Wavefront, IOLs may revive refractive surgery market

Richard L. Lindstrom, MD, told attendees here at RSIG that the refractive market will be revived by newer technologies.

ORLANDO, Fla. — Technologies soon to be available to ophthalmologists may revive the slumping refractive surgery market. This was the optimistic message delivered by Richard L. Lindstrom, MD, in a featured address to refractive surgeons here.

Dr. Lindstrom said the imminent introduction of wavefront-guided ablation, with its promise of “vision better than we can provide with glasses or contact lenses,” may boost the public’s interest in refractive surgery in 2003. In addition, the availability of phakic IOLs and other lens-based surgical options will allow surgeons to offer refractive correction to a greater range of myopes, he said.

Dr. Lindstrom made these remarks in the Refractive Surgery Interest Group’s Honorary Lecture here on the first day of Subspecialty Day, the yearly lead-in to the American Academy of Ophthalmology meeting. He is also scheduled to be honored with a Lifetime Achievement Award from the International Society of Refractive Surgery at that group’s meeting here this week.

Ophthalmology’s penetration of the refractive market “has only begun,” Dr. Lindstrom said. He noted that of approximately 275 million Americans, it is estimated that 55% need vision correction of some type. Currently, about 73% of those who need correction use glasses and 23% use contact lenses. Only about 4% have had refractive surgery to date.

Wavefront-guided custom ablation is about to reach the market, Dr. Lindstrom noted, as Alcon’s CustomCornea system has been recommended for approval by the Food and Drug Administration and other manufacturers’ systems will soon follow.

He predicted that when this technology becomes available, the public’s lagging interest in refractive surgery will be renewed. Citing the results of a trial of the Visx WavePrint system in which 71% of patients had postop uncorrected visual acuity of 20/16 or better, he said impressive visual results like these may spark a revival of attention.

Phakic IOLs, several of which are now in U.S. clinical trials, may allow surgeons to expand the range of myopes to whom they can offer surgery, Dr. Lindstrom said. These devices will be particularly helpful for patients with 8 D or more of myopia, he said.

Other technologies in development hold promise for the smaller market of hyperopes and for the potentially growing market of presbyopes, Dr. Lindstrom said. Many surgeons have not yet decided on a favored approach to hyperopia, he said, and refractive lens exchange seems to hold promise for this application. For presbyopia, small-diameter corneal inlays and accommodating IOLs may be viable options in the near future.

“I would love to have a surgical technique to offer the baby boomers as they reach the presbyopic stage,” Dr. Lindstrom said.

He predicted that the downward trend in refractive surgery will reverse in 2003 and procedure volume will increase, “offering strong growth and opportunity for all of you involved in this field.”