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Cover Stories | Mar 2006

A Shift in Focus

Will IOLs shift to the front of the refractive class?

After dominating the attention of refractive surgeons for more than 1 decade, LASIK may soon find itself sharing the stage with a new class of refractive lens implants aimed directly at aging baby boomers.

Looking strictly at the numbers, it is easy to see why this shift in refractive focus is already starting to occur. As of January 2006, the first group of baby boomers—the segment of the population born after World War II—began turning 60. If you're wondering why that is significant, baby boomers are the most powerful group of spenders in history. They are also now officially the largest segment of the population and control 70% of the wealth in the US.

During the past decade, there has been a 12 million-person increase in the number of people over 50. Compare that with a 9 million-person increase in the 18-to-34 age group, and it's obvious that the majority of today's population is simply getting older. Those of us in this 50+ age group, however, are not taking aging lightly.


The over-50 boomers have a much different approach to middle age and beyond than their predecessors. In an article published in the Houston Chronicle,1 David Kaplan pointed out how intent baby boomers are on trying to stay young. He wrote, “Products catering to the boomers are ready to explode.” He also quotes Ken Dychtwald, PhD, founder of Age Wave, a firm in San Francisco, California, that provides consulting for product/service development for boomers and mature adults, who says, “This group is a marketer's dream.” Kaplan goes on to point out that today's seniors have a revolutionary approach to aging and eschew anything that says “old.”

What this dominant population segment wants is to remain hip and youthful. They see themselves as vibrant and excited about the future. They want to stay mentally and physically active and open to new experiences. Kaplan and others quoted in the article point out that these individuals are not necessarily loyal to particular brands or products.

What baby boomers don't want is to look or feel their age. They disdain things like large-buttoned telephones and appliances obtrusively designed for the limitations of aging. Finally, boomers seem to deplore specific products and services that are designed and targeted to “seniors.” This brings us back to why a sudden shift in the focus of refractive surgery may soon be occurring. What's the universal sign of aging? Reading glasses and bifocals. With even a cursory knowledge of the lifestyles and purchasing habits of this population, it appears highly unlikely that this group will embrace their visual limitations.

If there ever were a group ideally situated for refractive lens exchange, this is it. After all, many in this age group were the same people who would not accept wearing glasses or contact lenses and helped establish LASIK as the most successful refractive procedure ever performed.


Let me point out there is no need for LASIK surgeons to panic. The LASIK market is as healthy as ever, and the shift I discuss here will be gradual. LASIK surely will continue to evolve into a more refined procedure, and there will always be a significant portion of the population who are not ideal candidates for refractive lens exchange and could benefit greatly from procedures like LASIK.

From the perspective of sheer market size and potential penetration, however, it's hard for a refractive surgeon not to lick his chops when comparing the LASIK market to that of refractive lens exchange. According to David Harmon, Publisher and Editor of Market Scope (St. Louis, MO), there are approximately 1.4 million LASIK procedures performed each year, on average (oral communication, November 2005). Of the 121,811,460 people in the 21-to-49 age group (which includes two market segments), 27% are myopes, who make up 85% of all LASIK performed. When you look at an estimated market penetration rate for LASIK of 4% to 5%, that number is almost identical to the 1.4 million procedures performed each year. That alone is a healthy number of patients for refractive surgeons.

However, a glance at the over-50 numbers reveals a much greater opportunity. There are currently more than 111,846,000 people in the US over age 50. Annually, 2.7 million cataract procedures are performed (mainly in the 65+ target group). However, virtually 100% of the over-50 segment are presbyopic, and probably close to 100% show at least early signs of cortical changes. Thus, almost 100% of this population are possible candidates for some type of lens implant procedure—the largest market in ophthalmic history.


When marketing the new premium IOLs to these patients, they should be classified as two distinctly different markets: the 50- to 64-year-old presbyopes and the 65+ cataract patients. The younger presbyopes will soon be seeking greater freedom from their reading glasses and bifocals. Product promotion to this age group is still in its infancy and can be compared to the early days of LASIK, when the benefits of the procedure were the main focus of advertising. A higher-than-normal percentage of presbyopes still read the newspaper and consistently view major affiliate television. Messages in these two media promoting new lens technology to help reduce or eliminate dependence on readers and bifocals are already showing signs of success. An added bonus to presbyopes undergoing refractive lens exchange is that they will never need cataract surgery.

The cataract patient is a horse of a slightly different color. A high percentage of these patients already know they have at least early signs of cataract development. They also are quite familiar with Medicare coverage. What they don't necessarily know, but are showing signs of high reception to, is that for the first time in medical history, they have a choice when it comes to their cataract procedure. The knowledge of the option to upgrade to a premium multifocal lens is already resulting in a 15% to 20% conversion rate in some practices. Although the out-of-pocket expense will still keep the premium lenses out of financial reach for some seniors, others are delighted to learn that Medicare will at least pay for a portion of their premium implant.

External Marketing

Because of declining reimbursements in cataract surgery during the past decade, very little advertising has been conducted in this field. Now, with the average cataract surgeon charging an additional $1,500 to $2,000 per eye for premium lens implants, I expect more cataract surgeons to return to advertising their services.

Seniors are responding well to these early marketing efforts that promote this exciting option for cataract surgery. These consumers still read and respond to many kinds of direct mail, especially newsletters. Direct mail invitations to free health and vision screenings are effective methods of reaching seniors, as are more traditional methods such as print ads in the obituaries section of the newspaper. Seniors also watch a large amount of daytime television, and advertisements for those time slots are less expensive than for prime-time television.

Internal Marketing

With internal marketing, the main challenges practices are already encountering with refractive lens exchange are the time and effort it takes to properly educate patients on the procedure's benefits and costs. The practices that are enjoying the most success are those with previous experience in refractive surgery. They excel at patient education and expectations management, and they have the right people for the job in all the right places.


One area gaining a lot of attention is surgical scheduling. Typically, scheduling was done by a staff member who simply asked the patient which Monday was best for him to have his cataract surgery. Since Medicare or insurance usually paid all or most of the bill, financial discussions (obstacles) were rarely a problem.

However, with today's refractive lens exchange procedures, patients spend a lot of time asking questions about lens choices, payment options, and Medicare coverage. It takes a qualified counselor to help the new refractive lens exchange patients make an informed decision about whether or not to upgrade to a premium IOL. It also takes more chair time for the surgeon in the lanes.

Additionally, surgeons and staff need to be careful about overpromising and underdelivering with refractive lens exchange patients. It's easy to get overly zealous about the potential of these new lenses when you see the prospective revenue stream they can generate. But, as many surgeons are finding out, 55-year-old hyperopic presbyopes paying $10,000 for bilateral refractive lens exchange surgery can be very demanding, chair-time–chewing patients if their results do not meet their expectations.


Yes, the market is huge, and the potential is even greater for the refractive lens exchange procedures. Let us all enter this new arena with the proper educational mindset and carefully grow this segment of ophthalmic surgery into what surely will become the most dynamic and life-changing movements in medical history. 

Michael W. Malley is 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.

1. Kaplan, D. Look who's turning 60. A new age for boomers. Houston Chronicle. August 21, 2005:A1, A16.
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