Disclosures: Brinton and Pinto report no relevant financial disclosures.
October 08, 2020
4 min read
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Will the increase in refractive surgery be sustained over time, or is it temporary?

Disclosures: Brinton and Pinto report no relevant financial disclosures.
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POINT

A perfect storm

Demand for LASIK and vision correction surgery fluctuates over time.

There is a seasonality to most consumer spending within the year as well as both economic and non-economic factors that put upward and downward pressure on refractive surgery volumes over time. It would be bold to say that the current lift is permanent, although it is worth considering which aspects of our present situation have staying power.

Jason P. Brinton
Jason P. Brinton

Without question, we are seeing an increase in LASIK demand due to “foggy glasses syndrome.” In an article for Good Housekeeping magazine in April, I shared several strategies to keep glasses from fogging up while wearing a face mask. These strategies provide temporary benefit, however, and none of them gets rid of foggy glasses better than just getting rid of glasses. When it comes to wearing contact lenses, patients intuitively understand that touching their eyes multiple times per day during a viral pandemic is undesirable. In some reports, up to 50% of patients acknowledge handling contact lenses without washing their hands. Contacts can be problematic even for those who are careful to always wash their hands. Surveys show that 94% to 96% of Americans think they wash their hands properly, but a USDA study published in May 2018 showed that we are doing so just 3% of the time. Despite the increased public awareness around the value of thorough handwashing, “rinse, rinse, flick” still equates to hand hygiene for many of our St. Louis contact lens-wearing patients booking LASIK consultations.

We are hearing from some patients that it is easier for them to come to an appointment when they are “working from home,” and doing less work in the office has left some with more time to work on self-improvement. Finances that were previously devoted to the travel, tourism and hospitality industries are being spent elsewhere, such as home improvement and self-betterment. These factors have created a perfect storm to buoy LASIK. If an effective vaccine is developed by this coming year, as we all hope, and is broadly accepted and administered by 2022, then much of this additional demand is likely to subside.

There is more to the recent increase in LASIK demand than foggy glasses and the hygiene issues that come with contact lens wear, however. People are spending more hours of their day at home and are giving more time to their loved ones. This has led many to reprioritize their time and resources, favoring expenditures that provide lasting value. This favors LASIK. Successful refractive surgery provides better vision than glasses or contacts, is safer than contact lens wear, and saves money over a lifetime (in the words of my fellowship mentor, Dan Durrie). Educating patients about these benefits is timeless.

Jason P. Brinton, MD, is a Healio/OSN Board Member.

COUNTER

Possibly not long lasting

John B. Pinto
John B. Pinto

I have been involved with corneal refractive surgery since the early ’80s when radial keratotomy came to full bloom in America, and every surgeon client wanted to open an RK clinic. Those were the days. You could fully equip a RK suite for $50,000, and the biggest clinical controversy was, “Should we use diamond or sapphire blades?” Five thousand dollars was a big monthly marketing budget, and because we were serving the large baby boomer bulge (the same patients choosing premium IOLs today), business flourished.

For the last 35 years, it has been interesting to observe the refractive surgery tide roll in and out. Mostly out.

  • Case volumes dropped when the Twin Towers fell 19 years ago and again in 2008-2009 with the great recession.
  • Premium IOLs and a run-up in senior patients created a professional and business opportunity that drew anterior segment surgeons away from a faltering keratorefractive surgery space and toward the new bonanza.
  • The presumption was that the economic sequalae of COVID-19 would represent another downward leg for LASIK, but as the pandemic recedes, interest has begun to return to 2019 baselines in some settings, and slightly more than that in others — perhaps because those who were not unduly harmed economically had discretionary dollars left over from a year of deferred traveling, concerts and dining out. If we are seeing a “bloomlet” today, I do not believe it will be long lasting.

What is the future? Here is my bet and counsel:

  • As more patients have LASIK, fewer are left to operate on, and more patients are entering an age range when lens-based correction is more sensible than cornea-based correction.
  • There is so much work to do in geriatric eye care that fewer and fewer surgeons will be interested in LASIK each year, and frankly, it is LASIK surgeon interest that drives what is spent on direct-to-consumer marketing, which in turn drives case volumes. LASIK is driven at least as much by surgeon pull as the customer’s push.
  • Surgeons who are intellectually and professionally attracted to LASIK will (and should) see more case volumes; their lower-volume, less interested, less committed colleagues will (and should) continue to withdraw from this segment of care.

John B. Pinto is the OSN Practice Management Section Editor.

Click here to read the Cover Story, "Refractive surgery on the rise during COVID-19 pandemic."