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Today's Topics | Jan 2011

Forecasted Volumes of LASIK and Presbyopiacorrecting IOLs for 2011

What do you anticipate laser vision correction and premium and presbyopiacorrecting IOL volumes will look like in your practice, in your geographic area, or for the nation in 2011?

The peak period for LASIK volume, which was about 10 years ago, was fueled in part by a large and highly motivated target audience—78 million baby boomers. The relatively small size of our current laser-eligible population, the 46 million Generation X, in the setting of an economic downturn has resulted in our current 50% decrease in procedural volume. But, be patient. There is a 76-million-strong, extremely tech-savvy Generation Y coming of age in a world where LASIK is a household word. In the short term, LASIK volumes will likely remain relatively flat, but on a percentage basis, mature practices will slowly regain local market share that was lost primarily due to discounting corporate centers in the immediate aftermath of the peak-volume years. Most new technology is initially criticized for its price tag; laser cataract surgery is no exception. The cost issue will begin to disappear as the enormous benefits of this approach become widely apparent and premium IOLs take center stage in ophthalmology.

I believe that LASIK recovery is going to be regionally variable. I have personally seen an increase in procedural volumes, mostly as a result of those patients who feel more secure about their jobs. The high unemployment rate has most people still worried about their job stability, and this affects LASIK volumes. We tend to think of the economy as the stock market, which can be followed from day to day. Most of the young patients who are having LASIK are worried about whether they will qualify for financing, and this often has to do with their jobs. I suspect that we will see 10% growth in LASIK volumes here in the Midwest. The volume of presbyopiacorrecting IOLs continues to grow slowly as we learn more efficient ways to counsel and select appropriate patients, and yet it is still lower than expected, given the advances in spectacle independence that these lenses provide. I think a growth in presbyopia-correcting IOL volumes of 2% to 4% annually should materialize over the next 2 years.

I believe LASIK volume will be up 20% if the trend continues, but it will still be down from previous years. The volume of presbyopia-correcting IOLs continues to increase every year. It is up 15% this year, and I suspect, if October 2010 is a good indication, it will be up even more in 2011.

I suspect that LASIK volume will be flat, even as the economy recovers, with a continuing shift to younger patients and more enhancements on patients who had LASIK 5 to 10 years ago. Premium IOL volume is only 7% of IOL implants now, an absurdly low number given the advantages of these lenses. Volume has been held back in part by the economy. A bigger problem is that physicians are not yet comfortable explaining the benefits of these lenses or handling refractive surprises with LASIK and other modalities. I predict strong growth in premium IOL volume as the economy improves, physicians communicate better, and they develop expertise in laser vision correction.

Although most refractive surgeons were hoping for some sort of recovery in 2010, LASIK volume was disappointingly flat last year. Despite a modest improvement in the economic indicators, discretionary spending continues to be restricted as people opt to save money rather than spend it. The Consumer Confidence Index (CCI) has generally followed LASIK volumes over the past decade. Even though the CCI is up to the low 50s from the low 20s in April 2009, it is still a long way off from the LASIK boom years of 2004 through 2007, when the CCI was often above 100. I expect a modest improvement in LASIK volumes and the CCI in the 5% to 10% range for 2011. Due to the private-pay component of presbyopia-correcting IOLs, I expect volume in this area will follow a similar pattern.

Laser vision correction volumes are on the decline if we look year to year in my region of the South, but there are many issues revolving around the decline. First, I have always followed the CCI as a barometer of surgical volume, but this information has been confusing lately. Our practice had pretty level year-on-year volumes in the early months of 2010, but the CCI was at an all-time low. In May, we had a marked decline in volume, but the CCI rose more than 5 points from April to May. So, our typical barometer is not helping. Second, unemployment and global uncertainty are affecting our current volumes. In North Carolina where I live and in the surrounding states, the unemployment rate averages 11%. When worried about employment, patients are less likely to spend money on elective procedures. Third, the recent European economic crisis and its global repercussions have affected laser vision correction volumes. Last, I think the refractive market is changing. One sign for my centers has been an almost 10-year decrease in the average age of laser vision correction patients. Many of our older (traditional) patients are choosing premium IOLs instead of laser vision correction.

Although we have been advertising more than in the past, laser vision correction volumes are flat, but we do have a higher conversion rate than ever before. I think this is related to patients who are truly interested in surgery and not just “kicking the tires,” so to speak.

Section Editor John F. Doane, MD, is in private practice with Discover Vision Centers in Kansas City, Missouri, and he is a clinical assistant professor with the Department of Ophthalmology, Kansas University Medical Center in Kansas City, Kansas. Dr. Doane may be reached at (816) 478-1230; jdoane@discovervision.com.

Stephen Coleman, MD, is the director of Coleman Vision in Albuquerque, New Mexico. Dr. Coleman may be reached at (505) 821-8880; stephen@colemanvision.com.

David R. Hardten, MD, is the director of refractive surgery at Minnesota Eye Consultants in Minneapolis. Dr. Hardten may be reached at (612) 813- 3632; drhardten@mneye.com.

Douglas Katsev, MD, is in private practice at the Sansum Santa Barbara Medical Foundation in California. Dr. Katsev may be reached at (805) 681-8950; katsev@aol.com.

Robert K. Maloney, MD, is the director of the Maloney Vision Institute in Los Angeles. Dr. Maloney may be reached at (310) 208-3937; info@maloneyvision.com.

Louis E. Probst, MD, is the national medical director of TLC The Laser Eye Centers in Chicago; Madison, Wisconsin; and Greenville, South Carolina. Dr. Probst may be reached at (708) 562-2020.

Karl G. Stonecipher, MD, is the director of refractive surgery at TLC in Greensboro, North Carolina. Dr. Stonecipher may be reached at (336) 288-8523; stonenc@aol.com.

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