Lack of LASIK growth partly due to outdated patient impressions

With advanced diagnostics, femtosecond laser flap cutters, and wavefront- and topography-guided treatment, LASIK refractive outcomes and safety have never been better. Yet global LASIK volume peaked at about 3.8 million procedures in 2007, and has struggled to break 3.6 million since. In the USA, the picture is even worse. Volume peaked at 1.4 million procedures in 2000, and has bumped along 
around 600,000 for the last five years, according to Market Scope data presented by Richard L Lindstrom MD at the 2016 ASCRS•ASOA Symposium & Congress in New Orleans, USA. “We are in a no-growth market globally and in the USA. The question is, why is that?” asked Dr Lindstrom, founder of Minnesota Eye Consultants in Bloomington, Minnesota, USA. NEW GENERATION, NEW ATTITUDES It’s not lack of candidates, Dr Lindstrom said. In the USA, just 12% of the more than 120 million candidate eyes have been treated – and the pool grows by one million eyes every year for myopia alone. Nor is it poor outcomes. More than 95% of commercial LASIK patients and 98% of military patients were at least somewhat satisfied, with well over 90% completely or very satisfied, according to an FDA quality-of-life survey. Nearly 80% had 20/20 or better vision, and 99% had 20/40, 12 months after surgery. What hasn’t kept up is public awareness and doctor interest, Dr Lindstrom said. Many patients have outdated impressions of LASIK, such as that it can’t correct astigmatism. And while marketing and advertising expenses per procedure have remained steady, total budgets have fallen. Some practices may find they get a better return marketing refractive lens exchange or premium intraocular lenses, he said. A similar dynamic may be driving a decline in ‘refractive only’ surgeons – since 2007 the proportion of US surgeons identifying as ‘refractive only’ dropped 84%, while those doing both cataract and refractive climbed. With the population ageing, some may feel there’s no need to fight for LASIK patients when there are plenty of cataract, glaucoma, diabetic retinopathy etc. cases, Dr Lindstrom said. Alternatives are also improving, Dr Lindstrom said. Extended wear and new materials have made contact lenses more convenient and comfortable. Even so, about three million patients give up contacts annually, but only 10% transition to LASIK. Many go back to spectacles. Thinner lenses and stylish-frame spectacles are not only attractive, they can be a fashion statement. “Perhaps there’s something wrong with our message,” Dr Lindstrom said. He pointed out that current surgeons started out marketing to their friends and colleagues and now are marketing to their children. “The messages I respond to are very different from the messages my children respond to,” Dr Lindstrom added. He suggested more focus on Millennials, now in their 20s, who are on their way to prime LASIK age in their 30s. REACH OUT TO MILLENNIALS Social media may be one way to reach Millennials, said Eric Donnenfeld 
MD, of New York University, USA. Outcomes are good, making outreach to friends a natural. “When people start talking about this on social media forums, the overwhelming message will be: ‘Wow, this is the best thing I’ve ever done’. We have to really encourage our patients to get involved in social media,” he said. Market research in conjunction with the ASCRS shows that there is big disconnect between what patients, particularly younger patients, want to hear and what surgeons think is important, Dr Lindstrom said. “They don’t care if it’s wavefront-guided or topography-guided, they want to know if it will help them see better when they go to the beach – and how big the risks are, and what the process is like, and later what it costs,” he added. Emphasising the excellent outcomes of modern LASIK may also help, said Steven Dell MD, Austin, Texas, USA. Patients treated with current wavefront 
and femtosecond laser technology often end up with better than 20/20 
uncorrected vision. In fact, three-quarters of patients treated in the PROWL-1 study of US military personnel were 20/12.5 or better six months after LASIK, he noted. Dysphotopsias and dry eye were also reduced from pre-op levels, so emphasising the minor and temporary nature of most complications may also help. LASIK patient satisfaction also compares favourably to other elective surgical procedures, Dr Dell said. “The only adjective I can come up with that describes current LASIK outcomes is superb,” he concluded. Richard L Lindstrom: 
rllindstrom@mneye.com Eric Donnenfeld: 
ericdonnenfeld@gmail.com Steven Dell: steven@dellmd.com