This article is more than 5 years old. Information may no longer be current.
Economy, technology, patient care allow today’s laser centers to thrive
Click Here to Manage Email Alerts
|
| ||
During the past 10 years, laser centers have evolved and thrived, due in part to the advent of procedures such as LASIK. However, not all laser centers that jumped on the initial bandwagon have been able to keep up with the fast-paced, ever-changing world of laser technology.
“Not all laser centers are created equal,” said Wallace Ryne, OD, FAAO, of Grapevine, Texas, in an interview with Primary Care Optometry News. “To survive in this day and time, you need to have the best technology — technology that reduces risk and enables the patient to feel comfortable with proceeding.”
Dr. Ryne was the clinical director of the now-defunct Beacon Eye Institute, which had five centers in 1997, and now is the clinical director of Clearview Laser Vision Center.
Statistics on laser centers
The first laser centers dealt primarily with photorefractive keratectomy, which was standard of care until LASIK proved to be safe and effective. “We did not survey surgeons in regards to procedures used in 1997,” said David Harmon, an expert on the refractive market for Market Scope, a source of information for the cataract and refractive markets. “However, we estimated the procedure mix at 29% LASIK and 71% PRK. There were approximately 215,000 total procedures performed that year.”
The number of procedures expected by the end of 2004 reflected a huge increase at 1.3 million, Mr. Harmon said in an interview. The numbers also indicate a significant shift from PRK to LASIK.
“In our survey for Q2-2004, surgeons reported that 90.1% of procedures were LASIK (conventional and wavefront), and 7.2% were surface ablation (such as PRK and LASEK),” Mr. Harmon said. “The remaining 2.7% were other techniques such as refractive lens exchange and conductive keratoplasty.”
LASIK and wavefront: huge gains
The shift in modality from PRK to LASIK appears to have provided a significant boost to the growth of laser centers. The advent of wavefront-guided custom ablations is another of many factors that have benefited laser centers.
“The recent growth in laser refractive surgery is secondary to an improved economy with higher consumer confidence levels,” said Richard L. Lindstrom, MD, chief medical editor for Ocular Surgery News and a Primary Care Optometry News Editorial Board member. “Another factor is improved outcomes through custom ablation and prolate algorithm treatments, a capability that has increased the number of patients achieving 20/20 vision or better, reduced night vision symptoms and reduced frequency of enhancements.”
In addition, Dr. Lindstrom told Primary Care Optometry News that positive press and improvements in surface ablation have been very helpful to the increasing success of laser centers. “Improvements in what I call advanced surface ablation, with better pain management, LASEK and now Epi-LASIK, increase the number of patients who can be safely treated,” he said.
According to Louis J. Catania, OD, FAAO, a Primary Care Optometry News Editorial Board member who practices at Nicolitz Eye Consultants in Jacksonville, Fla., customized ablations have certainly improved LASIK.
“Customized ablations have seemed to turn the tide of the negative press that had slowed interest and growth in LASIK,” Dr. Catania said. “It will be important not to raise expectations too high with custom by overstating its potential value, such as the ‘SuperVision’ hype.”
Dr. Catania was clinical director of the now-defunct Global Vision Inc., which had eight centers in 1997.
Unsuccessful centers: lessons learned
Dr. Ryne has had experience with both a successful laser center and one that failed to thrive. He discussed his observations and insights over the past several years. “Initially, all laser centers were created equal. We had only two lasers approved back in 1996, so each laser center basically offered the same services,” he said. “Originally, we were all limited in treating out to 6 mm only. We didn’t have the ability to address night vision problems.”
But as technology improved, Dr. Ryne said, there was more of a disparity between laser centers. “There were instruments such as the Orbscan [Bausch & Lomb, Rochester, N.Y.], where you can actually look at the back surface of the cornea to ensure that it is the right shape to proceed, but it was not inexpensive,” he said. “Then you had tracking lasers, and then came blade-free microkeratomes, and now there is wavefront-guided ablation.”
Dr. Ryne said being able to keep pace with this technology was crucial to the success or failure of many of the laser centers opened in the 1990s. He added that it is even more important today. “Now, due to the Internet, we are dealing with a very educated customer,” he said. “They are coming in and asking, ‘Do you do wavefront-guided ablations? So you have blade-free microkeratomes? How can you address night vision problems if they arise?’”
According to John W. Potter, OD, a Primary Care Optometry News Editorial Board member and vice president for clinical services with TLC Vision Corp., living in Dallas, many of the early laser centers used the wrong business strategies. “Ten years ago, there were more than 25 companies in the refractive surgery business in North America. Some of them tried to sell the surgery to potential consumers and prospective patients,” he said in an interview. “This strategy failed. There has never been a successful sales effort to potential consumers through the traditional advertising methods, and refractive surgery was not able to overcome that threshold.”
Dr. Potter said companies also faltered by focusing entirely on either optometry or ophthalmology services. “These failed because refractive surgery is unique in the history of both optometry and ophthalmology,” he said. “It demands the highest levels of eye and vision care to meld together in a seamless manner to offer the patient the best possible experience with the surgery.”
Dr. Ryne said his current laser center has proven to be a successful venture. “We have two lasers and the IntraLase [Irvine, Calif.],” he said. “It is amazing how many patients are willing to have this surgery if they realize you don’t need to use a blade.”
According to Dr. Ryne, since the IntraLase was installed in his center, 95% of patients have chosen that technology over the traditional microkeratome, even with an increased fee.
TLC: an enduring model
Of the original laser centers, the center that has had the most success is TLC, a business model that has grown to include more than 70 centers across the United States and Canada, up from 14 centers in 1997.
“We were able to do something that nobody else thought could be done,” Dr. Potter said. “TLC Laser Eye Centers have brought together optometry and ophthalmology in an arena where both professions are respected for their unique contributions to the patient experience in refractive surgery.”
Dr. Potter explained that this approach has been comforting to patients, as well as a boon to the business. “It worked. The doctors focus on the patient and the patient experience, which is what patients want,” Dr. Potter said. “This model was the key to our success. The patients enjoyed the benefit of these relationships, and our business grew.”
Dr. Potter said TLC continues to thrive. “Today, both optometry and ophthalmology are integrated into every level of the company,” he said. “The overall patient experience is as good as or better than anywhere in the world, and we continue to grow.”
The next “big thing”
Dr. Lindstrom believes that surface ablation will be the next major area of growth for laser centers. “Another advance will be improved flap makers, both laser and mechanical,” he said. “Expanding custom ablation into higher myopia and mixed astigmatism will also help grow volume.”
The biggest threats to the continued success of laser centers, Dr. Lindstrom said, are renewed negative press or a poor economy with low consumer confidence.
According to Steven C. Schallhorn, MD, of the department of ophthalmology for the U.S. Navy, there has been, and will continue to be, a strong shift toward surface ablation. “We are all appreciating that some patients are better off with a surface procedure compared to LASIK,” he said. “An example is a patient who has relatively thin corneas.”
Dr. Catania said he expects to see significant growth in the area of bladeless LASIK with femtosecond technologies, as well as in lens-based refractive surgery, particularly in the presbyopic ranges.
For Your Information:
- Wallace Ryne, OD, FAAO, can be reached at Clearview Laser Vision Center, 1643 Lancaster Dr., Ste. 301, Grapevine, TX 76051; (817) 329-2700; fax: (817) 329-8322; e-mail: wryne@clearviewlaservision.com.
- Dave Harmon can be reached at 13610 Barrett Office Dr., Ste. 211, Manchester, MO 63021; (314) 835-0600; fax: (314) 835-0606; e-mail: daveharmon@market-scope.com; Web site: www.market-scope.com.
- Richard L. Lindstrom, MD, can be reached at 710 East 24th St., Ste. 106, Minneapolis, MN 55404-3810; fax: (612) 813-3660.
- Louis J. Catania, OD, FAAO, can be reached at Nicolitz Eye Consultants, 1235 San Marco Blvd., Ste. 301, Jacksonville, FL 32207; (904) 398-2720; fax: (904) 398-6408; e-mail: lcatania@bellsouth.net.
- John W. Potter, OD, can be reached at 18352 Dallas Pkwy., Suite 136, Dallas, TX 75287; (972) 818-1239; fax: (972) 818-1240; e-mail: john.potter@tlcvision.com.
- Steven C. Schallhorn, MD, can be reached at 34800 Bob Wilson Dr., San Diego, CA 92314-5000; (619) 532-6702; fax: (619) 532-7272.