Project final groupno 08


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Project final groupno 08

  2. 2. AcknowledgementThrough this acknowledgement, we express our sincere gratitude towards all those peoplewho have helped us in the preparation of this research report, which has ben a very goodlearning experience for all of us.We would like to thank the Director H.D. Trivedi, the faculty, the Computer LabInstructor, the Libararian & the Administration staff of B.K. Majumdar Institute ofBusiness Administration-HLBBA for the support.Finally we express our sincere thanks to Prof. Neha Poddar who guided us throughout theproject & gave us valuable suggestions & encouragement to complete the researchproject successfully. We express our sincere gratitude to her that she gave her valuabletime to support us.Rini George(Group Co-ordinator)
  3. 3. PrefaceAs a part of the course curriculum the third Year BBA students are required to work ingroups & prepare a research based project report. The objective behind preparing thisproject report is to relate the management theories though in the classroom to theirpractical application.The preparation of this project report is based on the facts & findings noted during thesurvey & the information collected from various secondary sources such as internet,written documents & published documents. Inspite of our best efforts there may be errorsof omission & commissions which may please be excused.Our survey is restricted to the city of Ahmedabad. Ophthalmologist & the opticianssituated in Ahmedabad have been interviewed for the same. It includes the informationcollected through survey of local public & information collected from eye specialists.
  5. 5. EXECUTIVE SUMMARYThis project is an endeavour on the part of our entire group to understand the regional marketin the city Ahmedabad for a service known as ‘Laser vision correction surgery’ bysegregating the consumers into sets of existing users as well as the potential users of theabove said service.This project sought to obtain answers to 2 set of questions- a) With respect to the potential users – 1. Are they aware regarding such a ‘Vision Correction’ service being offered? 2. Do they find it to be a better solution for the purpose of vision improvement? 3. What according to them are the reasons for lower acceptability of this treatment as compared to other alternatives like spectacles and contact lenses? b) With respect to the existing users – 1 Are the tall claims made by the ‘laser eye surgery’ providers true and is it actually a better vision correction solution? First of all, the market research methodology i.e. ‘descriptive research’ process used has been explained i.e. we have used survey as a tool to understand the market. Secondly, the eye care industry background and secondary data available about laser vision treatment on the internet and in booklets has been presented. Thirdly, eye experts have been interviewed to understand whether this service is safe and reliable and all the ophthalmologists have approved of this service with the exception of just one doctor who advised against opting for this surgery Fourthly, the primary data findings with relation to the potential market has been analysed- which shows the availability of a large untapped market consisting of willing customers in Ahmedabad who could be convinced to use the said service by employing certain strategies to remove their misconceptions and by raising their awareness regarding this treatment’s long term benefits as compared to other available alternatives which are perceived to be cheaper as of now. Fifthly, the data has been collected from existing users of the service and presented to validate claims made by the laser eye surgery providers against the touchstone of experience. It has been found that the claims made are true and it is indeed a safe, better and one time solution if administered under expert’s supervision. We can conclude that, people in Ahmedabad perceive the city as a viable location in terms of expert services, state of art facilities and technology and really affordable prices for getting laser surgery done. But, to make Ahmedabad a more preferred and attractive destination for getting laser eye surgery done by a larger number of consumers in the future, some recommendations (like advertisements should provide specific rather than general information, convince the dear ones of the target consumer rather than just the target consumer of the benefits of the service etc.) have been made by our group towards the end of the project This has been an humble effort on our part and we hope the project findings may prove useful to everyone. 2
  6. 6. Laser vision correction (Refractive Surgery) – A Market Research Objective : To understand the market sentiments regarding laser surgery as a treatment to cure vision defects. ( A Detailed explanation of the market sentiments to be studied are stated as under -) Primary objective - a) Awareness regarding the treatment b) To understand consumer’s perception regarding this treatment i.e. whether they find it superior as compared to spectacles and contact lenses. c) Willingness to accept this treatment and factors hindering adoption Secondary objective –a) The reasons because of which one should opt for laser vision correction surgeryb) To find if there are any side effects after undergoing this surgery and if it is indeed safe and better option for vision improvement. Scope a) Respondents (people with vision defects) for the purpose of conducting a survey to be selected from the city of Ahmedabad only. b) We are going to research only about the laser treatment wherein its being used for vision improvement purpose 3
  7. 7. MARKET RESEARCHMarketing Research is the systematic and objective identification, collection, analysis, disseminationand use of information for the purpose of improving decision making related to the identification andsolution to problems in marketing.Marketing research attempts to provide accurate information that reflects a true state of affairs. It isobjective and meant to be conducted impartially. Thus, the motto of every researcher should be –‘Find it and tell it like it is.’Consumer marketing research is a form of applied sociology that concentrates on understanding thepreferences, attitudes, and behaviors of consumers in a market-based economy, and it aims tounderstand the effects and comparative success of marketing campaignsWe as a group seek to explore in depth on our project topic i.e. the study of the penetration of thetreatment ‘laser vision correction (refractive surgery) ’ in Ahmedabad city and obtain usefulfindings by using the tools of marketing research. Classification of Market Research Market Research Problem Problem Identification Solving Research ResearchThis project is a Problem Identification Research, because our interest solely lies in justidentifying or finding out various variables forming a part of the market environment for laservision surgery. 4
  8. 8. The role of marketing research in managerial decision making is explained further using theframework of the DECIDE model:D — Define the marketing problemE — Enumerate the controllable and uncontrollable decision factorsC — Collect relevant informationI — Identify the best alternativeD — Develop and implement a marketing planE — Evaluate the decision and the decision processWith respect to this project, we have performed just the first 4 steps i.e. till identification ofthe best alternative – i.e. we have given a list of recommendations to enable greaterpenetration of this service ‘laser vision correction surgery’ in Ahmedabad city. It has beendone so, because the last 2 steps are to be performed by the policy makers and executors. Market Research ProcessThe market research process consists of 6 major steps – 1) Define the problem and research objectives The problem to be addressed through this project is to find out the reasons underlying the low acceptance of ‘laser surgery’ as a vision correction option inspite of being a permanent and hassle free solution The content of the project would comprise of information regarding various costs and techniques of laser vision correction; expert opinion regarding about success ratio, side effects and permanency of better vision post – surgery & know consumers’ opinions regarding this treatment as to their awareness, apprehensions and beliefs regarding this treatment. This problem is to be researched in order to generate useful findings for people with vision defects and help them understand ‘laser surgery’ treatment better. 2) Develop the research plan a) Data source – Internet and books(secondary data) and primary data is also used b) Research approach – Survey/ Descriptive research Descriptive research design is a scientific method which involves observing and describing the behavior of a subject without influencing it in any way. Many scientific disciplines, especially social science and psychology, use this method to obtain a general overview of the subject 5
  9. 9. c) Research instruments – Questionnaire (for consumers) and Interviews(for eye experts) d) Sampling plan i) Sampling unit – People with vision defects ii )Sampling size – 460 units iii) Sampling procedure –Convenience sampling3) Collect information – Interviews of ophthalmologists and opticians have been conducted and the questionnaires have been filled by the people having vision related problem.4) Analyze information – Information collected from ophthalmologists and opticians as well as respondents with vision defect has been tabulated and analyzed by means of graphs.5) Present findings- It has been presented in the ‘Conclusions’ section of this project.6) Make decisions –We leave the decision making part (as to whether they have to opt for laser vision correction surgery or not) to the discretion of the user of the information given in this project. 6
  10. 10. INTRODUCTION TO LASER VISION CORRECTIONTraditionally, spectacles and nowadays even contact lenses is being used for the purpose ofvision improvement. But, as some of us know its been over a decade now, that a newtechnology known as ‘laser vision correction surgery ‘(Refractive Surgery) has come into themarket to serve our needs better. So, below stated are some facts that will enable betterunderstanding regarding this treatment.Laser Eye Surgery improves vision. The purpose of laser eye surgery is to correct refractiveerrors and reduce a persons dependency on glasses or contact lenses. The procedure uses alaser to reshape the cornea, the clear outer layer of the eye, in order to change the eyesfocusing power and improve vision. There are many types of laser eye surgery, but the mostcommon and well-known type of laser eye surgery is LASIK. LASIK is used to treat myopia(nearsightedness), hyperopia (farsightedness), and astigmatism (distorted vision).Over the past few years, laser eye treatment has been seen to make an enormous difference topeople with near-sight, far-sight and astigmatism. Its a difference that has changed theirquality of life as well as their quality of vision. For many people, laser treatment can meannew freedom. Advantages of laser vision correction are - • Freedom to change the way the world sees you • Freedom from the time-consuming, day-to-day hassle of glasses or contact lenses • Freedom to play sports without the inconvenience of glasses or contact lenses • Freedom to go on holiday and to work without worrying about your eyesight • Freedom to wake up during the night and see clearlyThe result is that more and more people, including many celebrities, are choosing to undergothis highly sophisticated and very successful procedure. Also, there are an increasing numberof clinics offering a variety of methods to correct your vision. 7
  11. 11. The various kinds of laser surgery techniques available are as follows –i) LasikLASIK is a surgical eye procedure that is performed to correct one’s eyesight, reducing theneed for glasses or contact lenses. LASIK is a procedure that permanently changes the shapeof the cornea, the clear covering of the front of the eye, using an excimer laser. By reshapingthe cornea, the refractive error is corrected and vision is improved.The Development of LASIKLASIK is an acronym for Laser Assisted In-Situ Keratomileusis. "Keratomileusis" is derivedfrom two Greek words that literally mean "to shape the cornea." "In-Situ" means "in place."Thus, the term LASIK means "to reshape the cornea in place using laser." In simple terms, aflap is cut in the top layer of the eye and folded back so a laser can reshape the surface of theeye and then the flap is put back and the eye heals. LASIK is one of the many eye surgeryoptions, but it is the most commonly performed laser vision correction procedure.The LASIK procedure is the combination of two sophisticated techniques of surgery with thepurpose of correcting refractive errors.1. The first technique uses a knife, called a microkeratome, to cut a thin layer in the cornea, leaving a hinge at one end of the flap. The flap is folded back to reveal the middle section of the cornea, called the stroma, the area to be sculpted by the laser. Cutting a flap allows for a rapid recovery of vision and reduces discomfort after surgery.2. The second technique uses pulses from a computer controlled Excimer laser (a cold, invisible, ultraviolet laser) to sculpt the underlying cornea by vaporizing a portion of the stroma and correcting the refractive error. Then the flap is replaced.The LASIK procedure was developed in 1990 by Dr. Lucio Buratto (Italy) and Dr. IonnisPallikaris (Greece), combining two known surgical procedures, Keratomileusis [RadialKeratotomy (RK)] and Photorefractive Keratectomy (PRK). They were the first to use amicrokeratome to cut a thin flap of cornea and then apply the Excimer laser to remove tissuefrom the cornea. The microkeratome had been used successfully in South America for about30 years, but had not been used in combination with the laser. It was Dr. Pallikaris thatsuggested the name Laser In-Situ Keratomileusis (LASIK) for this procedure. The evolutionof LASIK occurred in the search for a better form of refractive surgery to eliminate some ofthe limitations, risks, and complications of these earlier techniques.LASIK evolved from PRK and both surgeries use an Excimer laser in a similar manner. Themajor difference between the two surgeries is the way that the stroma, the middle layer of thecornea, is exposed before it is vaporized with the laser. In LASIK, a flap is cut in the stromalayer, which is folded back for the surgery, then replaced after the use of the laser. SinceLASIK does not disturb the sensitive top layer of the cornea there is less discomfort and afaster recovery than with PRK, and the visual benefits are the same. 8
  12. 12. In 1991, Dr. Stephen Slade performed the first LASIK procedure in the United States.LASIK is now the most commonly performed refractive surgery procedure.LASIK or Lasik (laser-assisted in situ keratomileusis) is a type of refractive surgery forcorrecting myopia, hyperopia, and astigmatism. LASIK is performed by ophthalmologistsusing a laser. The procedure is generally preferred to photorefractive keratectomy, PRK, (alsocalled ASA, Advanced Surface Ablation) because it requires less time for the patientsrecovery, and the patient feels less pain overall. However, there are instances where aPRK/ASA procedure is medically justified as being a better alternative to LASIK. Manypatients choose LASIK as an alternative to wearing corrective eyeglasses or contact lenses.a) Wavefront-guided LASIKWavefront-guided LASIK is a variation of LASIK surgery in which, rather than applying asimple correction of focusing power to the cornea (as in traditional LASIK), anophthalmologist applies a spatially varying correction, guiding the computer-controlledExcimer laser with measurements from a wavefront sensor. The goal is to achieve a moreoptically perfect eye, though the final result still depends on the physicians success atpredicting changes which occur during healing. In older patients though, scattering frommicroscopic particles plays a major role and may outweigh any benefit from wavefrontcorrection. Therefore, patients expecting so-called "super vision" from such procedures maybe disappointed. Still, surgeons claim patients are generally more satisfied with this techniquethan with previous methods, particularly regarding lowered incidence of "halos," the visualartifact caused by spherical aberration induced in the eye by earlier methods. Currently, thereis no research in support of the surgeons claims.LASIK BenefitsSource: Eye Surgery Education Council 9
  13. 13. ii) Radial Keratotomy (RK)The first practical application of Radial Keratotomy (RK) resulted from the occurrence of aneye accident. In the 1970s, Dr. Fyodorov of Russia was treating a boy whose glasses hadbroken and cut his cornea. When the boys eyes had recovered, his refraction was significantlyless myopic than it was before the injury. Dr. Fyodorov researched past efforts in refractivesurgery and eventually worked out a more predictable formula for refractive surgery.The Radial Keratotomy (RK) procedure involves using a series of peripheral cuts (incisions)radiating from the central cornea, with the result of flattening the central cornea. RK can onlycorrect low degrees of myopia and astigmatism. In 1978, American ophthalmologists becameinterested in Dry. Fyodorovs findings. After visiting Dry. Fyodorov in Russia, Dr. Leo Boresbrought the technology back to the United States.iii) Excimer LaserThe Excimer laser is a device that generates high-energy, cold, ultraviolet pulses. It is aunique type of light that does not cut bodily tissue, but rather weakens the molecular bond oftissue cells until the surface tissue disintegrates. When applied to laser eye surgery, the pulsesare delivered to the surface of the eyes cornea, literally vaporizing away eye tissue in order toreshape the cornea, one microscopic layer at a time.During laser eye surgery, the Excimer laser is computer controlled and programmed tocustom treat each individual eye with a high degree of precision. The Excimer laser is notedworldwide for it’s safety and effectiveness.Although the Excimer laser is now used for laser eye surgery, it was originally used foretching silicone computer chips in the 1970s. While working in the IBM research laboratoriesduring 1980 to 1983, Dr.s Rangaswamy Srinivasin, James Wynne, and Samuel Blum,discovered the potential of the Excimer laser in relation to biological tissue interactions. Theyrealized the laser could remove targeted tissue without causing any heat damage to thesurrounding material.Dr. Steven Trokel, a New York City ophthalmologist, made the connection for reshaping thecorneal tissue and patented the Excimer laser for vision correction. He performed the firstlaser surgery on a patients eyes in 1987. Over the next ten years, the techniques andequipment for laser eye surgery were perfected. In 1996, the first Excimer laser for refractivesurgery was approved for use in the United States.iv) Photorefractive Keratectomy (PRK)Photorefractive Keratectomy (PRK) was the first surgical procedure developed to reshape thecornea using a laser. In PRK, the top layer of the cornea, called the epithelium, is scrapedaway to expose the stroma layer underneath. Because there are nerve fibers in the epithelium,there may be some initial discomfort equivalent to a badly scratched eye. This can furthercause pain, irritation, watering of the eye, blurry vision, or the feeling of a particle in the eye.An eye bandage is worn to reduce the irritation and encourage healing of the tissue. FollowingPRK, vision is blurry for a few days, but improves as the corneal epithelium heals. Vision isoften reasonably good at one week and stabilized by six months. 10
  14. 14. v) ZyoptixZyoptix is a new and advanced laser eye treatment from Bausch and Lomb, which expertshope will help people with vision defects with a better choice.Zyoptix: Changing perspective of lifeSophisticated technology has made LASIK a fast, virtually painless and very popularprocedure. By 2001, over 2 million people world-wide had chosen LASIK for visioncorrection.Its hard to imagine that Zyoptix can take LASIK to a new dimension in terms of visioncorrection. The additional diagnostic screening benefits of wavefront technology has allowedpatient improved selection and personalised treatment to a level never imagined before.Zyoptix provides surgeons with so much more detailed information on which to basedecisions about your treatment.Zyoptix was the first system in Europe and Asia that applied Wavefront technology in lasereye treatment to provide Personalised Vision treatments (sometimes known as Wavefront orcustom LASIK). By September 2003 over 100,000 Zyoptix treatments had been performed.In October 2003, Zyoptix received FDA approval for use in the USA.Latest Technology: ZyoptixBuilding on its success Bausch & Lomb, launched the very latest technology for Zyoptixtreatments in September 2003.New features and benefits include: An enhanced safety feature that ensures theIris Recognition correct eye is treated A personal file that stores your uniqueZy-ID™ digital ‘map’ of each iris & treatment information Compensates and corrects for eyeA faster and Multi- movements during surgery in x, y and zDimensional Eyetracker dimensions Treatment times can now be more than twice100 Hz laser head source as fast 11
  15. 15. Improved Illumination & new Better visibility during treatmentmicroscope More people could eligible for Zyoptix treatment for example those with long/farNew treatment options sight, complicated (mixed) astigmatism, large pupils or thin corneas. Technology and the EquipmentThe advanced Zyoptix treatment depends on highly sophisticated, computer-controlledequipment, which is integrated by specialised software. In a Zyoptix treatment,the following equipment is used: • The Orbscan® topographer • The Zywave™ aberrometer • Iris Recognition / Zy-ID™ • Zyoptix Treatment Cards • The excimer laser • The eyetracker • The microkeratome 12
  16. 16. Things to be considered before selecting ‘LASIK’ –Although laser eye surgery is considered a relatively safe procedure, it is still major medicalsurgery. As an elective procedure, prospective patients should become informed about theLASIK procedure and learn about the options, benefits, risks and complications, so that theycan make an informed decision. It is important for patients to get an explanation of theprocedure from the doctor in order to know what to expect before, during, and after LASIKsurgery. Overall, the decision to undergo laser eye surgery involves choosing the bestprocedure, finding a qualified doctor, and determining if you are a good candidate for lasereye surgery.1. ProcedureThere are several necessary preparations in the preoperative period. The operation itselfinvolves creating a thin flap on the eye, folding it to enable remodeling of the tissue beneathwith a laser. The flap is repositioned and the eye is left to heal in the postoperative period.Factors affecting surgeryTypically, the cornea is avascular because it must be transparent to function normally, and itscells absorb oxygen from the tear film. Thus, low-oxygen-permeable contact lenses reduce thecorneas oxygen absorption, sometimes resulting in corneal neovascularization—the growth ofblood vessels into the cornea. This causes a slight lengthening of inflammation duration andhealing time and some pain during surgery, because of greater bleeding.Although some contact lenses (notably modern RGP and soft silicone hydrogel lenses) aremade of materials with greater oxygen permeability that help reduce the risk of cornealneovascularization, patients considering LASIK are warned to avoid over-wearing theircontact lenses. Usually, it is recommended that they discontinue wearing contact lenses daysor weeks before the LASIK eye surgery.A 2004 Wake Forest University study established that heat and humidity affect LASIKsurgery results, both during the procedure and in the two weeks before the surgery.a)PreoperativePatients wearing soft contact lenses are usually instructed to stop wearing them 5 to 21 daysbefore surgery. One industry body recommends that patients wearing hard contact lensesshould stop wearing them for a minimum of six weeks plus another six weeks for every threeyears the hard contacts have been worn. Before the surgery, the patients corneas areexamined with a pachymeter to determine their thickness, and with a topographer to measuretheir surface contour. Using low-power lasers, a topographer creates a topographic map of thecornea. This process also detects astigmatism and other irregularities in the shape of thecornea. Using this information, the surgeon calculates the amount and the locations of cornealtissue to be removed during the operation. The patient typically is prescribed and self-administers an antibiotic beforehand to minimize the risk of infection after the procedure. 13
  17. 17. b)OperationThe operation is performed with the patient awake and mobile; however, the patient issometimes given a mild sedative (such as Valium) and anesthetic eye drops.LASIK is performed in three steps. The first step is to create a flap of corneal tissue. Thesecond step is remodeling of the cornea underneath the flap with the laser. Finally, the flap isrepositioned. 1) Flap creationA corneal suction ring is applied to the eye, holding the eye in place. This step in theprocedure can sometimes cause small blood vessels to burst, resulting in bleeding orsubconjunctival hemorrhage into the white (sclera) of the eye, a harmless side effect thatresolves within several weeks. Increased suction typically causes a transient dimming ofvision in the treated eye. Once the eye is immobilized, the flap is created. This process isachieved with a mechanical microkeratome using a metal blade, or a femtosecond lasermicrokeratome (procedure known as IntraLASIK) that creates a series of tiny closelyarranged bubbles within the cornea. A hinge is left at one end of this flap. The flap is foldedback, revealing the stroma, the middle section of the cornea. The process of lifting and foldingback the flap can sometimes be uncomfortable. 2) Laser remodelingThe second step of the procedure is to use an Excimer laser (193 nm) to remodel the cornealstroma. The laser vaporizes tissue in a finely controlled manner without damaging theadjacent stroma. No burning with heat or actual cutting is required to ablate the tissue. Thelayers of tissue removed are tens of micrometres thick. Performing the laser ablation in thedeeper corneal stroma typically provides for more rapid visual recovery and less pain than theearlier technique, photorefractive keratectomy (PRK).During the second step, the patients vision will become very blurry once the flap is lifted.They will be able to see only white light surrounding the orange light of the laser, which canlead to mild disorientation.Currently, manufactured Excimer lasers use an eye tracking system that follows the patientseye position up to 4,000 times per second, redirecting laser pulses for precise placementwithin the treatment zone. Typical pulses are around 1 millijoule (mJ) of pulse energy in 10 to20 nanoseconds. 3) Repositioning of flapAfter the laser has reshaped the stromal layer, the LASIK flap is carefully repositioned overthe treatment area by the surgeon and checked for the presence of air bubbles, debris, andproper fit on the eye. The flap remains in position by natural adhesion until healing iscompleted. 14
  18. 18. c) Postoperative carePatients are usually given a course of antibiotic and anti-inflammatory eye drops. These arecontinued in the weeks following surgery. Patients are usually told to sleep much more andare also given a darkened pair of shields to protect their eyes from bright lights and protectivegoggles to prevent rubbing of the eyes when asleep and to reduce dry eyes. They also arerequired to moisturize the eyes with preservative-free tears and follow directions forprescription drops. Patients should be adequately informed by their surgeons of theimportance of proper post-operative care to minimize the risk of complications.Over time, most attention has shifted from other aberrations and centered on sphericalaberration. LASIK and PRK tend to induce spherical aberration, because of the tendency ofthe laser to undercorrect as it moves outward from the center of the treatment zone. This isprimarily an issue for major corrections. There are theories that posit that if the lasers weresimply programmed to adjust for this tendency, no significant spherical aberration wouldoccur. In eyes with few higher order aberrations, wavefront-optimized LASIK (rather thanwavefront-guided LASIK) may well be the future. 2. Selecting a good doctorOne of the most important decisions is choosing the eye surgeon that will perform thesurgery. An experienced and reputable doctor will increase the likelihood of a positiveoutcome. To find a qualified doctor, one should try to get a recommendation from yourprimary eye doctor and talk to other people who have had eye surgery. Also, be wary ofdiscount eye centers that offer rates much lower than other doctors - you usually get what youpay for - and you will most likely be sacrificing quality of care and treatment.One’s eyes are as unique as your fingerprints. The best LASIK results are achieved whentreatment is customized to one’s individual eyes using wavefront technology.Any individual’s eyes are as unique as his/ her fingerprints - no two eyes are the same. Eventwo eyes of the same person are different from each other. The recommended eye surgery fora person with visual defect will be based on a visual eye exam by the doctor. After the doctorexamines the patient’s eyes, he will be able to tell whether the patient is a good candidate foreither conventional or custom LASIK eye surgery. If a person does not meet patient criteriafor LASIK, it is likely that he/she may qualify for other laser eye surgery options.Before your laser eye surgery, as is required before most medical procedures, you will beasked to sign a consent form. At this time, if you still have any questions or concerns, makesure you discuss them with your doctor. 15
  19. 19. Patient Screening Affects OutcomeMany of the possible complications associated with laser eye surgery can be avoided withproper screening to ensure that you are an appropriate candidate for laser eye surgery, and ifyou are, what the best treatment is for your prescription. Your doctor should test and examineyour vision and explain the results with you. Most complications happen to patients that werenot good candidates for laser eye surgery in the first place, including people with large pupils,thin corneas, severe astigmatism, high or complex prescriptions, or other eye health problems.As with any important medical decision, it may be beneficial to get a second opinion. Doctorshave a financial incentive to accept you as a patient, and you want to find an experiencedrefractive surgeon that will carefully examine your eyes and make sure you are a goodcandidate for laser eye surgery. If you are not a good candidate or have a borderline case,hopefully one of them will let you know. A reputable laser eye surgeon should turn awaypatients that are unlikely to benefit from the procedure.3. Conditions necessary to be qualified as a LASIK canditateLASIK eye surgery has successfully treated many individuals with refractive errors, but thereare some people who are not good candidates for the procedure. Before LASIK surgery isperformed, a doctor should conduct pre-op tests and exams to make sure a patient meets thecriteria for LASIK eye surgery. Determining if someone is a good candidate for LASIKsurgery is important in determining the outcome of surgery. Many problems can be avoidedby properly screening patients.If one wears contact lenses, he/she will want to stop wearing them before their initial LASIKexam. Contact lenses change the shape of the cornea and it takes some time for the eyes tosettle into their natural curvature. It is important to allow enough time for one’s eyes tostabilize before proceeding with LASIK otherwise the measurements will not be accurate andthe results could be disastrous. Refer to the chart below for average time needed depending onthe type of contact lenses one wears.Timetable for Not Wearing Contact Lenses Before LASIK ExamSource: US FDA 16
  20. 20. 4. AgeAn individual’s vision should be stable for at least a year before laser eye surgery isperformed. Many children and teens who have refractive errors want to have LASIK surgery,but because eyes continue to change until growth is complete, it isn’t until the early twentiesthat most doctors will consider LASIK an option.New advances in eyesight corrective surgery are providing consumers greater choices.Patients in their 40s or 50s who are considering LASIK surgery to improve their vision mightwant to consider to be evaluated for implantable lenses as well. "Early signs of a cataractmight argue for surgery and implantation of multifocal lenses instead."The FDA has approved LASIK for age 18 and over. More importantly the persons eye needsto be stable for two years prior to surgery5. Health Condition Requirements • Pregnancy and Breastfeeding - Women who are pregnant or nursing will need to wait until hormone levels return to normal and the eyes stabilize before having laser eye surgery. • Eye Conditions - It is also important that the eyes are healthy and that the patient doesn’t have any conditions that would make them unsuitable for LASIK, such as severe dry eyes and corneas that are too thin or steep. However, for people who are not good candidates for LASIK because of severe dry eye or thin corneas, there are other laser eye surgery options that may be appropriate. • Autoimmune Disease - Another health issue that may make a person unsuitable for LASIK is the presence of an autoimmune disease. The concern with autoimmune conditions is the unexpected and undesirable responses to eye surgery. The FDA has listed autoimmune conditions as a contraindication for laser eye surgery, meaning it is not approved or advised. Although performing LASIK on a person with an autoimmune condition is an off-label use of a medical device, a doctor may legally perform the surgery if they feel it is medically appropriate. Many individuals with autoimmune conditions have undergone LASIK surgery and had successful results. If you have an autoimmune condition and want to consider laser eye surgery, make sure you discuss this with your eye surgeon, your primary care doctor, and a neurologist. 17
  21. 21. 6. Cost of the surgery - There is not one "right" price for laser eye surgery. The amount one pays will be based on many factors, including the surgeon one chooses, the equipment and quality of the laser system used, the time given to each patient and procedure, one’s vision prescription, and the type of procedures being performed. Comparing LASIK PricesWhen comparing advertised prices, one should also be comparing what is included in thatamount and what is not. There can be a wide variation in what the advertised price includes.About the only thing that is the same no matter where one goes, is that the price is quoted "pereye."The best value is not going to be in finding the cheapest price per eye but in the total qualityof service youll be receiving for the total amount youll be paying.When the cost of LASIK surgery can vary from less than $1,000 to over $3,000 per eye,obviously wide differences exist.Consider the following criteria: 1. SURGEON - The fee for a surgeon will be based on training and experience. A skilled surgeon with proper training and extensive operative experience will cost more than a surgeon with minimal training or a low amount of experience. Rather than trying to find the cheapest doctor, find out about the surgeons credentials and record of procedures. 2. EQUIPMENT - Technology matters and state-of-the-art equipment costs more. Ask what laser system the doctor is using and make sure that it is FDA approved for the procedure onell be receiving. As differences exist in the technology from machine to machine, one needs that machine that is best suited to correct their vision prescription. It is also important that the equipment be properly maintained. The equipment is expensive to purchase (about $500,000) and costly to maintain properly (about $90,000 annually), costs that are reflected in the price of surgery. A discount price may indicate that substandard equipment is used or that maintenance is not what it should be. 3. TIME- Fees can vary based on the level of preoperative testing and postoperative check -ups. Many problems can be avoided with proper screening and testing, so its important to find a doctor that will take the time to test and screen, answer questions and talk about expectations, explain procedures, risks and complications, follows up with postoperative check -ups, and performs enhancements if necessary. Ask if these tests and appointments are all included in the fee. A discount center may skimp on appointments or not provide adequate time with each patient. Also, while many reputable doctors quote prices that includes all visits and procedures, a discount center may lure one with a low surgery price, but it bills one separately for tests, visits and enhancements. 18
  22. 22. 4. PRESCRIPTION - The type of correction one needs will be determined by their vision prescription. The more correction that needs to be done, the higher the cost. Most people are not eligible for the low price stated in ads that advertise "LASIK from $500 per eye" as their eyes require more extensive correction or more follow-up after surgery. 5. PROCEDURE - The surgery price will be based on what LASIK procedures one is getting done. Custom LASIK uses wavefront technology to measure and map the eye, and costs more than traditional LASIK. LASIK with IntraLase which uses a laser to cut the flap in the eye rather than using a microkeratome, also costs more.Average Cost of Conventional LASIK in 2008Average Cost of Wavefront LASIK with Intralaser in 2008‘LASIK Price – should not be an issue’With something as important as one’s eyesight, it is important to consider more than price.One should look for a qualified doctor who uses up-to-date and well-maintained equipment,who will spend time to properly evaluate the eyes of people with vision defect and makes thebest recommendations for you, and who will provide thorough follow-up care. When giventhe cost for one’s eye surgery, ask what is included in the fee and what is not included. 19
  23. 23. 7. Lasik complicationsAlthough the majority of LASIK patients are happy with the outcome of their eye surgery, aswith any elective medical procedure, the possible complications should be considered prior totreatment. One may receive inputs from friends who have had the procedure and doctors whoperform the surgery, but ultimately the decision should be of the individual who isconsidering to undergo the surgery. • Factors for Favorable OutcomesMany complications can be avoided with proper testing and screening to ensure that you are agood candidate for LASIK eye surgery. Selecting an experienced surgeon who has performedhundreds or thousands of procedures also increases your chances of a successful surgery.There is never a guarantee in any medical procedure, even if youre the best candidate andyoure operated on by the best surgeon who uses the best equipment, but it greatly reduces thechance of an unfavorable outcome. • Rate of LASIK complications -According to studies done in the late 1990s, about five percent of LASIK patientsexperienced some type of problem.Currently, experienced LASIK surgeons report that only about 1% of their LASIK eyesurgery patients experience complications if the doctors carefully select only those people thatare good candidates for the procedure.Even if complications do occur, most of them can be corrected with further treatments andenhancements. It is very rare to experience permanent and significant vision loss with LASIKeye surgery. Many of the possible concerns associated with LASIK eye surgery can becorrected and treated with timely and accurate medical care. • Intraoperative complicationsThe incidence of flap complications has been estimated to be 0.244%.Flap complications(such as displaced flaps or folds in the flaps that necessitate repositioning, diffuse lamellarkeratitis, and epithelial ingrowth) are common in lamellar corneal surgeries but rarely lead topermanent visual acuity loss; the incidence of these microkeratome-related complicationsdecreases with increased physician experience. According to proponents of such techniques, this risk is further reduced by the use ofIntraLasik and other non-microkeratome related approaches, although this is not proven andcarries its own set of risks of complications from the IntraLasik procedure.A slipped flap (a corneal flap that detaches from the rest of the cornea) is one of the mostcommon complications. The chances of this are greatest immediately after surgery, so patientstypically are advised to go home and sleep to let the flap heal. Patients are usually given sleepgoggles or eye shields to wear for several nights to prevent them from dislodging the flap intheir sleep. A faster operation may decrease the chance of this complication, as there is lesstime for the flap to dry. 20
  24. 24. • Flap interface particles are another finding whose clinical significance is undetermined. A Finnish study found that particles of various sizes and reflectivity were clinically visible in 38.7% of eyes examined via slit lamp biomicroscopy, but apparent in 100% of eyes using confocal microscopy. • Early postoperative complicationsThe incidence of diffuse lamellar keratitis (DLK), also known as the Sands of Saharasyndrome, has been estimated at 2.3%. When diagnosed and appropriately treated, DLKresolves with no lasting vision limitation.The incidence of infection responsive to treatment has been estimated at 0.4%. Infectionunder the corneal flap is possible. It is also possible that a patient has the genetic conditionkeratoconus that causes the cornea to thin after surgery. Although this condition is screened inthe preoperative exam, it is possible in rare cases (about 1 in 5,000)[citation needed] for thecondition to remain dormant until later in life (the mid-40s). If this occurs, the patient mayneed rigid gas permeable contact lenses, Intrastromal Corneal Ring Segments (Intacs),Corneal Collagen Crosslinking with Riboflavin or a corneal transplant.The incidence of persistent dry eye has been estimated to be as high as 28% in Asian eyes and5% in Caucasian eyes. Nerve fibers in the cornea are important for stimulating tearproduction. A year after LASIK, subbasal nerve fiber bundles remain reduced by more thanhalf. Some patients experience reactive tearing, in part to compensate for chronic decreasedbasal wetting tear production.The incidence of subconjunctival hemorrhage has been estimated at 10.5% (according to astudy undertaken in China; thus results may not be generally applicable due to racial andgeographic factors).Late postoperative complicationsThe incidence of epithelial ingrowth has been estimated at 0.1%.Glare is another commonlyreported complication of those who have had LASIK. Halos or starbursts around bright lightsat night are caused by the irregularity between the lasered part and the untouched part. It isnot practical to perform the surgery so that it covers the width of the pupil at full dilation atnight, and the pupil may expand so that light passes through the edge of the flap into thepupil. In daytime, the pupil is smaller than the edge. Modern equipment is better suited totreat those with large pupils, and responsible physicians will check for them duringexamination.Late traumatic flap dislocations have been reported 1–7 years post-LASIK.Other ComplicationsLasik and other forms of laser refractive surgery (i.e. PRK, LASEK and Epi-LASEK) changethe dynamics of the cornea. These changes make it difficult for your optometrist andophthalmologist to accurately measure your intraocular pressure, essential in glaucomascreening and treatment. The changes also affect the calculations used to select the correctintraocular lens implant when you have cataract surgery. This is known to ophthalmologistsas "refractive surprise." The correct intraocular pressure and intraocular lens power can becalculated if you can provide your eye care professional with your preoperative, operative andpostoperative eye measurements. 21
  25. 25. Although there have been improvements in LASIK technology, a large body of conclusiveevidence on the chances of long-term complications is not yet established. Also, there is asmall chance of complications, such as haziness, halo, or glare, some of which may beirreversible because the LASIK eye surgery procedure is irreversible.The incidence of macular hole has been estimated at 0.2 percent to 0.3 percent. The incidenceof retinal detachment has been estimated at 0.36 percent. The incidence of choroidalneovascularization has been estimated at 0.33 percent. The incidence of uveitis has beenestimated at 0.18 percent.Although the cornea usually is thinner after LASIK, because of the removal of part of thestroma, refractive surgeons strive to maintain the maximum thickness to avoid structurallyweakening the cornea. Decreased atmospheric pressure at higher altitudes has not beendemonstrated as extremely dangerous to the eyes of LASIK patients. However, somemountain climbers have experienced a myopic shift at extreme altitudes.In situ keratomileusis effected at a later age increases the incidence of corneal higher-orderwavefront aberrations. Conventional eyeglasses do not correct higher order aberrations.Microfolding has been reported as "an almost unavoidable complication of LASIK" whose"clinical significance appears negligible."Blepharitis, or inflammation of the eyelids with crusting of the eyelashes, may increase therisk of infection or inflammation of the cornea after LASIK.[citation needed]Myopic (nearsighted) people who are close to the age (mid- to late-forties) when they willrequire either reading glasses or bifocal eyeglasses may find that they still require readingglasses despite having undergone refractive LASIK surgery. Myopic people generally requirereading glasses or bifocal eyeglasses at a later age than people who are emmetropic (thosewho see without eyeglasses), but this benefit is lost if they undergo LASIK. This is not acomplication but an expected result of the physical laws of optics. Although there is currentlyno method to completely eradicate the need for reading glasses in this group, it may beminimized by performing a variation of the LASIK procedure called "slight monovision." Inthis procedure, which is performed exactly like distance-vision-correction LASIK, thedominant eye is set for distance vision, while the non-dominant eye is set to the prescriptionof the patients reading glasses. This allows the patient to achieve a similar effect as wearingbifocals. The majority of patients tolerate this procedure very well and do not notice any shiftbetween near and distance viewing, although a small portion of the population has troubleadjusting to the monovision effect. This can be tested for several days prior to surgery bywearing contact lenses that mimic the monovision effect.There are reports of decrease in thenumber of corneal keratocytes (fibroblasts) after LASIK. • LASIK Eye Surgery Complications Include: 1) Visual Aberrations Symptoms 2) Dry Eye Symptoms 3) Infection. Symptoms 4) Incomplete Correction (undercorrection, overcorrection, or regression). Symptoms 5) Irregular Astigmatism. Symptoms 6) Flap Folds or Wrinkles. 22
  26. 26. 7) Keratectasia.. 8) Diffuse Lamellar Keratitis (DLK). 9) Epithelial Ingrowth. 10) Higher order aberrations 11) Spherical aberration8. LASIK SURGERY RECOVERYAlthough each laser eye surgery patient responds and heals differently to the LASIKprocedure, most patients have a quick recovery with little discomfort and wake-up the nextmorning with great vision. Always follow your doctors instructions for post-surgery care aswhat happens after laser eye surgery can affect the outcome as much as the laser eye surgeryitself. 1) Short Term RecoveryImmediately after LASIK surgery the doctor will have you rest for a short time in the office,then let you go home with instructions to rest for several hours (letting someone else driveyou home). The doctor may cover your eyes with an eye shield to protect them for the firstday. Most people experience 4-6 hours of mild irritation, and your doctor will probablysuggest taking a mild pain reliever. Your eyes may tear or water and your vision may be hazyor blurry. Your eyes may itch or feel like there is something in them, and you will want to rubyour eyes, but dont! There is a slim chance that rubbing your eyes could dislodge the cornealflap and necessitate further treatment. You may also experience sensitivity to light, but thisusually improves considerably after the first few days.• RestAlthough many LASIK patients can return to work the next day, you should try to schedule afew days of rest. Most doctors will advise you to avoid any exercise workouts or strenuousactivities for the first week that might traumatize the eye and affect healing. Strenuous contactsports are usually not recommended for at least a month after surgery, in order to protect theeyes from anything that might get in them and keep them from being bumped or hit.• Eye ProductsIn order to prevent eye infection from surgery, your doctor may advise you to avoid the use oflotions, creams or make-up around the eye for a short time, from a couple of days to a coupleof weeks depending on how your eyes are healing. It is also advised to avoid swimming andusing hot tubs for one to two months.• First Check-UpYou should see your laser eye doctor for the first check-up within 24-48 hours after surgery.Your doctor will remove the eye shield, test your vision, and examine your eyes. He may giveyou eye drops to use to help prevent infection and inflammation and advise you to useartificial tears to help lubricate the eye. Do not wear your contacts even if your vision isblurry. 23
  27. 27. LASIK Recovery TimetableSource: US FDA 2) Long Term RecoveryDuring the first six months after laser eye surgery (the normal healing time), one shouldexpect to visit your doctor for periodic check-ups. If at any time one’s vision or othersymptoms get worse instead of better, one should contact the doctor immediately and not waitfor their next scheduled visit. If there is a problem, it is best to treat it as soon as possible.After LASIK eye surgery, ones vision takes time to stabilize and may fluctuate for up to threeto six months.If further correction or enhancement is necessary, the doctor will usually wait until the eyeshave stabilized and the eye measurements are consistent for two consecutive visits at least 3months apart.LASIK eye surgery is permanent, however one’s eyes may change naturally with time.LASIK does not prevent presbyopia and the eventual need for reading glasses. 24
  28. 28. • LASIK EYE SURGERY STATISTICSMillions of people have had laser eye surgery and the majority are satisfied with the outcome(93% according to the ASCRS - American Society of Cataract and Refractive Surgery).Ninety-five percent of patients reported improved vision, and eighty-five percent said theirquality of life improved.Laser Eye Surgery ResultsSource: Eye Surgery Education Council• LASIK ExpectationsTwo LASIK patients with the same outcome may have a difference of opinion on the outcomeof the surgery, based on their expectations. Your doctor should discuss what to expect before,during and after your surgery, including any questions you might have. It is important to befully informed before the surgery.• LASIK enhancementFollowing LASIK surgery, the healing period is approximately six months. It is estimated thatan average of 5-10% or surgeries need an enhancement. A LASIK enhancement is just a fine-tuning of the original surgery should it be necessary.9. Comparing Test ResultsWhen comparing statistics on lasers and procedures, it is important to keep in mind theperspective and limits of the tests as reported. When viewing laser statistics, keep in mind thefollowing points:Todays results are probably better than FDA date due to technical improvements and surgeonexperienceFDA data in one study cannot always be fairly compared to FDA data in another study due todifferences in study designs and patient criteria - there has never been a head to head studythat has shown that one laser is consistently better than another laserStudies cannot cover every possibility 25
  29. 29. Once the FDA approves the laser, the surgeon can use the laser any way they believe isappropriate, commonly referred to as "off-label" use.In addition to reported laser results, the quality of the laser will also be dependent on whetheror not the laser equipment is being properly maintained.While it is true that certain patients may be better off with one type of laser over another, formost people the choice of laser does not make a significant difference. The final visionoutcome is more importantly influenced by the skill and experience of the surgeon and thequality of care before and after the eye surgery.One of the most important factors in achieving a positive outcome with laser eye surgery isdetermining whether one is a good LASIK candidate.• LASIK surgery resultsThe surveys determining patient satisfaction with LASIK have found most patients satisfied,with satisfaction range being 92–98 percent. A meta-analysis dated March 2008 performed bythe American Society of Cataract and Refractive Surgery over 3,000 peer-reviewed articlespublished over the past 10 years in clinical journals from around the world, including 19studies comprising 2,200 patients that looked directly at satisfaction, revealed a 95.4 percentpatient satisfaction rate among LASIK patients worldwide. Safety and efficacyThe reported figures for safety and efficacy are open to interpretation. In 2003, the MedicalDefence Union (MDU), the largest insurer for doctors in the United Kingdom, reported a 166percent increase in claims involving laser eye surgery; however, the MDU averred that theseclaims resulted primarily from patients unrealistic expectations of LASIK rather than faultysurgery. A 2003 study, reported in the medical journal Ophthalmology, found that nearly 18percent of treated patients and 12 percent of treated eyes needed retreatment. The authorsconcluded that higher initial corrections, astigmatism, and older age are risk factors for LASIKretreatment.In 2004, the British National Health Services National Institute for Health and ClinicalExcellence (NICE) considered a systematic review of four randomized controlledtrials[18][19] before issuing guidance for the use of LASIK within the NHS.[20] Regardingthe procedures efficacy, NICE reported, "Current evidence on LASIK for the treatment ofrefractive errors suggests that it is effective in selected patients with mild or moderate short-sightedness," but that "evidence is weaker for its effectiveness in severe short-sightedness andlong-sightedness." Regarding the procedures safety, NICE reported that "there are concernsabout the procedures safety in the long term and current evidence does not appear adequate tosupport its use within the NHS without special arrangements for consent and for audit orresearch."Leading refractive surgeons in the United Kingdom and United States, including at least oneauthor of a study cited in the report, believe NICE relied on information that is severely datedand weakly researched.On October 10, 2006, WebMD reported that statistical analysis revealed that contact lenswear infection risk is greater than the infection risk from LASIK. Daily contact lens wearers 26
  30. 30. The researchers calculated the risk of significant vision loss consequence of LASIK surgeryto be closer to 1-in-10,000 cases. Patient dissatisfactionSome patients with poor outcomes from LASIK surgical procedures report a significantlyreduced quality of life because of vision problems. Patients who have suffered LASIKcomplications have created websites and discussion forums to educate the public about therisks, where prospective and past patients can discuss the surgery. In 1999, Surgical Eyes wasfounded in New York City by RK patient Ron Link as a resource for patients withcomplications of LASIK and other refractive surgeries. Other patient-founded websites toassist those with complications are LaserMyEye founded in 2004 and Vision Surgery Rehabin 2005. Most experienced and reputable clinics will do a full-dilation medical eye exam priorto surgery and give adequate post-operative patient education care to minimize the risk of anegative outcome.For best results, Steven C. Schallhorn, an ophthalmologist who oversaw the US Navysrefractive surgery program and whose research partly influenced the Navys decision to allowits aviators to get LASIK, recommends patients seek out whats called "all-laser Lasik"combined with "wavefront-guided" software.The FDA website on LASIK clearly states: "Before undergoing a refractive procedure, youshould carefully weigh the risks and benefits based on your own personal value system, andtry to avoid being influenced by friends that have had the procedure or doctors encouragingyou to do so." As such, prospective patients still need to fully understand all the potentialissues and complications, as satisfaction is directly related to expectation.The FDA received 140 "negative reports relating to LASIK" for the time period 1998–2006.P.N. : This is presentation of secondary data – source of information being the internet – In orderto facilitate greater understanding of the service being researched and also to provide statistics ofglobal trends in this laser vision correction industry market that is spread worldwide. 27
  31. 31. ANALYSIS OF THE INTERVIEWS CONDUCTED • Interviews with Ophthalmologists ( eye doctors) -No. Name of Locality for Qualifications Experience No. of laser the doctor medical practice – surgeries in Ahmedabad done1 Yogesh Kapoor C.G.Road Refractive Surgeon- 18 years 1700 MS(ophthalmology)2 Mitesh Ramany Maninagar MS(ophthalmology) 14 years Over 5003 Diyank Bhrambhatt Navrangpura MS(ophthalmology) 15 years Over 5004 Brijesh .C.Patel Stadium Road MS(ophthalmology) 5 years 5005 Tejas D. Shah & Panjrapole M.S. D.O. 18 years Over 1000 Preksha V. Shah Crossroads(P.N. : Interview’s question format is attached in the annexures section)( Other than the 5 doctors mentioned above , we had gone to meet a 6th doctor –Dr.Ashish Dave inManinagar but he refused to discuss anything about laser vision correction because as an eye doctorhe didn’t believe it to be a safe or better solution for vision related problems so he had not prescribedor performed even a single laser surgery till now for any of his patients.) Presentation of information collected- 1) Types of treatment techniques available – a) Simple / Standard Laser b) P.R.K. c) Lasik d) Wavefront e) Tempto sound f) Lapto Lasik g) Zyoptix (advanced technology developed & provided by Bausch and Lomb clinic) 2) Cost range for treatment- Between Rs. 15000 to Rs.40000 ( Range found by taking the least among starting costs and highest among the maximum costs from the information given by the above mentioned 5 ophthalmologists) 28
  32. 32. 3) Laser surgery is recommended by-Laser surgery ACCORDING TO BELOW MENTIONED DOCTORS’ OPINIONis recommend Dr.Yogesh Dr.Mitesh Dr.Diyank Dr.Brijesh C. Dr. Tejas D.-ed by : Kapoor Ramany Bhrambhatt Patel Shah 50% - - 10% to 15% -Optician 50% 100% 100% 70% 100%Ophthalmologist 4) Various kinds of vision defects requiring such kind of a surgery are- a) Myopia b) Hypermetropia c) Astigmatism d) Far sightedness e) Near sightedness 5) ‘Laser surgery- as a permanent solution to all vision defects’- Doctors’ opinion was : a) Four doctors agreed that laser surgery was a permanent solution for vision defects b) Dr. Yogesh Kapoor (Chief surgeon at Bausch and Lomb clinic) believed that in some cases, patient may get vision defects again especially patients who before surgery also used spectacles with ‘more than 14’ power lenses. 6) The success ratio of such laser surgeries is- ACCORDING TO BELOW MENTIONED DOCTORS’ OPINION Dr.Yogesh Dr.Mitesh Dr.Diyank Dr.Brijesh .C. Dr. Tejas D. Kapoor Ramany Bhrambhatt Patel ShahSuccess ratio ofLaser surgery is : 96.75% 99.99% 99.90% 100% 100% 29
  33. 33. 7) Age limit for such a surgery – ACCORDING TO BELOW MENTIONED DOCTORS’ OPINION Dr.Yogesh Dr.Mitesh Dr.Diyank Dr.Brijesh .C. Dr. Tejas D. Kapoor Ramany Bhrambhatt Patel ShahAge limit for Above 18 18-50 years Above 18 Less than 40 NoLaser surgery is : years years years (person between 18- 21 years only, if their vision prescription has stabilized) 8) Side effects if any –then they are as follows:Side Effects ACCORDING TO BELOW MENTIONED DOCTORS’ OPINION Dr.Yogesh Dr.Mitesh Dr.Diyank Dr.Brijesh .C. Dr. Tejas D. Kapoor Ramany Bhrambhatt Patel ShahYes / No Some cases No Sometimes No No only due to negligence of doctors a) Dry eyes - a) Night glare - -Types of side effects b) Blurred b) Under night vision correction or over correction 9) Recuperating period All doctors felt that 1 day of rest after surgery is enough for patient to recover and feel better. 30
  34. 34. 10) Inspite of being a superior alternative to combat vision defects –reasons for lesser acceptability among people – ACCORDING TO BELOW MENTIONED DOCTORS’ OPINION Dr.Yogesh Dr.Mitesh Dr.Diyank Dr.Brijesh .C. Dr. Tejas D. Kapoor Ramany Bhrambhatt Patel Shah a) fear a)fear of damage a) surgery phobia a) ignorance a) ignoranceReasons for lesser b) ignorance to eyes b) surgery b) high costpopularity of c) high cost b) high cost phobiaLaser surgeryamong people isbecause of thesereasons : 11) Popularity of laser surgery from ‘Gender’ perspective –Popularity among ACCORDING TO BELOW MENTIONED DOCTORS’ OPINIONBoth genders Dr.Yogesh Dr.Mitesh Dr.Diyank Dr.Brijesh .C. Dr. Tejas D. Kapoor Ramany Bhrambhatt Patel Shah Less Less Less Males 50% favoured 60% favoured favoured More More More Females 50% favoured 40% favoured favoured 31
  35. 35. 12) Popularity of laser surgery with regard to economic stature of customers is – ACCORDING TO BELOW MENTIONED DOCTORS’ OPINION Dr.Yogesh Dr.Mitesh Dr.Diyank Dr.Brijesh .C. Dr. Tejas D. Kapoor Ramany Bhrambhatt Patel ShahSocio economicstatus of patients All income a) Mostly - rich All income All income All income opting for laser groups b) 20% - needy groups groups groupssurgery Spectacles cost between Rs.250 to Rs.1500 and contact lenses cost between Rs. 1500 to Rs. 5000- whereas laser surgeries cost around Rs 15000 to Rs 40000. Still, doctors said that cost was not a hindrance when something as important as eyes and its vision quality was concerned and in some cases when vision gets very weak getting laser surgery done becomes necessary- i.e. why people across all income groups opt for such an operation. 32
  36. 36. Presentation of information collected from opticians –(P.N. : Interview’s question format is attached in the annexures section)Opticians 1 2 3 4 5Ratio ofSpectacles andContact lenses 60% & 40% 80% & 20% 90% & 10% 80% & 20% 65% & 35%usage respectivelyWhether customersenquire regarding 7% to 8% Yes Yes 5% YesLaser VisionSurgeryGender - whichbrings more of Female Female Female Female Femalesuch queriesIncome group –which All Rich Rich Rich Richbrings more ofsuch queriesOpticians –whetheroffer laser surgery Yes Yes No No Yesrelated informationon own initiativeTie- ups with anyLaser centre Yes No No No NoLaser VisionSurgery– whether Mostly No No No Nosuperior toSpectacles andContact lenses 33
  37. 37. COMPOSITION OF THE RESPONDENTS OF THE SURVEYThe sampling method used is convenience sampling - still care has been taken to ensure thatrespondents selected come from varied localities of Ahmedabad, are of different age groups andincome classes, have opted for different vision correction solutions, have been experiencing visiondefects for different time spans and that the data is not gender biased. This has been done to enable usto get a more clear and accurate picture of the market sentiments of people all across Ahmedabad.So, before presenting the survey results – the respondents composition is being presented.(P.N. : Survey’s questionnaire format is attached in the annexures section) Total respondents = 460( A ) GENDERFemale respondents = 244( Including 15 laser surgery patients, other 229 respondents are those who use conventional solutionslike spectacles or contact lenses)Male respondents = 216( Including 9 laser surgery patients, other 229 respondents are those who use conventional solutionslike spectacles or contact lenses) GENDER COMPOSITION MALE 43% MALE FEMALE FEMALE 57% 34
  38. 38. ( B ) Area of residence of respondentsThe purpose behind selection of this criteria is to understand the attitude of people residing indifferent localities towards the treatment ‘ Laser Vision Correction Surgery’. Though all therespondents reside within Ahmedabad city , but still staying at different locations within the cityaffects their attitudes to great extent because each locality is more like a social group which has itsown values, lifestyle, spending capacities and cultural barriers and all of us very well understand theimpact of all of these on consumer buying behaviour - here we are primarily concerned withunderstanding the consumer’s (actual and potential) attitude regarding a service (laser surgery) beingoffered to them.Here, we have surveyed a total of 66 localities – the aim being a diversified set of respondents. Total respondents = 460Area No. of Respondents Area No. of RespondentsManinagar 73 Naroda 8Amraivadi 6 Rakhial 3Khokra 40 Meghaninagar 6Satellite 31 Kalapinagar 2C.G.Road 13 Gurukul 4Navrangpura 70 Ghirdharnagar 2Naranpura 30 Akbarnagar 1Bapunagar 11 Odhav 1Sardarnagar 1 Jawahar chowk 1Bavla 1 Nehrunagar 1Ashram road 3 Sardar patel park 1Vasna 10 Vatva 1Vadaj 3 Kalupur 3Vejalpur 4 Ranip 1Raipur 1 Science City 1Khedia 1 CTM 3Isanpur 18 Stadium Crossroads 6Sabarmati 9 Bopal 2Motera 3 Shastrinagar 1Ghodasar 6 Bodakdev 3Ambavadi 4 Thakkarbapanagar 2Hatkeshwar 1 Prahladnagar 1Vastrapur 3 Bhimjipura 1Chandkheda 7 Subhashbridge 1Shahpur 3 Sarkhej 2Shahibaug 14 Thaltej 1Nikol 2 Paldi 3Swastik 1 Ghatlodia 2Panchvati 2 Chandlodia 1New C.G. Road 13 Ellisbridge 1Hansol 4 Ankur 1Law garden 2 Indira bridge 1Jivraj Park 1 Judges Bungalow Road 1 35
  39. 39. A map of Ahmedabad city has been presented in order to understand better that how dispersed isour respondent set and this has been done in order to ensure an unbiased response which wouldnot have been the case if we would have opted for people concentrated in just a few specificlocations. 36
  40. 40. ( C ) AGE OF RESPONDENTS Total respondents = 460 AGE OF RESPONDENTS FEMALE MALE TOTAL 0 - 10 2 0 2 10 - 20 150 81 231 20 - 30 38 61 99 30 - 40 19 20 39 40 - 50 28 37 65 50 - 60 5 16 21 60 - 70 2 1 3 TOTAL 244 216 460 160 AGE OF RESPONDENTS 140 NO. OF RESPONDENTS 120 100 FEMALE 80 MALE 60 40 20 0 0-10 10-20 20-30 30-40 40-50 50-60 60-70 AGE GROUP 37
  41. 41. ( D ) PERIOD OF VISION DEFECT EXPERIENCEBy including question regarding this criteria in the questionnaire used for the survey , we sought tounderstand whether the period of vision defect experience was an important underlying factor usedby people to select laser vision correction surgery or not.But, surprisingly period of vision defect experience did not influence respondents much. As most ofthem with similar periods of eyesight problems experience had varying opinions regarding laservision correction surgery.Period of vision defect 0-6 6-12 12-18 18-24 24-30 30-36 TOTALGenderFemale 156 69 13 1 4 1 244Male 114 66 17 10 9 0 216TOTAL 270 135 30 11 13 1 460 PERIOD OF VISION DEFECT EXPERIENCE 180 160 NO. OF RESPONDENTS 140 120 100 Female 80 Male 60 40 20 0 0-6 6-12 12-18 18-24 24-30 30-36 PERIOD OF VISION DEFECT EXPERIENCE 38
  42. 42. ( E ) INCOME OF RESPONDENTSThis criteria was added to check if a person’s income had bearing on his decision to opt for lasersurgery , as it was offered at a comparatively higher rate than spectacles or contact lenses. But, nospecifically biased response was seen owing to the income factor. Total respondents = 460INCOME GROUP FEMALE MALE TOTALUpto 20000 117 77 19420000 – 40000 68 78 14640000 – 60000 27 27 54Above 60000 32 34 66TOTAL 244 216 460 INCOME OF REPONDENTS 140 NO.OF RESPONDENTS 120 100 80 FEMALE 60 MALE 40 20 0 Upto 20000 20000 – 40000 40000 – 60000 Above 60000 INCOME OF REPONDENTS 39
  43. 43. ( F ) MEASURE SELECTED FOR VISION CORRECTIONAs mentioned earlier also, the respondent set included just the people with vision defects, we havetried to select respondents who use varied means to combat vision problems, again it was an attemptto avoid skewed data. Total respondents = 460VISION CORRECTION SOLUTION USED FEMALE MALE TOTAL Spectacles 184 178 362 Contact Lenses 28 18 46 Both ( Spectacles and Contact Lenses) 17 11 28 Laser Surgery 15 9 24TOTAL 244 216 460 MALE 5% 4% Spectacles 8% Contact Lenses Both ( Spectacles and Contact Lenses) Laser Surgery 83% 6% FEMALE 7% Spectacles 11% Contact Lenses Both ( Spectacles and Contact Lenses) Laser Surgery 76% 40
  44. 44. After, looking at the composition of the respondents set – it can be clearly understood that utmostcare has been taken to collect the relevant data from a varied set of people to get unbiased responsesin order to maintain a level of accuracy inspite of the limited sample size that we had chosen.We were also able to make out that the respondents’ belonging to any particular locality, age group,income group, gender etc. did not have a bearing on their responses i.e. to emphasize on the fact thatwe received varied responses from people belonging to same groups (groups as in age group, incomegroup etc.)This above stated finding in a sense contradicts the beliefs of the eye experts ( Opticians andOphthalmologists ) . The experts beliefs were – 1. Females were in more favour of this treatment than the males ( Respondents of both genders showed great confidence in this treatment ) 2. Only the affluent class were keen on getting this treatment done ( Respondents of middle and lower middle class also were willing to get this treatment done )Thus, even those people whom the experts considered as not being a segment of the potential marketwere actually keen to know more about this service and take its benefit in the near future.P.N. – Henceforth, from the next page onwards - all the data i.e. being presented is just about those 436 ( 460 – 24 = 436 ) respondents who use spectacles or contact lenses only. These 436 respondents are the potential consumers for laser vision correction surgery treatment. Their opinions will reflect the sentiments of the potential or available market. This data will be of utmost importance to the entities providing this service as they will be better informed and equipped to reach out to a greater number of these type of respondents who have not yet used their service but in future may decide to do so – if their certain problems with regard to acceptance of the said service are well addressed. The analysis for the remaining 24 (460 – 436 ) respondents i.e. people who have already undergone laser surgery i.e. the actual consumers of this service is given separately after the analysis of these 436 respondents. 41
  45. 45. ( A ) AWARENESS REGARDING THE EXISTENCE OF A ‘ LASER VISION CORRECTION SURGERY ’ TREATMENTA question was asked to determine whether people were aware of such a treatment being offered tocombat their eyesight related problems. Assessing the awareness level among people in Ahmedabadbeing the primary objective of our project, because then only we could list reasons for non acceptanceof laser vision correction surgery among these potential customers (people using spectacles andcontact lenses). The reason being that ‘awareness’ is the precondition for acceptance or nonacceptance of any product or service- in this case for the ‘ laser surgery’ service being offered .Listed below are the responses generated for the question – ‘Awareness regarding the existenceof a treatment like ‘ Laser Vision Correction Surgery ’ ? Gender Female Male TOTAL Response Yes 207 184 391 No 22 23 45 TOTAL 229 207 436 AWARENESS REGARDING LASER VISION CORRECTION TREATMENT 250 200 NO.OF RESPONDENT 150 FEMALE MALE 100 50 0 Yes No RESPONSES 42
  46. 46. (B) EXPOSURE TO ADVERTISEMENT ABOUT ‘ LASER VISION CORRECTION SURGERY ’ Responses generated with regard to the question asked –‘ Have you come across any advertisements for ‘laser vision correction surgery’? ’ Gender Female Male TOTAL Response Yes 182 168 350 No 47 39 86 TOTAL 229 207 436 EXPOSURE TO ADVERTISEMENT 200 180 NO.OF RESPONDENT 160 140 120 Fem ale 100 Male 80 60 40 20 0 Yes No RESPONSES 43
  47. 47. ( C ) MEDIUM OF ADVERTISEMENT – BY WHICH CONSUMERS ARE EXPOSED TO INFORMATION ON LASER VISION CORRECTION SURGERYThere were 5 options of advertisement mediums given to the respondents to select from – they wereas follows – a) Hoardings b) Television c) Newspaper d) Radio e) Other print mediaRespondents of the survey questionnaire had selected one or more options of mediums where theyhad come across advertisements about ‘laser vision correction surgery’. Here, we have not listed thefrequency of respondents who had selected any particular option or set of options, but we have ratherlisted the frequency of their exposure to a number of type of mediums of advertisements – because‘which medium’ was not our area of interest (with relation to the objective of our project ) but ratherwe chose to study ‘how many different mediums’ were the potential customers exposed to – because,it would have a more direct impact on the level of awareness and probable acceptance of thistreatment as it is a known fact that - more the number of sources that provide information regarding aproduct/service – more is the product/service recall – because repeatedly given information tends toget stored in consumer minds – this in turn may translate into more acceptance by the potentialcustomers n the future. Gender Female Male TOTALNo. of advertisement mediums No medium 45 36 81 1 medium 90 66 156 2 mediums 73 69 142 3 mediums 15 31 46 4 mediums 5 4 9 5 mediums 1 1 2TOTAL 229 207 436 No. of advertisement mediums 100 90 N o re p d nts 80 70 o. f s on e 60 Female 50 Male 40 30 20 10 0 No 1 2 3 4 5 m e dium m e dium m e dium s m e dium s m e dium s m e dium s No. of adve rtis e m e nt m e dium s 44
  48. 48. The same question has been analysed, in order to understand which mediumhas been more effectivein order to analyse which medium has been successful to inform a greater mass of peopleWe, can see that hoardings and newspaper have been major mediums for educating people regardingthis treatmentMEDIUM OF ADVERTISEMENT MALE FEMALE TOTALHoardings 146 93 239Television 45 16 61Newspaper 90 138 228Radio 5 5 10Other Print Media 20 66 86TOTAL 306 318 624 MEDIUM OF ADVERTISEMENT 14% 2% Hoardings 37% Television Newspaper Radio 37% Other Print Media 10% 45
  49. 49. ( D) SUPERIORITY OF ‘LASER VISION CORRECTION SURGERY’ AS COMPARED TO OTHER VISION CORRECTION SOLUTIONS LIKE SPECTACLES AND CONTACT LENSESThis information was sought by means of the questionnaire used in the survey in order to determinewhether the people considered laser vision correction surgery to be better as compared to otherconventional vision solutions in the first place – because their perception with regard to its superioritywill determine acceptance of laser vision correction solution in the near future by the respondents(potential customers).Gender Female Male TotalResponseYes 169 161 330No 58 45 103Not sure 2 1 3Total 229 207 436 Superiority of laser surgery as compared to other vision correction solutions 180 160 No. of respondents 140 120 100 Female 80 Male 60 40 20 0 Yes No Not sure Responses 46