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What a growing patient pool means for future of refractive surgery


Delivering the Steinert Lecture during the ASCRS Refractive Day, Richard L. Lindstrom, MD, provided his thoughts on the current and forthcoming state of laser refractive surgery.

After a series of ups and downs, the refractive surgery market has stabilized at a new low base from which only small changes are expected in the near future.

According to Richard L. Lindstrom, MD, the longer-term outlook is more optimistic thanks to a growing patient pool.

Surgeons wanting to take advantage of this opportunity to build their refractive surgery practice, however, will need to implement marketing techniques that are based on understanding of the unique cultural and generational issue of the future refractive surgery population, he said.

Delivering the Steinert Lecture during the ASCRS Refractive Day, Dr. Lindstrom provided his thoughts on the current and forthcoming state of laser refractive surgery.

“I expect that as the millennials age and begin to enter their 30s, we will begin to see a steady increase in LASIK procedures, but that will occur slowly over the next decade,” said Dr. Lindstrom, founder and attending surgeon, Minnesota Eye Consultants, and adjunct clinical professor emeritus, Department of Ophthalmology, University of Minnesota, Minneapolis, MN.

“Once we start to see that growth, industry and ophthalmologists will begin to start investing in laser refractive surgery again, and those surgeons who have appropriately positioned themselves to provide and market this service will do quite well,” he said.



Insights on past trends

A review of data on the annual volume of laser refractive surgical procedures shows that LASIK got off to a quick start and strong start, but the continual growth came to a halt after the Sept. 11, 2001 terrorist attacks and declined further during the Great Recession.

Even though downturns in the economy and in the consumer confidence level with those events were the basis for the drop-off in the refractive surgery market, LASIK volume failed to recover after economic conditions strengthened in recent years.

Ruling out weak economic conditions for the stagnation, Dr. Lindstrom examined alternative possible explanations, including exhaustion of potential candidates and poor surgical results leading to dissatisfied patients.

However, he discarded both of those ideas.


“LASIK is most often performed to treat myopia, and with our epidemic of myopia, the pool of treatable patients is large and growing,” Dr. Lindstrom said.

“Furthermore, the results of two global literature reviews along with findings of the recent PROWL studies confirm that LASIK is highly successful and associated with a low rate of complications, which are mostly treatable,” he said.

According to Dr. Lindstrom, shifting population demographics is a major factor underlying the stagnated LASIK market and the potential for its upturn.

“LASIK is a procedure that is of greatest interest to people in their mid-30s who have become tired or intolerant of contact lenses and have the financial resources to pay for the surgical procedure,” he explained.

“The initial surge we saw in LASIK occurred because the baby boomer population had reached this threshold age,” he said. “Today, however, the baby boomers are candidates for refractive lens exchange to address presbyopia or are of cataract age.”


Looking ahead, Dr. Lindstrom suggested that compared with baby boomers, the millennials represent an even larger population of potential LASIK candidates, but it will be a few more years for most before they might become interested in the procedure.

The average age of the millennials is currently only 27 years. With improvements in technology and spectacles, they are more likely to be satisfied with their contact lenses and spectacles compared with the baby boomers.

Furthermore, many millennials who might currently be interested in LASIK do not have the financial resources to pursue the surgery considering that many are saddled in debt and underemployed. A few years from now, once student loans are repaid and as their careers advance, cost is likely to become a less important constraint, Dr. Lindstrom said.


Declining physician interest

Another issue explaining the current state of the LASIK market is that ophthalmologists’ interest in offering the procedure has dropped off, both because of its downturn market and as a result of the growth in other opportunities.

“With the expansion that has been occurring in refractive cataract surgery and microinvasive glaucoma surgery (MIGS), there are a lot of new procedures that can keep anterior segment surgeons busy,” Dr. Lindstrom said. “Therefore, many laser refractive surgeons have stepped away from marketing and promoting LASIK as a segment of their practice and some have even stopped offering it entirely.”

Furthermore, some surgeons who continue to do LASIK may not be doing as well as they could because they have not stayed in step with a need to develop new marketing techniques and financing options.


Dr. Lindstrom pointed out that the messages and avenues for effectively reaching today’s pool of potential LASIK candidates are different than those relied on in the past.

Social media, in particular, plays a major role. Many of the ophthalmologists who started in laser vision correction decades ago, however, lack knowledge of the current promotional approaches that are most likely to garner attention and generate interest. Some balk entirely at the idea of implementing them.

In addition, there is a need to appreciate that economic factors may still limit the ability to pursue LASIK for some interested patients.

“The key here will be to have programs available that can make the procedure appealing and affordable,” Dr. Lindstrom said. “A good strategy may be to offer it at a monthly payment plan that matches the costs of continuing contact lens wear.”


Dr. Lindstrom is a consultant and/or investor in many companies that market technologies for laser refractive, refractive cataract, and microinvasive glaucoma surgical procedures.

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