The impact LASIK has had on the ophthalmic and refractive surgery industry has been remarkable. Sources have indicated that since 1995, when the baton was passed in the US from incisional keratotomy to excimer laser refractive surgery, procedural volumes have soared to over 1,000,000 eyes treated annually, creating a multibillion dollar-per-year industry. All segments of the ophthalmic industry—private refractive surgery practices, multinational corporate laser service providers, manufacturers of excimer lasers and microkeratomes, and the associated industries of small surgical instrument manufacturers, as well as numerous trade publications—have felt the enormous impact of LASIK. Prior to laser vision surgery, ophthalmic practice comprised mainly three areas: medical/surgical care, routine vision care, and optical/contact lens services. Once LASIK gained acceptance as a refractive treatment, vision enhancement became more than just a restorative procedure. The demand for laser vision correction created new jobs on both the industry and service sides of refractive surgery. Virtually overnight, vision care became a hot topic, and LASIK was the central theme. Refractive had arrived.
The LASIK phenomenon had several factors working in its favor: quick recovery, the ability to treat astigmatism, wide capacities for spherical correction, and a promising overall safety record. Industry capitalized on the boom. Laser manufacturers, excited by sales of disposables and per-procedure royalties, promoted a Star Wars-like image of the technology with terms like “ultraprecision,” “laser,” and “non-surgery.” While third-party payer reimbursements were declining, a bull market economy was generating disposable income for patients and venture capital for manufacturers and corporate laser start-ups. Ophthal-mologists' phone lines were busy with prospective patients who wanted the same treatment from which a friend or relative had benefited. However, the bubble did finally burst, once the economy started to slow and negative reports of LASIK outcomes began to emerge. Although LASIK may currently be struggling to reestablish its foothold, refractive surgery has not been forgotten.
What all of us in the vision care business must remember is that even while patient volumes are waning, there are new technologies on the horizon that will have their own impact on the ophthalmic landscape. Untapped markets will be discovered as refractive vision correction gains public acceptance as a quality of life service. It is up to the next generation of treatments to build upon what LASIK has accomplished. With this first volume of Cataract & Refractive Surgery Today, we have the opportunity to look at these young lions that will either attempt to overtake the king of the refractive jungle, or remain in its shadow.
