Bringing LASIK into Your Office
If you're merely waiting for
co-management situations to improve, you may be missing out on
the most important LASIK trend to date.
By Neil B. Gailmard, O.D., M.B.A., F.A.A.O.
There's a revolutionary trend developing in optometry, and it
could change the types of vision care services we offer -- and
the way we derive income. Optometrists are beginning to provide
laser refractive surgery as part of their practices.
I'm not talking about laser consulting services, co-management
or even co-ownership of a nearby laser center. I'm talking about
building a laser surgery suite within the office, leasing or
buying an excimer laser and bringing in a surgeon and specialized
team to provide the whole service on-site -- in your practice.
Give it a try
A big difference exists between providing total laser vision
correction therapy and operating within the referral-based models
we're used to. My partner and wife, Susan, and I opened our own
laser vision practice last April. Our first day of in-office
surgery was June 2. Since then, we've noted several significant
trends in our practice, including the following:
- Increased patient volume. Not
surprisingly, we've seen a major increase in patient
volume in our practice since we added our new specialty.
- Greater need for all of our services.
Offering laser vision correction has garnered new
interest from the entire community. Of course, not all
patients are ideal candidates for refractive surgery;
many are better suited for contact lenses or spectacles.
But we were surprised to see that many of the family
members of new laser-assisted in situ keratomileusis (LASIK)
patients have visited us for traditional optometric
- An increase in new patients. It's
also interesting to note that about half of the patients
who've undergone LASIK at our office have been new to our
practice. We have a large patient base, but it's too
small of a pool of people to attract large numbers of
laser vision patients. Once we made the commitment to
offer the procedure, the people who were interested
As you can see, our practice has undergone a very exciting and
rewarding transition -- one that could add a whole new dimension,
or even change the course of your practice, as well.
This month, in part one of a three-part series, I'd like to
give you more information about this exciting new trend and
explain how it could change the way we traditionally practice
optometry. In part two, which we'll publish in February, I'll
discuss step by step what to do to set up this refractive option
in your practice. Then, in March, I'll wrap up the series with
advice on how to market this new option to your patients.
Will optometrists do the procedure?
Eventually, I think O.D.s will have the legal option to become
trained and licensed to actually perform a laser surgical
procedure. But I'm not sure how long it will take for this to
happen, and I'm not going to idly sit by and wait while LASIK
prices continue to drop, cutting many O.D.s out of co-management
by default. Market share and practice reputations are being built
I commend Oklahoma and Wisconsin for their legislative efforts
to allow optometrists to use lasers, and I encourage the schools
of optometry to push the envelope in training our students for
the future. However, I need to position our practice as a leading
laser vision specialist now. Providing the service in my office
with our own laser and our own surgeon on staff is a great way to
start. This has poised us for greater participation in laser
vision correction as laser technology develops and as optometric
In the beginning
When I first graduated from optometry school in 1976 and
started my practice from scratch, I evaluated the competition
among optometrists, ophthalmologists and opticians. I understood
the strong points of optometrists and ophthalmologists, but I
remember thinking that the independent optician was at an extreme
disadvantage to me because he or she couldn't refract or
When I looked closer at the opticians who were most successful,
I realized that in many cases they'd simply bought a lane of exam
equipment, designed an exam and contact lens area and hired an
optometrist. Many of them did very well, earning excellent
reputations in the vision care market and growing into strong,
profitable operations. I hope my venture into laser refractive
surgery will take the same path.
Why do it in-office?
When I refer a patient to a laser vision center, I'm not
concerned that I won't see that patient back for follow-up care.
It's common practice for centers and surgeons to return patients
to the referring doctor. I'm concerned about the future word-of-mouth
referrals from that patient. And, you'll have a lot of them. Some
studies estimate at least 10 new patient referrals come from each
happy LASIK patient. I'm convinced that I'd have missed most, if
not all, of these referrals if I'd continued working within the
present co-management models.
My not receiving referrals may even be quite innocent on the
part of the laser center or surgeon. They may not be trying to
actually "steal" patients, but referrals just naturally
flow there. My practice received very few referrals for LASIK
when we were in the co-management model, but we're receiving many
in the full-service model. If we look at the process of the word-of-mouth
referral, we can break it down into two critical points.
- Starting at 1-day post-op and continuing for
the next several weeks, the LASIK patient is generally
ecstatic. He's seeing great without glasses
or contacts, and the recovery is very easy. He's quite
proud for going through with the procedure, and he wants
to tell everyone he sees about his experience.
You can't get a much better practice building tool than
this. Unfortunately, when everyone asks him where he
underwent the procedure, he'll tell his friends and
family the name of the laser center. He may even say the
name of the town where the laser center is located and
give the name of the eye surgeon who performed the
However, I think you'll find that more often than not the
patient won't mention his O.D.'s role in the process at
all. Or, if he does, he'll position it as secondary in
the process. This seems unfair because the referring
patient may have been in the optometrist's practice for
many years, and the O.D. also provided valuable
counseling and pre- and post-op care.
- How does the laser center handle the call if
a potential LASIK patient does bypass the co-managing O.D.
and make a direct referral? Keep in mind
that the caller I'm referring to isn't the O.D.'s patient
-- just a friend of the O.D.'s patient, so there's no
real loyalty. The response depends on the center's
philosophy, and that may depend on who owns the center.
But problems can develop in any case. Does the center
accept patients directly? Does it ever provide primary
care and pre-op and post-op services?
If so, the original optometrist has lost the referral.
Centers that have policies not to see a patient who calls
without a referral may feel forced to change that
philosophy as the laser market changes. Even if the
center doesn't provide primary care at all, the center
staff will generally give prospective patients a list of
local O.D.s who participate with them. So, unless the new
patient specifically asks for you, he may end up going to
one of your colleagues.
In addition to capturing the referral network, offering
laser vision correction in your practice delivers
important advantages to your reputation as an expert and
leader in the fast developing field of laser vision
What business are you in?
Successful firms of all types have learned not to define their
businesses too narrowly. Companies that haven't changed with the
times have suffered, or perished. Examples include:
- typewriter companies that thought they were in the
machine business, rather than word processing and
- encyclopedia publishers that thought they were in the
book business, rather than the information business
- railroad firms that thought they were in the train
business, not the transportation field.
As optometrists, we're in the vision correction business.
Refraction is our mainstay, and as technology brings new forms of
refractive therapy, we must embrace them and become leaders in
providing them. We're not just in the exam, eyeglass, contact
lens and eye drop business.
Now, that's not to say that we can't survive if we don't
participate in laser vision correction, but do you want to? Do
you see laser vision correction as an opportunity or threat? I
think it can be either, and it depends on how you position it in
If you seem to be seeing a lack of interest in LASIK among
your patients, it may be because they're already perceiving that
you don't do it. And those who are interested in the procedure
will quietly go elsewhere. Some aren't interested now, but they
may be someday. In my view, we must embrace change.
The future of laser vision correction
The trends we're seeing now tell us what's likely for the near
future. We'll continue to see erosion of LASIK fees in the
competitive marketplace. We'll see corresponding reductions of co-management
fees, and some laser centers may eliminate them. The range of
patients who are ideal LASIK candidates will expand, while
excimer lasers will become smaller, more portable and less
expensive to buy or lease.
The newer laser designs are contained in a machine that's the
size of a large photocopier. Lasers are already available on what's
termed a roll-on/roll-off basis. This allows many users to share
the cost of the laser, and it makes the per-eye use of the
Also, lasers are more portable than ever. Special trucks with
custom suspensions and power lift machines on wheels transport
the laser from one location to another. A laser technician
calibrates the device at each site. Many laser centers, M.D.
offices and some O.D. offices acquire lasers this way.
Technological advancements and surgical experience will also
make laser vision correction more accurate, less risky and more
accepted. Couple that with low fees, and who knows where it will
lead in 10 or 20 years? A laser vision procedure may become as
common and simple as having a tooth filled.
In part two of this article, I'll focus on how we set up our
laser vision practice, including the amount of space we allotted,
the amount of money we spent, and more. Our experience may help
you avoid any pitfalls of adding this valuable service to your
Dr. Gailmard is in practice at Gailmard Eye & Laser
Center in Munster, Indiana, and he serves as Chairman of the AOA's
Practice Management University.
Optometric Management, Issue: January 2001