Disclosures: Lindstrom reports he has relevant financial disclosures for Johnson & Johnson Vision, Alcon, Zeiss, Bausch Health, Minnesota Eye Consultants and Unifeye Vision Partners; is a dues-paying member of ASCRS, AECOS, RSA and ISRS of AAO; and is a member of the ARSC executive committee (no compensation is received for ophthalmic society or ARSC membership and participation).
October 08, 2020
3 min read
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Corneal refractive surgeons may see positive times ahead

Disclosures: Lindstrom reports he has relevant financial disclosures for Johnson & Johnson Vision, Alcon, Zeiss, Bausch Health, Minnesota Eye Consultants and Unifeye Vision Partners; is a dues-paying member of ASCRS, AECOS, RSA and ISRS of AAO; and is a member of the ARSC executive committee (no compensation is received for ophthalmic society or ARSC membership and participation).
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Many corneal refractive surgeons are reporting strong patient interest in LASIK, SMILE and PRK as the COVID-19 pandemic moves into its eighth month in the United States.

Richard L. Lindstrom
Richard L. Lindstrom

From a high level, there are several reasons to expect a resurgence of patient interest in corneal refractive surgery. The increasing use of masks makes spectacle wear less desirable secondary to fogging. In addition, air leakage around the masks increases tear evaporation, worsening dry eye symptoms and reducing contact lens tolerance. Finally, savings rates have increased for some over the months of the pandemic, and potential patients have, of necessity, reduced discretionary spending in other areas. And of course, both federal and state government programs have provided increased spendable income for many. Savings are at record highs in the U.S.

Just more than a decade ago, Dan Durrie and I met with the three CEOs of the large strategic companies that dominated corneal refractive surgery: Alcon (Kevin Buehler), Advanced Medical Optics, now Johnson & Johnson Vision (Jim Mazzo) and Bausch + Lomb, now Bausch Health (J. Andy Corley). After a day’s discussion and a constructive dinner in Fort Worth, Texas, together with the American Society of Cataract and Refractive Surgery we created the American Refractive Surgery Council (ARSC) to support accurate information gathering and education in the field of corneal refractive surgery. The original three corporate members have now been joined by Zeiss and Ziemer. ASCRS, the founding ophthalmic society member, has been joined by the International Society of Refractive Surgery of the American Academy of Ophthalmology, the American-European Congress of Ophthalmic Surgery and the Refractive Surgery Alliance.

The mission has remained the same: accurate information and quality patient education in corneal refractive surgery. The current ARSC executive director is Jim Wachtman. For those interested in further information, ARSC has a substantial website, as do each of the participating companies and ophthalmology societies.

We are all aware that corneal refractive surgery volume in the U.S. approached 1.4 million cases in 2000, just 5 years after FDA approval of the first excimer laser. Most experts predicted case volume would continue to grow, and it has globally, but in the U.S., the trend surprisingly has been downward in case volume from 2000 to 2015. In 2015, according to ARSC data, only 605,618 corneal refractive surgery procedures were done in the U.S., less than half the number 15 years earlier. This was a bottom for corneal refractive surgery in America, and case volumes rose 26% over the next 3 years, reaching 762,331 procedures in 2018. Again, most experts predicted continuing steady growth as the millennial generation patients replaced the baby boomer generation that drove adoption in the early years of laser refractive surgery. However, unexpectedly, case volumes fell 8% in 2019 as compared with 2018. While demographics and access to a new procedure by a large previously untapped target population may explain the initial surge in interest from 1996 to 2000 with a following slow decline, they do not fully explain the year-to-year changes.

Consumer confidence is another confirmed predictor of corneal refractive surgery volume, which is a discretionary spend. One of the best measures of consumer confidence is the University of Michigan Consumer Sentiment Index, which through interviewing 500 consumers each month since 1966 has proven to be a good measure of consumer optimism or pessimism about America’s current financial situation and consumer expectations for the short-term and long-term future. Corneal refractive surgery case volumes fell 54% in the second quarter of 2020 as the COVID-19 pandemic hit, and of course consumer confidence tanked as well. The University of Michigan Consumer Sentiment Index is now again trending up, which is positive for corneal refractive surgery volumes for the fourth quarter of 2020 and into 2021, as long as we do not get a severe second wave of COVID-19 or a major economic downturn.

The corneal refractive surgeon has always been able to drive volume with targeted direct-to-consumer external marketing. For the busy corneal refractive surgery practice, now may be a good time to increase marketing spending. I would suggest the corneal refractive surgeon keep a careful watch on COVID-19 case numbers, which we want to see continue to trend down, and the University of Michigan Consumer Sentiment Index, which we want to see continue to trend up. Fewer COVID-19 cases, stronger consumer confidence, a healthy economy, the increasing interest and aging of the millennial patient, the side effects of chronic mask wear, increased consumer savings and perhaps a little external marketing could make fourth quarter of 2020 and 2021 good for the corneal refractive surgeon.