COVID-19 Resource Center
COVID-19 Resource Center
Source/Disclosures
Source: Healio Interviews
Disclosures: Berdahl reports he is a consultant for Alcon, Johnson & Johnson, RxSight and Zeiss. The other sources report no relevant financial disclosures.
October 08, 2020
9 min read
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Refractive surgery on the rise during COVID-19 pandemic

Source/Disclosures
Source: Healio Interviews
Disclosures: Berdahl reports he is a consultant for Alcon, Johnson & Johnson, RxSight and Zeiss. The other sources report no relevant financial disclosures.
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Refractive surgery rates have seen a steady increase since the reopening of ophthalmic surgery centers during the COVID-19 pandemic, creating a surprising influx of procedures as patient interest continues to rise.

Ella G. Faktorovich, MD, of Pacific Vision Institute, which reopened June 2, said the number of laser vision correction procedures she performed from June to August increased by 42% over the same period in 2019.

Ella G. Faktorovich, MD
To handle the increase in consultations and surgical procedures, Ella G. Faktorovich, MD, has opened her practice an additional day a week.

Source: Ella G. Faktorovich, MD

Pacific Vision Institute is not alone in this phenomenon, as practice owners and surgeons have reported refractive surgery rates and interest from patients have risen steadily since reopening earlier this year.

“We’ve always been interested in the psychology behind patients pursuing refractive surgery. The most common reason patients give us now is, ‘I’m at home. I have time to do it,’” Faktorovich said.

Pacific Vision Institute has administered surveys to its refractive surgery patients since 2008 to catalog data on the reasons why patients decide to pursue refractive surgery. In the past 3 months, most patients have said their newfound ability to work from home has led to more flexibility in their schedules.

“They spend no time commuting. They’re not traveling for work or for leisure as much anymore. Their time is flexible, and they have much more availability now to schedule appointments, consultations and procedures,” Faktorovich said.

The trend has been unexpected, OSN Cornea/External Disease Board Member Elizabeth Yeu, MD, said. The surgical volume has not slowed down at Virginia Eye Consultants since its reopening in June.

June 2020 was one of the most productive months in the history of the practice, she said.

Elizabeth Yeu, MD
Elizabeth Yeu

“Obviously, some of this was pent-up demand, but it shows you how productive we could actually be. Is it that people are getting these extra stipend checks? Is it because people are not traveling and they’re diverting more of their funds to taking care of themselves? Are people recognizing that vision is an absolute necessity and not just a commodity or a luxury? I’m not sure,” she said.

Sidney Gicheru, MD, clinical spokesperson for the American Academy of Ophthalmology and medical director at LaserCare Eye Center in Texas, said his practice has seen a significant increase in laser refractive surgery procedures since the state reopened for surgery in May.

LaserCare Eye Center’s volume was up 175% in June and 160% in July compared with 2019 volumes. In August and early September, the practice experienced a slowing of the initial surge in laser refractive surgery.

“Overall, while the trend in 2020 laser refractive surgical volume was higher than 2019, other parts of the practice, such as cataract surgery and comprehensive services, were significantly lower in 2020 compared to 2019. This decrease is directly related to the COVID-19 pandemic. Were it not for COVID-19, 2020 would likely have been a very strong year,” Gicheru said.

Gicheru said his practice offers SMILE vision correction, which is gaining traction among patients and could be a potential reason for the increased volume and interest.

Glasses and masks

One of the most frequent comments heard from patients has been the frustration of wearing glasses with a mask. Glasses fog up easily when wearing a mask, Yeu said, and can inhibit vision.

In addition, hearing aids in older patients, combined with glasses and a mask, can make for a cluttering around the limited space of the ear, she said.

All of these factors have led to a boom in interest.

“I have evaluations for LASIK all the way through October. That is absolutely a medical intervention of convenience. Most won’t wait until October. They’ll shop around and see if they can get a sooner appointment, but appointments have been booming. We’ve had to open up extra days, both for surgical appointments and evaluations, because patients are eagerly calling, emailing and inquiring about vision correction surgery options,” she said.

Refractive surgeries at Vance Thompson Vision were up more than 10% in July 2020 compared with July 2019, OSN Refractive Surgery Board Member John P. Berdahl, MD, said. Both refractive and refractive cataract procedures have increased.

It is a surprising outcome, Berdahl said. Many surgeons would have predicted medically necessary cataract procedures, cornea transplants and glaucoma surgeries would decrease slightly and elective cash-based refractive surgeries would take a big hit during reopening.

John P. Berdahl, MD
John P. Berdahl

“I suspect that this is being driven primarily around glasses fogging up due to masks and patients being frustrated. Some people might be simply saying that life is worth living well, and with more disposable income due to no vacations or eating out, now is the time for this. Stimulus dollars may have helped a little as well, but in general, I’m very surprised at the interest,” he said.

Investing in vision

Patients have shown a greater interest in taking control of their vision during the COVID-19 pandemic, OSN Cornea/External Disease Board Member Eric D. Donnenfeld, MD, said.

Donnenfeld reported Ophthalmic Consultants of Long Island has experienced a 25% increase in both refractive surgery and presbyopic IOL implantation with cataract procedures in June and July 2020 over the same time period in 2019.

Eric D. Donnenfeld, MD
Eric D. Donnenfeld

“A lot of this has to do with the loss of control and the feeling of insecurity associated with the pandemic and taking control of your own vision. Being less reliant on glasses and contact lenses has had a marked increase on interest in patients today than in patients 6 months ago before the pandemic struck. It’s one of the few ways that you can really control your own environment and your own future,” he said.

The interest could also be complemented by the new technologies currently available, with AcrySof IQ PanOptix trifocal IOL (Alcon) and the Light Adjustable Lens (RxSight) leading patients to undergo refractive surgery, Berdahl said.

Multifactorial interest

The interest is probably more multifactorial than most surgeons realize, Healio/OSN Board Member George O. Waring IV, MD, FACS, said.

Waring Vision Institute has seen an increase of almost 50% for all refractive surgery procedures in June and July 2020 over the same period of time in 2019.

It is well understood that laser vision correction volumes correlate with the consumer confidence index, Waring said. The New York Times reported in 2008 that LASIK surgery volumes decreased in step with the economy during the 2008 recession. There was also a decline in 2001 when the economy weakened.

Many surgeons were concerned about another decline during the pandemic, Waring said.

“But many of us felt this may not be an accurate predictor because we had not lived through a health crisis of this magnitude ever, at least not in our lifetimes. This was not a financial crisis. It was a health crisis, so therefore we couldn’t draw the same conclusions. We were left with a lot of obvious uncertainties,” Waring said.

While practices had to close their doors earlier this year for several months, many were still able to participate in virtual consultations with patients. This included consultations for LASIK, which patients showed great interest in discussing, he said.

It gave the practice a “running start” when it reopened, focusing primarily on elective surgeries. The natural backlog of patients helped, but there were several other factors that played into the refractive procedure boom, Waring said.

An influx of free time, as other practice owners noted, contributed to the refractive surgery interest. Also, unemployment benefits may have led some patients to decide to undergo refractive surgery, he said.

“There was unemployment, but people were getting unemployment checks. In some cases, people were getting extra money for things that they wanted to take care of that they had not been able to previously,” Waring said.

Discretionary spending has decreased, so many patients have considered reinvesting in themselves because they are not going on vacation or spending money on hotels or luxuries as they normally would.

Value in refractive surgery

The value proposition for refractive surgery over a patient’s lifetime became clearer as well. The average consumer may spend $20,000 on contact lenses, contact lens solutions, prescription glasses and prescription sunglasses over a lifetime, Waring said.

“From a financial perspective, vision correction pays for itself very quickly, and people end up making money on the investment during their lifetime in what they save through glasses and contact lens expenses. People have started to really key into this fact,” he said.

The temporary closure also seemed to make patients understand that the refractive surgery option may not always be immediately at their fingertips.

“Patients are telling us, ‘What if something bad was to happen again?’ What if they didn’t have a chance to get glasses or contact lenses? What if it was so bad, and they were stuck without them? It was really an ‘aha’ moment for many of them. Many didn’t want to put this off again,” he said.

Waring Vision Institute specializes in both laser vision correction and refractive cataract surgery, and there was concern that interest in these advanced cataract opportunities would fall off during the pandemic.

“People weren’t working, and we thought they would be more protective of their money. It was the opposite. Our volumes haven’t fallen off, and they might have even increased slightly. It was all the same reasoning as refractive surgery, but just for a different age group of patients,” Waring said.

Be prepared

Surgeons need to be prepared for all patient questions during this period of time. The increase in interest and free time also means patients can now pursue multiple consultations, research surgical options and shop around for a surgeon who fits them the best, Faktorovich said.

Be prepared for questions such as, “What makes you different from other surgeons?” and recognize that patients have time to pursue different options, she said.

“For surgeons interested in doing more procedures, I’d be very proactive in educating patients who come in for general eye exams about laser vision correction, knowing that they’re likely looking for these opportunities right now. I’d make it apparent on my website that I offer this service, and I’d bring up laser vision correction to every patient who comes in for a general eye exam. I’d want to at least educate them about it during their appointment,” she said.

Also be ready to answer patients’ questions about why they should choose your practice, she said.

Risk for burnout

To handle the increase in consultations and surgical procedures, Faktorovich said she has opened her practice an additional day a week.

This has been commonplace for many practices, as the increase in consultations and surgeries has necessitated additional workdays and longer hours. Thus, burnout is a worrying reality for many surgeons during this time, Yeu said.

Many practices have not staffed up to their previous pandemic levels, she said, but are seeing the same volume of patients or even an increase.

“Everyone is working a little harder, and emotions are running high for everyone, whether it’s the patient and their own belief systems or our staff and what they have going on. Tensions are brewing right underneath the surface,” she said.

The additional restrictions placed on patients, such as wearing masks at all times or not being able to be accompanied by a family member unless absolutely necessary, have contributed to the tension during the day.

Surgeons need to be aware of their own health and recognize the signs of burnout before it becomes too late, she said.

“It’s very important, and now more than ever as we do what we need to do to take care of this higher volume of patients, to be mindful that through it all that somehow we’re not forgetting to take care of ourselves. Our health is so important. It’s imminent that if we continue at this pace, we are leaving ourselves more vulnerable to illness,” Yeu said.

Will the trend continue?

There are too many factors to predict if the uptick in refractive procedures will continue, Yeu said. As practices move into the fall, when the flu becomes more prevalent and COVID-19 cases may increase, surgical procedures may possibly decrease.

But when a vaccine is released, the weather warms up, or hospitalizations level out or dip down, the trend could increase again, she said.

“I think it will go up and down, but I think we’re going to see this higher volume overall for quite some time,” Yeu said.

The future is unknown, but practices should feel more confident moving forward after having survived a global pandemic. If there is a second or third wave, something that will require another long shutdown, practices should be better prepared with the lessons they learned from earlier this year, Waring said.

COVID-19 is not going away, but practices should be better suited to reach patients and service their clients physically with the strategies they have implemented.

“There are many silver linings of this pandemic for practices. One, you’ve learned what is important in your practice, to be able to reevaluate your priorities, to streamline your processes and have time to improve. Two, the renewed interest in vision correction has been a true gift that we can help so many people and now even with less overhead because we streamlined our processes,” Waring said.

Nobody knows what will happen in the coming months, how the pandemic will turn out or what new restrictions may be placed on practices, Berdahl said. Interest in refractive surgery should remain high as long as the economy is sustained, but if the economy dips and patients begin to worry about finances, their interest in refractive surgery will likely follow.

Click here to read the Point/Counter to this Cover Story.