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Up Front | Mar 2005

The Market for Refractive Lens Exchange

Is it ophthalmology's Holy Grail?

If you're old enough to be reading this publication, you're probably old enough to notice that your near vision may not be as sharp as it used to be. Your intermediate-to-distance vision could probably use some help as well. We'll leave the gray hair and laugh lines for another article.

In concert with the President's focus on the burgeoning middle-aged segment of today's population, ophthalmologists are suddenly keeping a closer eye on the “tweeners,” as we say in Texas. That's refractive terminology for everyone who is too old for LASIK and too young for cataract surgery. It refers to everyone who will eventually be an ideal candidate for refractive lens implants.


In case you're wondering how huge the potential market may become for refractive lens exchange, just look around. How many colleagues do you see slipping on a pair of reading glasses or bifocals when they are not seeing patients? From soccer moms to Starbucks-sipping professionals on their way to the office, the bulk of the population is either headed for or is currently “enjoying” the visual challenges associated with middle age.

Despite the benefits of customized wavefront-guided LASIK, LASIK with IntraLase (Intralase Corp., Irvine, CA), or epi-LASIK, these procedures do not represent the ideal answer to the question presented to eye care practitioners daily by thousands of men and women: “Is there a better alternative to my reading glasses or bifocals?”

As we saw with the introduction of conductive keratoplasty (Nearvision CK; Refractec, Inc., Irvine, CA), the initial interest by surgeons was substantial, and advertising campaigns directly aimed at presbyopes generated an ample response from the public. These factors simply confirmed what most of us already knew: People were and still are desperately searching for a way to maintain a higher quality of vision throughout their entire life, despite their age or refractive error.

This generation of Americans won't settle for less. They've grown accustomed to working hard and taking advantage of today's technological advancements. Those for whom flat-screen plasma television sets, home entertainment centers, satellite radio and television, and high-speed Internet connections have become the norm will not settle for reading glasses or for waiting until they need cataract surgery to improve their vision. If properly informed about the potential benefits of refractive lens implants, these consumers will want them.

In the past 5 to 10 years, laser vision correction has represented a rather substantial blip on ophthalmology's radar screen. However, it will soon be overshadowed by the gathering storm of presbyopes and middle-aged consumers seeking better vision through other options. Eventually, Mother Nature runs her course and forces everyone to come to terms with presbyopia, which has unofficially become the Refractive Holy Grail. That's the true potential of the refractive lens exchange market.

There is little doubt that refractive lens exchange will have a major impact on the field of ophthalmology. It may never surpass the sheer volume of cataract surgeries performed, but in my opinion, that is only because cataract surgery is subsidized under our Medicare program with little or no out-of-pocket expense to patients.

By comparison, depending on a patient's age, refractive lens exchange has a major out-of-pocket expense, and only time will tell what effect that will have on its overall success. This brings us to the meat and potatoes of this article: With a higher price tag than any other refractive procedure, how do you effectively market refractive lens exchange to your patients?


To date, practitioners are using two primary methods to market the new refractive IOLs to patients. One is to target patients with cataracts who are still too young to qualify for Medicare benefits. This patient group is a fairly substantial percentage of the population, and most of these individuals have medical insurance that would cover their cataract procedure. The surgical results with this age demographic have been impressive, because these patients need more than just correction for presbyopia, myopia, hyperopia, or astigmatism. They also have reduced vision and compromised contrast sensitivity from changes in their crystalline lenses. So, even if they are not totally satisfied with the near, intermediate, and distance vision they gain from their lens implants, the quality of their overall vision is so vastly improved that it makes up for any visual limitations (usually of near vision) they may experience.

Practices targeting this demographic bill the patient's insurance company for the regular cataract removal and charge the patient an additional premium for the cost of the refractive lens. This approach obviously takes a big bite out of the financial obstacle of the procedure for most patients and makes it easier for some practices to build their volume. However, not every insurance provider allows the added billing, so be sure to check with each carrier beforehand.

The other method of marketing refractive lens exchange to patients is to target the 45- to 60-year-old age group, which is substantially larger than the age group of individuals 60 to 64 years of age. In this demographic, you can promote an effective alternative for reading glasses, bifocals, and trifocals. The early Crystalens (Eyeonics, Inc., Aliso Viejo, CA) campaigns have received a strong response in the 55-and-older demographic. Although the majority of these patients do not have sufficiently dense cataracts to ethically bill their insurance provider, these individuals are in their highest earning years. Therefore, it's not a question of whether or not they can actually afford a $5,000 lens implant procedure; it's whether or not the procedure's perceived value is equal to or greater than the $5,000 fee. This is where proper patient education comes into play.


To be able to convince patients that $5,000 per eye is a bargain for the quality of vision and lifestyle they will enjoy after surgery, you will need a well-trained counselor with the right patient information and materials to help patients make an informed decision. Don't expect to make a dynamic impression on patients—or to increase their perception of the value of the procedure and your practice—if you're handing out generic brochures and copies of poorly designed information sheets. The higher the cost of your procedure is, the higher the quality of your presentation materials needs to be. Engage patients with interactive DVDs that depict the aging of the human eye and how advanced lens implant technology can bring their world back into focus. Encourage them to take home a DVD or CD-ROM to learn more about how this technology will change their lives. Create customized brochures that clearly show the benefits of refractive lens exchange, the history of your practice, and the quality and training of your surgeons. These materials may seem like a big expense, but the money you spend to properly educate your high-end patients will pay huge dividends when they choose to have their procedures performed at your practice instead of your competitors'.


Do not assume that your LASIK coordinator or surgery scheduler has the ability to start counseling potential refractive lens exchange patients without additional training. These employees will need to know the qualities of an ideal candidate, the realistic expectations for most patients, recovery times, pain and discomfort issues, possible risks and complications, and the entire process from work-up to postoperative recovery. Perhaps even more important than this knowledge will be the coordinator's ability to enhance the scheduling experience in such a way that finances do not become an obstacle, too. There is a definite sales aspect to this area of scheduling, but a good salesperson never has to actually “sell” the procedure to anyone. He is able to present information and options in such a manner that the patient simply agrees with the information being presented and makes an informed decision. Patients do not want to feel that they are being “sold,” and that is where a good counselor can be worth his weight in gold. I've said it before in numerous columns: Do not leave your practice's future in the hands of unqualified surgery schedulers or counselors.

In my company's most recent focus-group study in Houston with postoperative customized Intralase refractive surgery patients, my staff and I were reminded why the specialty's penetration rate for LASIK remains below 5%. The two main obstacles preventing 95% of the population from having LASIK are fear and finances, not necessarily in that order. To be able to overcome these deterrents, your counselor or surgery scheduler needs to properly allay patients' fears about refractive lens exchange and demonstrate affordable ways they can pay for it. Regarding safety, promote the features of your ASC, such as your low infection and complication rates and the fact that cataract surgery and IOL implantation have become the safest and most successful surgical procedures performed today.


If you thought it was difficult to get patients to pay $2,400 per eye for customized wavefront laser technology, imagine the difficulties you'll face when you hit your patients with a $5,000 per-eye fee for refractive lens exchange. That's why it's imperative to introduce affordable financing options early in the conversation, even before you mention the actual price and sticker shock sets in. Offer financing to everyone, not just the patients who think they can't afford full payment or whom you think might need financing. Enlighten all potential patients about the benefits of preapproval, online approval, zero-percent–interest financing, and other alternatives. Your goal with financing is to shift patients' focus from if they can afford it to which financing option best fits their budget. Partner with a finance company that simplifies the online process and offers rebates, feedback, and unsurpassed customer service. Compare finance companies based on overall approval rates versus the lowest interest rates. Patients who are refused financing are less likely to undergo the procedure in your clinic because the experience is both personally embarrassing and damaging to their credit.


The FDA's recent labeling of refractive lens implants has been surprisingly generous. Some products allow practitioners to advertise “near vision, distance vision, and everything in between.” That's very strong copy and music to the ears of every consumer frustrated by reading glasses, bifocals, or trifocals. Although the new implants are being approved to treat cataracts, the cataract market is not the target demographic for refractive lens exchange. As I mentioned earlier, it is the 45- to 64-year-old segment of the population. For print ads, feature people in this age range. Make sure your headlines address the problems most patients are encountering. One effective print campaign in Dallas shows a driver looking out a window at road signs and other objects at various distances. The headline says, “See far, see near, see intermediate.” It's not an extremely creative or catchy headline or layout, but it reflects exactly what patients want to experience.

In your advertising, you can effectively use many of the same media as for LASIK. Radio, newsprint, and television are your three best options. This slightly older demographic still comprises fairly loyal newspaper readers. To introduce something as exciting as this technology, think bigger rather than smaller. Design an ad with a large effective headline. For example, “New Vision for Middle-Aged Eyes!” leaves room for an attractive photo. Also, do not get too specific or lengthy with the copy. You do not need to promote the name of a specific lens or manufacturer for the ad to be successful. Patients are more interested in the benefit and result of the procedure than in the name of a lens or manufacturer, although these may become more important as accommodating IOLs start competing against newer multifocal lens implants entering the market.

For radio, remember to target older and perhaps more professional listeners. News talk programs for men and women work great, as do religious radio networks. National Public Radio would be an excellent choice for this demographic as well. Avoid advertising on Top 40 stations as well as rock and alternative music stations.

Potential television stations include both cable and network television. The absolutely most effective time to air television commercials is during the winter months, when days are colder, nights are longer, and more time is spent indoors. For cable stations, CNN, Fox News, A&E, TNT, H&G, and CNBC are your best bets. For network television, early morning times between 5:00 am and 7:00 am are affordable and effective. Noon news works as well. Prime-time spots are costly, and their cost effectiveness is sometimes difficult to determine. Keep in mind that television is a visual medium, and nothing will tarnish your image quicker than a poor television commercial, regardless of the offer.


Overall, the potential market for refractive lens exchange is larger than most of us realize. If you're currently limiting your practice to just laser vision correction, you may be positioning it poorly for the future. The good news for cataract surgeons is that the transition from offering only LASIK to including refractive lens exchange will be seamless. The integration may be more difficult for LASIK surgeons who are not properly trained or certified in clear lens extraction, cataract removal, and IOL implantation. Those tempted to hurry into this promising sector of refractive surgery regardless of their training will only hurt the specialty in the long run, because the media wolves are waiting at the window to prove wrong the potential of this promising new technology. Therefore, remember the three Cs in your selection process for patients considering refractive lens exchange: Be cautious, careful, and conservative.

Michael W. Malley is the President and Founder of the Centre for Refractive Marketing (CRM Group), an ophthalmic consulting/advertising agency established in 1988. Mr. Malley may be reached at (713) 839-0202; mike@refractivemarketing.com.
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