Article Date: 2/1/2004

Optometrists Embrace A Shifting Paradigm
O.D.s and their patients gain new enthusiasm for LASIK thanks to the promise and profits of wavefront technology.
By Randall F. Fuerst, O.D., Sacramento, Calif.

With the advent of wavefront technology and the accelerating shift among patients and practitioners toward laser vision correction, I'm reminded of a book called "The Innovator's Dilemma: When New Technologies Cause Great Firms to Fail." The author, Clayton M. Christensen, explains how certain companies missed out on great profits because they didn't see the potential in a new innovation. They viewed certain technologies -- the personal computer, for example -- as disruptive to their business and their relationships with customers.

Today, O.D.s and patients alike are changing the paradigm of how we view laser vision correction. Advances such as wavefront-guided LASIK, with impressive outcomes and promise for the future, are encouraging new LASIK patients to come forward and bringing hesitant O.D.s in from the sidelines.

With wavefront, LASIK is no longer a "disruptive" technology, but rather a standard mode of vision correction we offer alongside lenses. Studies show that custom ablation not only offers far better visual results than traditional LASIK, but wavefront-guided LASIK can also detect and measure halos and other issues associated with the traditional procedure. We can even use it to re-treat patients with halos resulting from traditional LASIK. Wavefront-guided LASIK is an exciting advance that's here to stay.

Succeeding with LASIK

In my practice, we have 7 years of LASIK experience. With nine locations, we currently have seven LADARVision Systems, the platform composed of the LADARVision 4000 Excimer Laser and the LADARWave CustomCornea wavefront aberrometer.

We've succeeded with wavefront-guided LASIK because we haven't locked into a single approach to the technology; we've changed as new advances came along. This isn't the case with all O.D.s. Optometrists have a lot of refractive patients, but the number of O.D.s who refer for LASIK is small. O.D.s tend to concern themselves with patients' specific problems, rather than providing an overall solution. If a patient can't read the football scores on television or see clearly at night, the O.D. might simply make a 0.50-diopter change in the patient's prescription.

When LASIK first came out, the resulting visual acuities were anywhere from 20/20 to 20/40, and halos and night vision impairment were common problems. Today, the bar has risen dramatically. Wavefront allows outcomes to reach the 90th percentile, with no spherical aberrations. We can help patients see as well or better than they did with eyeglasses.

To make it work, our practice is grounded in several important ideals:

These ideals have helped us remain successful even through downturns in the economy. This approach can work for other practices as well.

Adding wavefront-guided LASIK

When we opened our first center in 1996, we used VISX technology. Two years ago, we switched completely to Alcon's LADARVision 4000 Excimer Laser System because we like its effective closed-loop tracking and Gaussian beam. We consider it the gold standard for wavefront.

The number of our patients who receive LADARVision CustomCornea treatment is in-creasing steadily. Currently, it's close to 30% of our overall volume, or 50 to 80 eyes per month. In some locations, 90% of patients eligible for wavefront-guided LASIK get the procedure.

Thanks to good communication and an interdependent culture, we have an efficient comanagement process in place for wavefront-guided LASIK. During patient exams, our O.D.s present LASIK as a vision-correction option and discuss the wavefront-guided approach. We always project confidence in the technology. We believe in it, and we want that assurance to come through to our patients.

If a patient has an interest in LASIK, the O.D. asks the patient to come back in 1 or 2 weeks. The patient receives a packet of information to take home and read.

At the next visit, we perform topography and pachymetry to make sure that wavefront-guided LASIK is feasible. If so, we discuss it and refer the patient to the surgeon for an Orbscan and wavefront analysis.

If the patient wants surgery at this point, the surgeon schedules a preoperative visit. If not, the patient returns to the O.D. to discuss other options. Patients who forego surgery may choose to have it sometime in the future as their comfort level and confidence build or as they become financially able. For those who have the surgery, the O.D.s in our practice handle follow-up exams and care.

We promote wavefront-guided LASIK using Alcon patient materials in the office, the same way we use posters and other materials for frames and contact lenses. This marketing supports our recommendation for wavefront-guided LASIK, which is a $4,000 to $4,500 procedure in our practice.

Guarding your bottom line

Not only do I consider wavefront-guided LASIK a major step in improving patient care, but I also see it as essential for positioning ourselves financially. Consider these projections:

1. The frame industry is projecting flat sales in the next 3 to 5 years.

2. LASIK volume is increasing (projected at 6% in 2004); 40% of these procedures are expected to be wavefront-guided by the end of 2004.

3. Cataract procedure volume has been rising.

4. IOLs and other presbyopic treatments are increasing.

Patients want surgical alternatives. They're hearing about their friends' excellent results with wavefront-guided LASIK. As savvy patients research the latest advances in LASIK technology, demand for LASIK likely will increase. If O.D.s don't present it as an option, we may start losing patients.

These predictions give us an opportunity to prepare our practices for the shift to wavefront-guided LASIK. All of us need to get involved by developing our skills and expertise. It's an area where O.D.s can be progressive and adapt with their patient base.

Tracking new improvements

Wavefront-guided LASIK is enhancing optometric practice. As the technology has improved LASIK outcomes, patients have expressed greater satisfaction -- a situation that will continually get better through new developments.

The advent of wavefront technology has encouraged many O.D.s to embrace LASIK as a viable form of vision correction, quieting concerns about complications like halos and dry eye. We're comfortable with LADARVision's level of performance, and LASIK patients have become another service sector in our practice.

Research in wavefront-guided LASIK is developing rapidly. To stay up to date, it's essential that O.D.s scrutinize new technologies as they emerge and pay close attention to published outcomes and research.

Soon, I hope to see approvals for better algorithms, which are currently being evaluated in FDA-mandated investigations. We may see a shift toward surface ablation, which may allow for larger peripheral ablation zones.

We're at an exciting point, where technology is allowing us to help patients in ways we never could before. O.D.s will be an integral part of the movement to offer patients the services they desire and the best care possible.

Dr. Fuerst is CEO of Pacific Laser Eye Centers Medical Group in Sacramento, Calif.


Optometric Management, Issue: February 2004