Patients are serious about procedure and ready to move forward.
This article was reviewed by Christopher L. Blanton, MD
Policies implemented in response to the start of the COVID-19 pandemic led to changes in health care utilization.
Even after restrictions were eased, fear of contracting the coronavirus infection caused many patients to cancel or postpone appointments for examinations and elective procedures involving physical visits.
Refractive surgery, however, is a notable exception that seems to have gotten a kick start during the COVID-19 era.
“The number of refractive surgery procedures we are performing is way up since the start of the pandemic, and I think this trend will continue,” said Christopher L. Blanton, MD, of the Inland Eye Institute in Colton, California.
Sharing some of his practice data, Blanton reported that his multi-office group saw a dramatic increase in monthly refractive surgery leads beginning in June 2020 that represented a 200% increase compared with the period from December 2019 to February 2020.
The growth in leads was followed by a rapid rise in the number of appointments scheduled for evaluations and then a steady increase in the number of monthly surgeries.
“The patients who are coming in now for a refractive surgery consultation are braving the risk of exposing themselves to COVID. They are serious about having a procedure and ready to proceed,” he said. “We are not seeing a large proportion of patients who are just trying to gather some information or shopping around with the idea that they might decide to go ahead with the surgery sometime in the future.”
Edward E. Manche, MD, and Sandy T. Feldman, MD, MS, also said they saw increases in patient interest in refractive surgery and scheduled procedures during the COVID-19 era.
Manche said he believes some of the increase in procedures, which was first noted during summer 2020, reflected the influx of patients whose previously scheduled procedures were deferred by mandate or intentionally postponed even after stay-at-home orders were lifted.
“Even after we took care of that backlog, however, our refractive surgery segment continued to increase,” said Manche, a professor of ophthalmology and director of cornea and refractive surgery at Byers Eye Institute, Stanford University School of Medicine, Stanford, California.
The surgeons report an uptick in all types of laser vision procedures—LASIK, PRK, and SMILE—as well as in refractive lens exchange. Feldman is also offering phakic IOL implantation to appropriate candidates.
“The Implantable Collamer Lens (Staar Surgical) or the toric version can be an excellent option that should not be left out of the refractive surgery toolbox,” said Feldman, in practice at Clearview Eye and Laser Medical Center in San Diego, California.
Multiple factors seem to be driving the growth of refractive surgery during the pandemic.
Feldman said that soon after the office closed to nonessential visits, calls were coming in from front-line health care workers who were finding the need to wear glasses underneath facial personal protective equipment an added burden.
“Some of the first people who heard from were respiratory therapists who were working directly with COVID patients and having to wear protective coverings all day,” she said.
Glasses fogging while wearing a mask was another leading issue prompting inquiries about refractive surgery, as were repeated warnings to avoid touching the face, which caused contact lens wearers to question the potential for risks associated with inserting and removing their lenses.
Participation in virtual meetings may also have drawn people’s attention to their appearance and led them to think they would look better without glasses.
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Others have said they do not want their face in the outside world to be a mask with glasses, Blanton said.
Having refractive surgery also became more feasible during the pandemic for many individuals for reasons relating to affordability and ease of scheduling.
“Many people who are not spending money at restaurants, travel, or entertainment seem to be focusing on what they could use that money for to improve their daily life,” Feldman pointed out. “The desire for good vision and to see better without needing glasses or contact lenses is almost universal, and that want was heightened by situations created by the pandemic.”
Adapting to the shift
The increased volume of patients seeking refractive surgery has led to some practical challenges, according to Manche.
“We struggled at times with staffing during the pandemic,” he said. “Many of my employees took months off from work because of child care issues.”
Manche noted that this was especially the case during the first months of the pandemic.
“All of my employees are back now, and although we are fully staffed, we are looking to hire additional employees to handle the increased volume,” he added.
Blanton also described hiring more staff and directing more resources to marketing. He said that as soon as guidance allowed reopening for nonurgent/nonemergent visits, his practice immediately saw an increase in requests for refractive surgery evaluations.
To accommodate and help drive the trend, changes were introduced to facilitate scheduling that included giving patients access to the calendar so they could choose an appointment time and contracting with a phone answering and scheduling service that allowed patients to call in for appointments 24/7.
In response to the trend, Blanton said the practice office was reconfigured to accept a larger number of patients.
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In addition, more optometrists were brought into the practice to help handle the growing number of consultation appointments.
Office staff received sales training to increase the rate at which leads would be converted to evaluations, outreach to referring optometrists increased, and the marketing budget was bolstered to capture demand using a direct-to-consumer paid search, social media advertising, and offering special pricing for first responders.
Feldman noted that it seems easier to get patients into the office because with social isolation and working from home, people are craving human interaction wherever they might get it. That said, patients need to feel safe in the office setting.
“Focusing on creating an environment that makes patients feel comfortable is probably one of the most important things that a practice can do at this time,” Feldman said.
It is impossible to predict the trajectory of the pandemic. Similarly, there is no way to know with certainty whether increased interest in refractive surgery will persist going forward.
While some of the pandemic-related factors fueling the interest in refractive surgery may disappear over time, others are likely to continue.
Blanton pointed out that he does not believe masks will go away soon, and even as vaccination rates increase, he said he expects that many people will still be working remotely and thinking about their screen image when participating in virtual meetings.
“Furthermore, I believe that the pandemic has raised consciousness about infection risk and focused attention on keeping the hands away from the face,” he said. “People who are contemplating refractive surgery are also eager to have it sooner than later, thinking that offices may need to close again in the future if community infection rates increase.”
Blanton, however, proposed that word-of-mouth referrals may be one of the biggest drivers of refractive surgery case volume going forward.
“Volume for laser vision correction surgery has never reached its potential,” he explained. “These are great procedures that have phenomenal functional and refractive outcomes when performed with our modern technology. Patients who have the surgery are extremely satisfied with the results and realize how it is saving them money that would otherwise be spent on glasses or contact lenses.”
Blanton also notes that lack of public education about the safety and benefits of laser vision correction has limited its uptake. Instead, lay media and online reports of the rare disasters have spawned fear about the procedures.
“Word of mouth from friends, family, and others they trust has a greater influence on patient decision-making for this elective procedure than hearing from a provider about the benefits and safety,” he said.
Blanton added that his advice to anyone who does refractive surgery and is not seeing an increase in patient interest is to strike while the iron is hot and do whatever possible to ramp up word of mouth.
“If you have a marketing department, talk to your staff about what can be done that is different,” he said. “I encourage surgeons to spend more money on marketing that will bring patients in the door.”
Manche also said he believes the increased interest in refractive surgery will continue. Like Blanton, his optimism is based in the belief that word of mouth is the most powerful driver of new patient referrals.
“We have incredible outcomes, outstanding safety, and high patient satisfaction with all of our laser vision correction procedures,” Manche said. “Because of the recent increase in case volume, we now have a wave of newly treated happy patients who are talking about their positive experience that hopefully will perpetuate the trend we have seen.”
Feldman said she believes millennials in particular will help maintain the growth in refractive surgery volume, but she is realistic in pointing out that the economy will also influence the trend.
“I think there is definite interest in refractive surgery among the millennial population because these individuals grew up during the LASIK era and are familiar with the procedure,” she said. “Even though there may be more competing interests for their dollars in the future as people return to work and other activities, I think the millennial generation is especially interested in health and wellness so that as long as they have the financial resources, I think these individuals will be willing to spend their money on refractive surgery. I believe that people in Generation X who had laser vision correction years ago and are finding their vision changing because of presbyopia will be coming back to find a new solution to avoid the need to wear glasses.”
Christopher L. Blanton, MD
Blanton is a medical monitor for Johnson & Johnson Surgical Vision and a consultant for Eyevance Pharmaceuticals, CorneaGen, and Triad Life Sciences.
Sandy T. Feldman, MD
Feldman is a consultant for Johnson & Johnson Surgical Vision.
Edward E. Manche, MD
Manche is a consultant for Avedro and Johnson & Johnson Surgical Vision. He performs sponsored research for Alcon, Allergan, Avedro, Carl Zeiss Meditec AG, Novartis, and Presbia and owns equity in RxSight, Vacu-Site, and Placid0.