The Business of Refractive Surgery 2004 (Hallway Controversies- American Society of Cataract & Refractive Surgery) by Dr. Jeff Machat

1. Hallway Controversies:
The Business of Refractive
Surgery 2004
No, Optometry is NOT
Dead
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2. No, Optometry is NOT Dead
Optometry s role will increase in the RS
1. Historically
2. Demographically
3. Patient perspective
4. Surgeon perspective
5. Economic perspective
6. Personal perspective
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3. No, Optometry is NOT Dead
HISTORICALLY:
• Shared Care is a natural complement to all
facets of medicine
Family MD > Cardiologist > Cardiac Surgeon
• ODs and MDs share this same relationship
• History shows fluctuating trends, this past
year is not indicative of the next 5 years
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4. No, Optometry is NOT Dead
Optometry s Role in Refractive surgery will
increase as:
• More patients have refractive surgery
• More surgeons perform refractive surgery
• More refractive options introduced
• More technologies develop e.g. wavefront
• More price confusion continues
• More problems surface and appear in the press
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5. No, Optometry is NOT Dead
DEMOGRAPHIC ARGUMENT:
• The majority of good refractive surgery
candidates receive their primary eye care
from an optometrist, estimated at 70% of
the potential candidate pool
• Optometrists are trusted by their patients
• Optometrists will always be involved in
vision care options for their patients
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6. No, Optometry is NOT Dead
CLINICAL ARGUMENTS:
• Optometrists will always have greater
knowledge and insight into the candidacy of
their patients
– Stability of Rx & CL history
– Past ocular history
– Occupation & Hobbies etc...
– Personality & Expectations !!!!
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7. No, Optometry is NOT Dead
• Optometric Co-management provides
certain essentials and unique benefits to
refractive surgery candidates:
– Pre-op: Candidacy, Education, Refraction and
Ocular evaluation confirmation, controversially
help with Surgeon/Center/ Laser selection
– Intra-op: Reassurance, Continuity of care
– Post-op: Convenient and More frequent
evaluation
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8. No, Optometry is NOT Dead
PATIENT ARGUMENTS:
• Candidates need to make sense of all the
marketing hype:
– Centers, Lasers, Surgeons, Prices, Technologies
• They require access to unbiased information
based upon their particular eye history and
prescription
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9. No, Optometry is NOT Dead
PATIENT ARGUMENTS:
• Optometric co-management provides a vital
quality control aspect
– By assessing patients post-operatively
separately from the surgeon, patients feel
reassured
– Patients desire an advocate and trust their
optometrist to seek solutions for any problems
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10. No, Optometry is NOT Dead
SURGEON ARGUMENT:
• the surgeon with a well selected candidate,
• clinical information, history and insight
• highly informed re: risks factors /presbyopia
• allows the surgeon to perform more surgery
• provides more convenient & frequent post-
op care with continuity of care for Readers,
Night Rx, Retinal evaluations
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11. No, Optometry is NOT Dead
PATIENT & CLINICAL ARGUMENTS:
• Good surgeons may or may not
co-manage
• Poor surgeons do not co-manage
• Patients ask their OD: Where would you
go – they may not pick you, but they will
always pick someone proficient in RS
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12. No, Optometry is NOT Dead
ECONOMICS ARGUMENT:
• Economics of competition has brought into
question role of optometry
• As fees reduce– question is where to cut:
Marketing vs. Optometric Care
• Marketing in major cities is not typically
cost effective and can easily range from
$100 for a typical patient lead to
$1000 per patient acquisition or double
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13. No, Optometry is NOT Dead
ECONOMICS ARGUMENT:
• Concede that within the deep discount LASIK
marketplace, ODs have been excluded
• Concede also that 90-98% of LASIK patients
will do well with minimal post-op care
• Problem is which patients will not do well ?
• One poor outcome can negate 100 good ones!
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14. No, Optometry is NOT Dead
ECONOMICS & PATIENT ARGUMENTS:
• Most marketing dollars do nothing to
educate patients
• Most centers place similar messages despite
differences:
– Everyone either invented or pioneered
LASIK
– Or was the First at Something!
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15. No, Optometry is NOT Dead
ECONOMIC & CLINICAL ARGUMENTS:
• Optometry provides a vital link for most
patients and high volume centers
– Information conduit
– Screening satellites
– Post-operative care satellites
– Continued eye care centers
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16. No, Optometry is NOT Dead
ECONOMIC & BUSINESS ARGUMENTS:
• Most candidates see an OD
• Most candidates trust their OD
• ODs are ideally suited to provide clinical
history & information on their patients
• ODs are ideally suited to educate their
patients on RS
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17. No, Optometry is NOT Dead
ECONOMIC & BUSINESS ARGUMENTS:
• By having optometry provide much of the
pre-operative and post-operative care,
surgeons are able to:
• perform more surgeries
• dedicate more time to care for more
complex and problem cases
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18. No, Optometry is NOT Dead
ECONOMIC & BUSINESS ARGUMENTS:
• While in-house optometric care is cheaper,
it fails to provide the other essential aspects
of quality care:
• unbiased information,
• continuity of care and trust,
• independent quality control
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19. No, Optometry is NOT Dead
ECONOMIC & BUSINESS ARGUMENTS:
• Negative rumors & Negative press can only
be effectively dealt with through education
which optometry can provide
• Each of these points will become
increasingly important as refractive surgery
continues to evolve
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20. No, Optometry is NOT Dead
ECONOMIC & BUSINESS ARGUMENTS:
• Low price corporate centers did exclude
optometry but they have failed to stand the
test of time
• Marketing is too expensive and impossible
to differentiate the players at the high end
• Optometry will always have influence on
this segment of the candidate pool
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21. No, Optometry is NOT Dead
My Refractive Surgery Experience with
Optometry:
• High quality patient experience provided
which always stands the test of time
• Increased role as I introduced Wavefront
Guided LASIK last year in Toronto
• My competition has once again shifted back
toward co-management this past month
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22. No, Optometry is NOT Dead
THANK YOU
FOR THE OPPORTUNITY,
Jeffery J. Machat MD
Toronto, Canada
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23. The Business of Refractive
Surgery
Oh Yeah !
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24. No, Optometry is NOT Dead
• The closing of low cost LASIK centers
promotes the role of optometry
• The increase in LASIK advertising
promotes the role of optometry
• The introduction of Wavefront actually
promotes the role of optometry again
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25. No, Optometry is NOT Dead
• Wavefront Technology will be marketed at
a premium
• Optometry influences most at the high end
• ATMs did not eliminate bank tellers
• Autorefractors and similarly, aberrometers
will not replace the role of optometry
• Most expensive cars come standard with
best options, comanagement is high end
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26. No, Optometry is NOT Dead
• Everyone will have their own opinion based
upon their personal experience &
competitor positioning with ODs
• Nevertheless, Optometry will once again
increase in importance with:
– the decline of low cost LASIK centers
– introduction of Wavefront Technology
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27. No, Optometry is NOT Dead
My Refractive Surgery Experience with
Optometry:
• Cautious, Conservative as a whole
• Spend more chair time pre & post-op
• High index of clinical suspicion: Over-refer
• No safety difference in follow-up problems
observed with ODs & MDs
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28. No, Optometry is NOT Dead
PATIENT ARGUMENTS:
• Optometry in general provides each patient
with far more unbiased information
regarding surgical risks and clinical results
• Optometry as a whole is far more
conservative than ophthalmology with
respect to elective refractive surgery
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29. No, Optometry is NOT Dead
PATIENT ARGUMENTS:
• Patients need post-operative care and most
feel most comfortable with their own OD
• Visiting their OD is less time consuming:
often both for travel & office time
• Patients post-operatively need continued
care for:
– Readers, Night Rx, Retinal evaluations
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30. No, Optometry is NOT Dead
PATIENT & CLINICAL ARGUMENTS:
• If a patient sees their own optometrist and has
a poor result:
– striae, loss of bcva, or severe night glare
• ODs will not refer again despite any real or
perceived economic benefit
• Only excellent clinical results promote referrals
• Marketing however ignores past results
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31. No, Optometry is NOT Dead
• Poor quality surgeons will not receive
optometric support,
• We Concede: Not all high quality surgeons
comanage
• However: Extremely rare for less proficient
surgeons to receive referrals
• Fee amounts are another issue
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32. No, Optometry is NOT Dead
• To imply that Optometrists are incapable of
providing high quality post-operative care is
insulting to optometrists and other non-
surgical professionals
• Just as most surgeons are excellent caring
professionals, so are most optometrists
• Proper refractive surgery training can be for
anyone
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33. No, Optometry is NOT Dead
• To imply that an optometrist would refer a
patient to a substandard surgeon for a few
hundred dollars is ludicrous
– The optometrist has a longstanding relationship
with his patient
– The entire family as well as friends are often
patients and therefore the remainder of the
practice may be at risk
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34. No, Optometry is NOT Dead
– The optometrist is still is required to care
for their patient
– Problem patients are costly in chair time
– Problem patients are costly in emotional
stress
– Legal liability is still an issue for
optometry
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35. No, Optometry is NOT Dead
ECONOMIC & BUSINESS ARGUMENTS:
• ODs already present vision options of
glasses & contacts to their patients,
refractive surgery is simply another option
• ODs must be part of the economic reality of
refractive surgery to present this option
• ODs can cost-effectively provide services,
pre-op, intra-op & post-op
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