The Mindset of the Refractive Patient

In When laser refractive surgery became available in the US in 1995, the refractive surgery market included fewer than 1,000 surgeons who had performed radial keratotomy (RK) or automated lamellar keratomileusis on a total of 400,000 patients. Ten years later, approximately 4,000 US ophthalmic surgeons have performed a combined lamellar/laser procedure (LASIK) on more than 4 million patients.

Refractive surgery has emerged as its own consumer product category, with high public awareness of LASIK—a stark contrast to earlier days of refractive surgery, when consumers were trying to understand the difference between RK and PRK.

Although a recent survey (data on file at Intralase Corp., Irvine, CA) indicates that more than 80% of myopic patients agreed that not having to wear glasses or contact lenses would be great, this desire has not translated into action. To date, approximately 700,000 Americans undergo LASIK each year in the US. The cumulative 4 million patients treated thus far represent only 7% of the 60 million Americans who are considered prime candidates for the procedure (Figure 1). Furthermore, this pool will continue to expand as the number of Americans reaching adulthood each year exceeds the number having LASIK. The gap between desire and action can largely be attributed to consumers' fear of undergoing surgery on their eyes. It is important to note for the purpose of comparison that contact lenses, which have been around a lot longer than refractive surgery, have never penetrated beyond 20% of the spectacle-wearing population. Low prices in both categories have failed to significantly increase the demand for alternatives to spectacles. Consumers' fear about anything's or anyone's touching their eyes will likely reign in refractive surgery for years to come.

Technology will play a role in reducing consumers' fears. Ophthalmic technology is expanding the refractive surgery category beyond lasers to include nonlaser approaches (conductive keratoplasty [CK; Refractec, Inc., Irvine, CA]), implants (IOLs), and even inlays (Permavision; Anamed Inc., Lake Forest, CA). These technologies have the potential to make refractive surgery more acceptable to the masses by increasing treatment options for all consumers while continuing to raise the bar regarding both safety issues and the efficacy of results (Figure 2).

Indeed, the explosion in refractive surgery technology puts a pressure on providers that didn't exist with the “one size fits all” mentality associated with LASIK. Nomograms for treatment will have to incorporate lifestyle and vision task needs on par with age and refractive error. Certainly, the complexity involved in future refractive procedures will create a significant burden on the surgical protocol.

The increased complexity facing surgeons translates into a potentially negative situation for consumers. In addition to new choices afforded by evolving technology, new descriptors of procedures will emerge such as temporary, removable, and (eventually) adjustable. This development in refractive surgery is good, but, if left unmanaged, the messages delivered by providers through their advertising and educational efforts run the risk of creating even more confusion in the marketplace and delaying consumers' decision making as they try to figure out which procedure is best for them.

No single procedure will be “best” in the way that technology has evolved thus far. The tried and true marketing messages are likened to raised bets in Texas Hold ‘em: the laser was promoted as better than RK, LASIK as superior to PRK, and now wavefront-driven LASIK as better than standard LASIK. Those messages are rapidly wearing thin with consumers because of the diversity of refractive options becoming available and their consistently and comparably excellent results. Ironically, poor marketing might be the primary culprit in keeping refractive surgery from reaching its market potential. As an alternative to promoting new surgical technologies over older ones, surgeons will need to develop what I term marketing protocols with the same level of attention they give to surgical protocols to improve their clinical results. The concept of diagnose, recommend, treat can be applied to the marketing process involved with each prospective patient. That is, surgeons will need to gather a lot of data on each patient in order to understand his or her specific goals and fears. Because the data collection occurs prior to the recommendation of a treatment course, this approach will not be as easy as running an advertisement that touts LASIK's benefits and waiting for the phone to ring. Refractive surgeons' entire approach to marketing communications—from external advertising and promotions to internal counseling and written materials—will need to be extremely focused to segment and target the different subgroups of patients who will be most likely to benefit from a particular refractive technology.

In the days when the only tool refractive surgeons had was the hammer called LASIK, every patient looked like a nail. During the past decade, we have gained extensive insight and knowledge about what marketing tactics do and do not work for refractive patients. Refractive surgeons now have a growing list of tools at their disposal, and their marketing protocols will need to be formalized and disciplined in order to select the right tool for the job.

Shareef Mahdavi draws on 20 years of medical-device marketing experience to help companies and providers become more effective and creative in their marketing and sales efforts. Mr. Mahdavi welcomes comments at (925) 425-9963 or shareef@sm2consulting.com. Archives of his monthly column may be found at www.crstoday.com.