After a strong initial uptake of laser cataract technology since its introduction nearly 2 years ago, we expect the expansion of this important market segment to continue. The LenSx Laser (Alcon Laboratories, Inc.) was the first word in US laser cataract technology, but it will not be the last. Although the manufacturer should be able to leverage its first-tomarket status and maintain its market-leading position, more recently cleared and launched systems from OptiMedica Corporation, LensAR Inc., and Bausch + Lomb and Technolas Perfect Vision GmbH (and from Ziemer Ophthalmic Systems AG beginning in 2013) will compete effectively based on their different technologies.
During the next few years, we expect that the laser companies and surgeon investigators will be able to demonstrate in clinical studies that this technology delivers measurably improved refractive outcomes to patients. Ultimately, this evidence could lead to changes in governmental policy that would allow surgeons to balance bill patients for the laser in cases involving conventional IOLs but without the use of the laser to correct astigmatism based on overall refractive benefit. Trying to predict changes to Medicare policy, and the timing of such changes, however, is not for the faint of heart.
Even when a refractive benefit of laser cataract technology is proven, it is likely to remain uncovered by Medicare and other payers for the foreseeable future due to ongoing financial pressures on the health care system. As long as patients continue to find a way to pay for the technology out of pocket, it will be in the interest of both providers and laser manufacturers to maintain this offering as an elective upgrade.
Laser cataract technology will not be the force that increases the market penetration of premium IOLs. Improvements in IOL technology itself will have to drive this shift.
Looking ahead 5 to 6 years, we forecast that laser technology could be used in 800,000 out of 4 million total US cataract procedures, representing 20% market penetration. The placement of 120 to 150 lasers per year in the United States during this time frame suggests an installed base of about 800 lasers. Usage of each laser by three to five active cataract surgeons could drive annual procedural volumes of about 1,000 per laser. Alternatively, using a top-down approach to the market, an overall US procedural penetration rate of 20% would represent the technology’s adoption by surgeons who are responsible for 60% of all US cataract procedures, with the use of the laser in one-third of these procedures. Based on these procedural volumes, the annual US market for laser technology at the manufacturer level would reach approximately $350 million, and annual procedural fees of approximately $750 million would be generated in the United States.
Predictions beyond this time frame require a crystal ball that we do not possess. We can, however, look for precedents in laser vision correction: the excimer and femtosecond laser platforms took more than 10 years to become firmly rooted offerings, especially if one considers the regulatory premarket approval process required for the former device. Although we do not foresee all cataract surgery is being performed with a laser (due to ongoing financial considerations as well as surgeons and patients who are reticent to adopt new technology), we anticipate that approximately half of all cataract surgery in developed nations will ultimately be performed using a laser. An additional “X factor” is at hand: we have not yet seen the full capability of the femtosecond wavelength. It is our assessment that ongoing research and development strongly suggest that many more applications will be developed to further refine cataract surgery and other ophthalmic procedures.
Mr. Lachman is a consultant to Abbott Medical Optics Inc. and has a financial interest in LensAR Inc. Shareef Mahdavi is president of SM2 Strategic and section editor for Cataract & Refractive Refractive Surgery Today’s “Premium Practice Today” feature. He is also a partner in Spectacle, a consulting firm that helps surgeons successfully integrate laser cataract surgery into their practices. Mr. Mahdavi may be reached at (925) 425-9900; firstname.lastname@example.org.