Im Rahmen der DOC 2019 hielt Dr. Detlev Breyer diesen Vortag über seine Marketingstrategie für sein Angebot 'ReLEx SMILE'.

1. Breyer, Kaymak & Klabe Eye Surgery and Premium Eyes are Consulting, Study Center & MAB for:
Abott, Alcon, AlimeraSciences, Allergan, AMO, Bayer, Carl Zeiss Meditec, Ellex, Fluoron, Geuder, iOptics, LensAR, Medicem,
Novartis, Oculentis, Oertli, Revision Optics, Santen, Staar Surgical,
Sifi Medtech, Thea, Topcon, Visufarma, Ziemer
Succesful Business of Refractive Surgery in a Private Premium Setting
Detlev R. H. Breyer
2019
Nürnberg

2. Dr. med.
Detlev Breyer
Dr. med.
Hakan Kaymak
Dr. med.
Karsten Klabe
Dr. rer. nat.
Philipp Hagen
Prof. Dr. med.
Gerd U. Auffarth
Dr. rer. nat.
Andreas Fricke
Dr. med. Florian
T. A. Kretz
Who am I? to tell YOU this…

3. Who am I? Usually a Surgeon and Scientist
• Started 15 years ago with a non surgical private practice
• Today over 10.000 intraocular cases
• From cataract refractive, DMEK, glaucoma surgery to complex vitreoretinal
• „Anything but tumors“
• Own science institute with 4 fully employed phycisist, chemist and biologist
• Consulting, study center, speaker, MAB for over 15 companies

4. How Are Other Successful Private Refractive Settings?
• International leading refractive surgeon and successful entrepreneur
• Dan Reinstein

5. Breyer, Kaymak & Klabe Eye Surgery and Premium Eyes are Consulting, Study Center & MAB for:
Abott, Alcon, AlimeraSciences, Allergan, AMO, Bayer, Carl Zeiss Meditec, Ellex, Fluoron, Geuder, iOptics, LensAR, Medicem,
Novartis, Oculentis, Oertli, Revision Optics, Santen, Staar Surgical,
Sifi Medtech, Thea, Topcon, Visufarma, Ziemer
Successful Business of Refractive Surgery in a Private Setting
Detlev R. H. Breyer
Bilder von Fotograf Schadow Arkaden und Oberkassel

6. What´s The Difference? Private / Chain Business
Private Setting Chain
Ownership
Always follow the $ trail
Surgeon tells the way Economist tells the way
Marketing Budget 1 Mio. Euro Several Millions
Internet Presence &
Branding
1 or 2 cities
PremiumEyes, LVC
Many cities
Optical Express
Sales Argument Eminence Method
Strategy Premium upper class surgery
Family 5 Star Business
High volume general
population
Widespread 4 Star Business
Pricing High price Low/Medium price

7. What Makes A Private Refractive Setting Successful?
• Surgeon affiliated factors
• Education and personal surgical experience of a surgeon
• Scientific work: own publications, peer reviewing, own institute, res. network
• Awarded Surgeon: accepted by other surgeons
• Pioneering work: only the best surgeons....
• Indipendence from method: One surgeon offers ALL! surgical procedures
• Indipendence from companies: surgeon is choosing the best product

8. Internationale Anerkennung: Publikationen und Review Tätigkeit

9. What Makes A Private Refractive Setting Successful?
• Personal factors
• Personality / Charisma of the surgeon and team
• Society network
• Social engagement: international and at home (Khmer sight, Opera,
Museums,Theater, city, Sport club)
• International patients / Testimonials
• Presence in media (TV/Print/Social Media)

10. What Makes A Private Refractive Setting Successful?
• Personal factors
• Personality / Charisma of the surgeon and team
• Society network
• Social engagement: international and at home (Khmer sight, Opera,
Museums,Theater, city, Sport club)
• International patients / Testimonials
• Presence in media (TV/Print/Social Media)

11. What Makes A Private Refractive Setting Successful?
• Personal factors
• Personality / Charisma of the surgeon and team
• Society network
• Social engagement: international and at home (Khmer sight, Opera,
Museums,Theater, city, Sport club)
• International patients / Testimonials
• Presence in media (TV/Print/Social Media)

12. What Makes A Private Refractive Setting Successful?
• Personal factors
• Personality / Charisma of the surgeon and team
• Society network
• Social engagement: international and at home (Khmer sight, Opera,
Museums,Theater, city, Sport club)
• International patients / Testimonials
• Presence in media (TV/Print/Social Media)

13. What Makes A Private Refractive Setting Successful?
Soft service factors
• Ambiance of clinic (designer furniture, well known art...)
• Place of clinic: Real estate: site, site, site
• Polite & elegant manners: the rot starts at the top
• More employees (120) than needed - taking a lot of time for patients
• Service of clinic: own App, private assistant, social media
• High personal availability: cell phone number and e mail adress

14. What Makes A Private Refractive Setting Successful?
Soft service factors
• Ambiance of clinic (designer furniture, well known art...)
• Place of clinic: Real estate: site, site, site
• Polite & elegant manners: the rot starts at the top
• More employees (120) than needed - taking a lot of time for patients
• Service of clinic: own App, private assistant, social media
• High personal availability: cell phone number and e mail adress

15. What Makes A Private Refractive Setting Successful?
Soft service factors
• Ambiance of clinic (designer furniture, well known art...)
• Place of clinic: Real estate: site, site, site
• Polite & elegant manners: the rot starts at the top
• More employees (120) than needed - taking a lot of time for patients
• Service of clinic: own App, private assistant, social media
• High personal availability: cell phone number and e mail adress

16. What Makes A Private Refractive Setting Successful?
Soft service factors
• Ambiance of clinic (designer furniture, well known art...)
• Place of clinic: Real estate: site, site, site
• Polite & elegant manners: the rot starts at the top
• More employees (120) than needed - taking a lot of time for patients
• Service of clinic: own App, private assistant, social media
• High personal availability: cell phone number and e mail adress

17. What Makes A Private Refractive Setting Successful?
Hard work & a positive philosophy & creativity for many years
Refractive Surgery in a private setting is definetely No quick & easy money
You are the conductor of a symphony orchestra, be prepared to work 24/7

18. VisuMax Mel 80
Never Forget the Fundament of Your Success
Behandlungsmethode Femto-LASIK ReLEx SMILE
Laser-Platform CZM Mel 80 CZM VisuMax
# Augen 404 1192
M:W [%] 48:52 45:55
MW ± SD Min Median Max MW ± SD Min Median Max p
Alter [Jahre] 37 ± 9 18 37 70 34 ± 8 19 33 72 <0,001
Sphäre [dpt] -2,25 ± 2,19 -9,25 -2,25 5,50 -3,94 ± 1,90 -9,75 -3,75 0,75 <0,001
Zylinder [dpt] -0,90 ± 0,90 -4,75 -0,75 0,00 -0,69 ± 0,68 -3,50 -0,50 0,00 <0,001
Sphärisches Äquivalent (SÄ)
[dpt]
-2,70 ± 2,11 -10,00 -2,50 4,00 -4,29 ± 1,90 -10,00 -4,25 -0,13 <0,001
CDVA [logMAR] -0,01 ± 0,07 -0,28 0,00 0,36 -0,02 ± 0,06 -0,20 0,00 0,30 <0,001
UDVA [logMAR] 0,87 ± 0,40 -0,18 0,98 1,30 1,10 ± 0,30 -0,02 1,30 1,30 <0,001
Zentrale korneale Dicke [µm] 550 ± 30 442 550 632 549 ± 30 469 547 655 0,38
Flap-/Cap-Dicke [µm] 116 ± 9 100 120 160 138 ± 13 110 140 150 <0,001
Ablationons-/Lentikeldicke [µm] 66 ± 24 14 64 151 92 ± 29 36 89 168 <0,001
Zielrefraktion (Laser) [dpt] 0,02 ± 0,43 -1,50 0,00 1,00 0,38 ± 0,40 -2,00 0,50 1,25 <0,001

19. 0%
25%
50%
75%
100%
3oder
mehrverl.
2verl.
1verl.
gleich
1gew.
2gew.
3oder
mehrgew.
AnteilderAugen[%]
∆CDVA [Snellen Lines]
Sicherheit: CDVA(post) - CDVA(prä)
High Safety
Signifikante Unterschiede (p<0,05):
• SMILE mit leicht besseren (1-2 Buchstaben)
Mittelwerten bei 6M, 1J und 2J
 Leichte Vorteile für ReLEx SMILE bei Sicherheit
∆CDVA = CDVA(post) - CDVA(prä)
n = #Augen Femto-
LASIK
ReLEx SMILE p
MW ± SD
6 M
54 174
<0,05
0,01 ± 0,06 -0,01 ± 0,07
1 J
55 271
<0,05
0,00 ± 0,06 -0,05 ± 0,08
2 J
29 89
<0,05
0,01 ± 0,06 -0,03 ± 0,07
3 J
34 50
0,16-0,03 ±
0,07
-0,01 ± 0,07
5 J
32 26
0,14-0,03 ±
0,07
-0,01 ± 0,05
“n verl. (gew.)“:
≥5*n (≤-5*n) Buchstaben Unterschied
Kein Auge
mit Verlust
von 2 oder
mehr Zeilen

20. High Predictability
• Leichte Unterkorrektur von ca. 10%
 Verwende internes Nomogram
während Planungsphase der OP:
Erhöhe die Zielkorrektur des SÄ bei
myopen Augen um 10%.
Zielkorrektur SÄ =
SÄ(Laser-Ziel) – SÄ(prä)
Erzielte Korrektur SÄ =
SÄ(post) – SÄ(prä) Lineare Fitgerade: y = m*x + b
n = #Augen
Femto-
LASIK
ReLEx
SMILE
( m | b )
R²
6 M
54 176
( 0,96 | -0,20 ) ( 0,88 | 0,06 )
0,98 0,95
Vorhersagbarkeit
Zielkorrektur SÄ [dpt]
ErzielteKorrekturSÄ[dpt]

21. High Effectiveness
Signifikante (p<0,05 , Wilcoxon Rangsummentest) Unterschiede:
• SMILE mit leicht besserem UDVA 1 und 2 Jahre nach OP
Betrachte Untergruppe mit:
SÄ(Ziel) = 0,0 dpt ± 0,5 dpt
 Mehr Daten benötigt
monokularer UDVA(post) [logMAR]
Median Femto-
LASIK
ReLEx
SMILE
p
MW ± SD
6 M
0,00 0,00 0,05
0,04 ± 0,12 0,01 ± 0,12
1 J
0,00 -0,06 <0,001
0,01 ± 0,10 -0,03 ± 0,1
2 J
0,04 -0,04 <0,01
0,08 ± 0,20 -0,03 ± 0,09
3 J
0,03 0,00 0,05
0,06 ± 0,15 0,01 ± 0,13
5 J
0,02 0,00 0,82
0,03 ± 0,10 0,03 ± 0,10
Unkorrigierter Fernvisus
6M 1J 2J 3J 5J 6M 1J 2J 3J 5J
LASIK SMILE

22. Few Induced HOA
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
Astigmatismus
(RMS)
Total HOA (RMS) Coma (RMS) Sphärische
Aberrationen
OkulareAberrationen[µm]
Okulare Aberrationen (6mm)
Lasik präop. (n=255)
Lasik post (n=157)
Smile präop. (n=631)
Smile post (n=524)
Signifikante (p<0.05) Unterschiede:
• Astigmatismus wird durch Femto-LASIK und ReLEx SMILE reduziert
• Aberrationen höherer Ordnung postoperativ in beiden Gruppen leicht erhöht
Keine signifikanten Unterschiede zwischen beiden Gruppen
Signifikante (p<0.05) Unterschiede:
• Astigmatismus wird durch Femto-LASIK und ReLEx SMILE reduziert
• Aberrationen höherer Ordnung postoperativ in beiden Gruppen leicht erhöht
Keine signifikanten Unterschiede zwischen beiden Gruppen

23. • Geringe Komplikationsraten
(vergleichbar mit Literaturwerten)
• Geringe Rate an Nachbehandlungen
Vergleichbare Ergebnisse in beiden
Gruppen
Few Complications and Retreatments
Behandlungen
Femto-
LASIK
SMILE
total 404 100% 1197 100%
vollendet 404 100% 1192 99,6%
abgebrochen 0 0% 5 0,42%
Komplikationen
Vakuumverlust 3 0,74% 6 0,50%
vollendet 3 2
abgebrochen 0 4
Lentikel nicht separierbar - 1 0,08%
…
Nachbehandlungen
refraktiv (meist innerhalb 6M) 5 1,24% 4 0,34%
Re-LASIK 5 -
PRK 0 3
ICL 0 1
Keratokonus
CXL 1 0,25% 1 0,08%
Sonstiges
Spülung 2 2
Flap-Lifting 6 -
1 x ICL,
3 x glasses/CL
1 x Trans-PRK

24. Having All That Said, Never Forget:
Nothing is as rewarding as helping and philantropy!

25. Partner of
Thank You Very Much For Your Kind Attention!