliminate corneal astigmatism but to reduce it enough that the patient is spectacle independent most of the time. I still create LRIs manually, and I have no plans to use a femtosecond laser for any aspect of cataract surgery, as it will only slow me down without providing better clinical outcomes and results.

GIVING BACK

With regard to my economic model, I believe that giving back to others who are less fortunate will return full circle. For the past 10 years, I have aligned with Help Moldova, the Norwegian humanitarian organization, to introduce modern cataract surgery (phacoemulsification) in that country. Since 2004, I have donated 16 phaco machines to different hospitals in Moldova and trained about 20 local eye surgeons to perform surgery on their own. I have also taken part in organized eye care in Greenland for 2 to 3 weeks each year since 2002, either as a cataract surgeon or by providing patients in rural areas of the country with various outpatient services.

Working in these two countries has affected how I view economic success. When I think about how spoiled we are in our part of the world, it dampens my eagerness to obtain new technologies. For instance, in 2007, I was humbled when I was the first surgeon in Moldova to treat a patient with diabetic retinopathy using laser therapy. Moldova was the last country in Europe to adopt this technology, approximately 30 years after the treatment was introduced in Western Europe, including in my own country.

PARTICIPATION IN STUDIES

Another positive measure of economic success, in my estimation, is participation in clinical studies for products or procedures that have the potential to further enhance our patients’ quality of life. In collaboration with the University of Bergen and University College London, I recently started the Bergen Angle Closure Study, a population-based study to detect the true prevalence of primary angle-closure suspect, angle closure, and angle-closure glaucoma and to study anatomic structural changes in the anterior segment in the same population.

This study requires much time, patience, and significant self-funding, which I am happy to do because I am convinced that angle-closure glaucoma is the most forgotten and misdiagnosed eye disease of our time. But as a result of this multiple-year project and financial commitment, I will surely not be adopting new techniques in cataract and refractive surgery at this time.

CONCLUSION

Today, I place more value on patient happiness than I do on my own economic success. I enjoyed many accomplishments early in my career, but now I prefer to do the best for my patients for the least amount of money and to study new areas of ophthalmology that can make a large impact on our patients’ quality of life. After all, I am a simple guy from the countryside of Bergen, Norway.

Jan Askvik, MD, practices at Bergen Eye Clinic, in Bergen, Norway. Dr. Askvik states that he has no financial interest in the products or companies mentioned. He may be reached at e-mail: jaskvik@broadpark.no.