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Finances And The Market | Mar 2015

How We Have Weathered the LASIK Market

The experiences of two refractive surgeons.

By Stephen Coleman, MD


LASIK is all I do. It is all I have ever done. Although the overall market has at times been quite volatile, my practice has generally remained consistent over the past 18 years. (For more on Dr. Coleman’s bullish attitude about LASIK, visit eyetube.net/?v=iluke.) A long list of macro- and microfactors account for this, I am sure, but in discussions with friends, I find myself repeating some fundamentals that have not changed for me over the years. Here are three things in my practice that I have never done and three that I have always done.


No. 1. Surveys

Receiving a survey on my phone just as my bags are being stowed in the trunk can diminish a wonderful stay at a great hotel for me. I have never tracked phone calls or leads or sent out a survey to evaluate patients’ satisfaction. Instead, I consider the day of a consultation to be an opportunity to shine, and if it is executed properly, the next phone call should come unprompted from a future LASIK patient. Identifying a potentially dissatisfied patient requires practice and is almost always directly related to a residual refractive error, which I address aggressively.

No. 2. Discounts and Promotions

I have never offered any type of time-limited discount or promotional price, regardless of the state of the economy. I have also avoided tiered pricing. I know many doctors who successfully use these strategies, and they work in many areas. Patients to whom I have spoken over the years who have been offered one of these financial incentives at another practice, however, have generally seemed confused and a little frustrated.

No. 3. Additional Fees

I have never charged patients additional fees on top of my practice’s global fee for LASK. All eye drops, medications, and a night at the Courtyard Marriott that is a 1-minute walk from my office are included. New Mexico is a rural state, so driving long distances is common. Making LASIK straightforward for my patients has always been my approach.


No. 1. Prompt Postoperative Management

I have always examined all of my patients on the morning after their LASIK procedure. If I cannot be there on Saturday morning, I do not schedule LASIK on Friday, which is typically my busiest day. In my experience, most post-LASIK problems can be eliminated on the first postoperative day through explanations, a customized eye drop regimen, addressing subtle issues related to the flap, or paying strict attention to the epithelium. As an attending surgeon once told me during my training, not making rounds immediately after surgery is like bowling through a curtain: you cannot truly know your results, validate what you have communicated to a patient preoperatively, or adjust your surgical technique if you do not see patients postoperatively. It made sense to me then, and it makes sense to me now.

No. 2. Enhancements

I have always focused heavily on my enhancement rate and, more specifically, on how these patients are handled. Regardless of how a surgeon determines or defines this number, it is the most important percentage in any practice. If a primary LASIK procedure is mostly a science, enhancements are mostly an art that takes into account how, when, and why. Paying strict attention to this number may help to decrease or eliminate the need for satisfaction surveys.

No. 3. Screenings

I have continually worked to improve my accuracy in determining who the ideal LASIK candidate might be. As a result, my selection criteria have consistently narrowed over the years, even as laser parameters have expanded. This is particularly the case for hyperopes. Healthy young adults with mild to moderate myopia are my target population, and making the entire LASIK process straightforward and pleasurable for this demographic has always been one of my primary goals.


The future of LASIK is bright. The 78 million baby boomers accounted for the initial spike in LASIK volume. Refractive surgeons are currently muddling through Generation X, a group numbering 46 million at most. Up next is Generation Y, which at 78 million rivals the baby boomers but with some distinct advantages for surgeons: Millennials are comfortable and familiar with technology, and they inherently understand the precision, accuracy, and reproducibility offered by lasers. Customizing preoperative screenings, financing, and postoperative visits for this demographic will be the key to successful LASIK practices going forward.

By Louis E. Probst, MD

Ever since the sudden drop in LASIK numbers in 2008, succeeding in this market has been a challenge. The smaller LASIK pie has to be cut into smaller pieces because of all the providers. Many refractive surgeons have elected to diversify by getting back into cataract surgery, or they have stopped performing refractive surgery altogether. I decided instead to double down and fully commit myself to resurrecting my LASIK practice. As of 2015, I have succeeded, but it has required some significant adjustments.


During my 20 years as a LASIK surgeon, I have always comanaged my LASIK patients. Comanagement has been a particularly good model for me during the recession, because optometrists are the gatekeepers for myopes and provide excellent care for my patients. Except for value LASIK providers who can advertise a low price, direct marketing is not currently cost-effective, because this advertising reaches fewer interested patients and it has become hard to differentiate one provider from all of the others. Since the last recession, I have instead focused on providing the best possible service to my patients and their optometrists.


With LASIK volumes still only increasing by single digits year to year, I needed to enhance my services. One strategy has been to expand my practice’s hours of operation by providing evening and weekend consultations and Saturday procedure days. This change was a tough sell to my staff members, who were not accustomed to working weekends. Years later, however, I can say expanded hours are very popular with my patients. They are generally successful and employed individuals, so offering services when they are off work makes sense in the same way it does for other retail businesses.


Because I work with TLC, which has centers across the United States, I was able to increase my volume by providing LASIK at more centers. In 2008, I was performing LASIK at three centers. Now, I perform LASIK at five centers, and that number will soon rise to six. The increased travel has been hard, especially because of my grade school-aged children, but as a 100% refractive surgeon, I needed to make the change. Fortunately, my wife is also a physician, so she understands the commitment required. That said, we constantly review our work status to make sure that we have maintained an appropriate balance.


At present, I find myself in an interesting situation. The busy procedure days that can require me to change my travel plans have returned. My staff is busy again. The path to this point has been long and required many adjustments. The improved economy has certainly helped, but my LASIK practice is finally back at full force. n

Stephen Coleman, MD
• director, Coleman Vision, Albuquerque, New Mexico
• (505) 821-8880; stephen@colemanvision.com

Louis E. Probst, MD
• national medical director, TLC Laser Eye Centers in Chicago; Madison, Wisconsin; and Greenville, South Carolina
• (708) 562-2020

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