In early 2020, LASIK procedure volume and business appeared to be on an upswing. Industry numbers were showing treatment volumes in January and February on an upward trend compared to 2019. Then, in the middle of March, the COVID-19 pandemic changed the world.
Most ophthalmologists, eye care practitioners, and almost all so-called nonessential medical workers were forced to shut down. Practices that specialized in refractive surgery and commercial LASIK centers were not spared.
The uncertainty of what a medical practice might look like on the other side of the COVID-19 shutdown was frightening. Historically, LASIK has been a consumer-driven procedure. LASIK surgery had seen rapid growth in the late 1990s and then an acute reduction with the bursting of the internet bubble in the early 2000s. This was followed by another significant cycle of procedure volume growth and then another reduction following another bubble bursting with the great financial crisis of 2007 and 2008. Finally, after a decade of volume stagnation, procedure volume was again trending up, as the demographic driver changed to the millennial generation.
Many felt that the COVID-19 pandemic would significantly reduce LASIK procedure volume, as in previous economic crises. This feeling was primarily based on our knowledge that LASIK and refractive surgery are mainly driven by consumer sentiment and require significant discretionary income. To the surprise of many industry experts—including medical equipment manufacturers, commercial LASIK operators, and independent physician LASIK center owners—procedure volume has been robust, with a renewed level of enthusiasm. Many haven’t seen such enthusiastic growth since before the 2007–2008 crisis. The cause is probably multifactorial or, as some might say, a perfect storm of converging factors.
It seems that three main factors contributed to this perfect storm of resurgence in LASIK enthusiasm: financial motivators (which always play a significant role), lifestyle changes, and safety concerns.
Financial motivators. Over the past several years, there has been a clear demographic shift to the millennial generation, 80 million strong, as the main group of patients pursuing LASIK. Although this has been a challenging population to consistently market to, many of these individuals meet the economic and clinical criteria for a good LASIK candidate.
The millennial demographic was clearly affected by the COVID-19 pandemic. In mid-March, most nonessential workers started working from home. Most of this group of potential refractive surgery patients did not lose their jobs. They did not leave their houses, their meetings with coworkers occurred via Zoom, their screen time increased, and their workday became potentially indefinite.
Financial motivations for this massive group of patients during the pandemic-associated lockdowns are based on a lack of places to spend their disposable income. Almost overnight, many millennials had income to spend. Vacations and spring breaks were canceled. Couples with young kids had little to no childcare costs due to the closing of daycare centers nationwide. Summer camps were canceled. Gym memberships, personal fitness fees, and other monthly memberships were gone. There were no weddings or bachelor or bachelorette parties to attend. And on top of it all, there was a stimulus check with an extra $1,200. Because everyone was working from home, there was no need to spend money on clothes, no need to get expensive haircuts, manicures, pedicures, or significant personal grooming. No morning Starbucks, no happy hours after work. No concerts, sporting events, or any type of live entertainment to attend.
All these reductions in monthly spending—painful though some might have been—freed up significant disposable income that is now being used by many for LASIK surgery.
Lifestyle changes. A second factor that set up the perfect storm for refractive surgery volume to increase had to do with all that extra time at home, with individuals staring at their computer, phone, and tablet screens. People soon began to realize that staring at a screen all day resulted in increased eye fatigue. This was even more significant for those wearing contact lenses.
It is now not uncommon for patients to cite dry eyes from their contacts and the extra time they currently have as motivators for seeking LASIK. In consultations, patients often say that mask requirements have led to them “steaming up their glasses.” This is quite frustrating for patients and has been an unexpected and surprising motivator.
Safety concerns. The third motivator is the safety aspect—the possibility of viral transmission through hand-eye contact. Early in the pandemic, several articles hit the media suggesting that the novel coronavirus could be passed via the tears.1 Thanks to the media, patients became very aware of this potential route of transmission. Our staff continues to field questions about viral transmission through hand-eye contact daily. Although the tears are probably not a significant likely source of transmission,2 this seems to be one of the factors that has further motivated prospective LASIK patients.
WILL IT HOLD UP?
As we move through the summer and into the fall, it will be interesting to see if this enthusiasm for refractive surgery continues to hold up. As mentioned previously, refractive surgery has historically been driven by consumer confidence and upbeat economic sentiment. With ongoing economic uncertainty, the potential for sustained job furloughs and layoffs, and the continual potential for resurgence of viral spread, it’s hard to imagine that this perfect storm of LASIK enthusiasm will last. But we all hope that the storm continues to surge.
1. Bender K. The eyes have it: Novel coronavirus in eye can be communicable. Contagion Live. April 6, 2020. https://www.contagionlive.com/news/the-eyes-have-it-novel-coronavirus-in-eye-can-be-communicable. Accessed August 18, 2020.
2. Low Risk of Coronavirus Spreading Through Tears. American Academy of Ophthalmology. March 25, 2020. https://www.aao.org/newsroom/news-releases/detail/low-risk-of-coronavirus-spreading-through-tears. Accessed August 6, 2020.