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New technologies can bring patient interest back to LASIK
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When laser vision correction volumes peaked more than a decade ago, there were about a million procedures performed annually. Ophthalmologists and optometrists had found a way to work together to comanage care, an arrangement that has worked well.
In laser vision correction’s (LVC’s) heyday, a busy optometric practice might have been referring as many as 15 to 20 patients every month for refractive surgery.
Today, total procedures in the U.S. have declined considerably. Well-documented economic woes and declines in consumer confidence are largely to blame, although price-focused advertising also confused consumers and commoditized the procedure.
Sandy T. Feldman
Kevin M. Reeder
Optometric referrals have dropped off even more sharply than the overall procedure volume, suggesting that more patients are going straight to surgeons without involving their primary care eye provider. As doctors who have been comanaging LVC patients together for more than 15 years, we have seen personally how comanagement and refractive surgery technology has evolved. This may be a good time to bring some excitement back – both to the patient experience and to OD-MD comanagement.
Improved outcomes
It is ironic that procedure volume has declined even as results have gotten so much better. We used to counsel patients to go home and take a nap right after LASIK surgery, mostly to get them through the period of greatest pain and discomfort. But in the last 2 years, patients are more comfortable and have better immediate vision after LASIK or much less discomfort after advanced surface ablation (PRK) thanks to better flap technology, medications and drops.
We also used to talk about “20/happy,” meaning that our goal was to get patients to a happy place, even if they didn’t necessarily see 20/20. Today, however, it is quite realistic to counsel patients to expect 20/20 or better vision after surgery.
New technologies
Specific technologies have contributed to these gains, and it is important that the eye care community keep talking about them.
The first is custom, wavefront-guided surgery, which has been available for several years, but is still appealing to patients who are reassured that a highly customized map of their eye will be used to develop the treatment.
Femtosecond laser flaps are another technology that is reassuring to patients. Newer, faster femtosecond lasers shorten healing time and make the procedure more comfortable for patients.
Finally, a unique ocular lens by Nexis Vision, which is placed on the eye for 4 hours or overnight after surgery, also aids in comfort and visual recovery. The Nexis lens is thicker than a contact lens and fit more tightly. In lieu of goggles, the lens shields the cornea and also promotes healing by minimizing edema and encouraging dehydration, provides a scaffold for smoother epithelial regrowth and provides clearer optics.
With this combination of technologies, almost 90% of patients see 20/25 or better immediately after surgery. Moreover, the vast majority of patients are able to send text messages on their smart phones immediately after surgery. Patients are a little less confident about their ability to drive, but about 60% of those with the Nexis lens say they feel ready to drive as early as 1 hour after surgery.
Because these new technologies enhance the patient experience and provide better vision and less discomfort in the first few hours after surgery, they represent a huge step forward in comanagement.
A proactive approach
Some would argue that no matter how great the refractive results, it does not make good financial sense to steer patients toward a procedure that will take them out of contact lenses or glasses. However, comanagement fees can be about the same as several years of repeat visit profits from a contact lens or spectacle patient.
In addition, patients who have had LASIK are often the most interested in investing in their eyes for the future. They will still need sunglasses and possibly prescription glasses for reading, computer work or night driving if a monovision correction was performed. If they have been properly educated about their eye care, they will understand the importance of continuing eye exams. It is true that LVC shifts the focus of their care from vision correction to ocular health, but most LVC patients are retained by the referring practice.
The reality is that people who are interested in LVC, if not educated by their OD, will have it anyway. In many cases, they will be going to laser centers that now offer glasses and contacts as well and may never return. This is an alarming trend.
With a good working relationship between optometrist and surgeon, there are benefits to both doctors. By referring and comanaging, optometrists take the opportunity to be a full participant in patients’ care and retain their trust. Additionally, primary eye care providers are well qualified to help patients choose the right surgeon who will ensure a positive experience that reflects well on both doctors.
The surgeon benefits by getting a LASIK patient who has already been educated about the procedure and has appropriate expectations. Surgeons get better results when referring doctors in the community participate in the process because they get much more detailed input about the patient’s ocular and systemic health history, their lifestyle and expectations, and their tolerance for risk and pain. Only a primary eye care provider who has known the patient for years can provide that.
The patient benefits
But it is the patients who benefit the most from a team approach. A good partnership between the optometrist they know and trust and the ophthalmologist who will perform the surgery can truly enhance patient satisfaction with the LVC experience.
Ideally, it will feel completely seamless to the patient. We tell patients they will spend most of their postop visits with the doctor they know well and who is convenient for them but that their surgeon will always be available should anything unexpected occur. They have the benefit of plenty of guidance before surgery from a trusted source and can enjoy a calm and supportive postop care environment. They know we are going to work as a team to give them the best possible care.
We find that patients really do merge together their opinion of both doctors who participate in the care, which means that we both benefit from word-of-mouth referrals for LASIK.
Today’s results should inject some enthusiasm into the conversation about laser vision correction. For the right candidates, it can be an opportunity to change their life in a positive way. To us, that means a fulfilling professional life.
Wavefront-guided surgery, femtosecond lasers and a postsurgical lens are improving outcomes.