1. COVER STORY
The Mindset of the
Refractive Patient
Using what we have learned so far to improve how we attract consumers.
BY SHAREEF MAHDAVI
hen laser refractive surgery became avail-
W able in the US in 1995, the refractive sur-
gery market included fewer than 1,000
surgeons who had performed radial ker-
atotomy (RK) or automated lamellar keratomileusis on
a total of 400,000 patients. Ten years later, approxi-
“Consumers’ fear about anything’s
or anyone’s touching their eyes
will likely reign in refractive
surgery for years to come.”
mately 4,000 US ophthalmic surgeons have performed
a combined lamellar/laser procedure (LASIK) on more myopic patients agreed that not having to wear glasses
than 4 million patients. or contact lenses would be great, this desire has not
Refractive surgery has emerged as its own consumer translated into action. To date, approximately 700,000
product category, with high public awareness of LASIK— Americans undergo LASIK each year in the US. The
a stark contrast to earlier days of refractive surgery, when cumulative 4 million patients treated thus far represent
consumers were trying to understand the difference only 7% of the 60 million Americans who are consid-
between RK and PRK. ered prime candidates for the procedure (Figure 1).
Furthermore, this pool will continue to expand as the
CO N S U M E R AWA R E N E S S A N D F E A R number of Americans reaching adulthood each year
Although a recent survey (data on file at Intralase exceeds the number having LASIK.
Corp., Irvine, CA) indicates that more than 80% of The gap between desire and action can largely be
attributed to consumers’ fear of undergoing surgery on
their eyes. It is important to note for the purpose of
comparison that contact lenses, which have been
around a lot longer than refractive surgery, have never
penetrated beyond 20% of the spectacle-wearing popu-
lation. Low prices in both categories have failed to sig-
nificantly increase the demand for alternatives to spec-
tacles. Consumers’ fear about anything’s or anyone’s
touching their eyes will likely reign in refractive surgery
for years to come.
R E D U C I N G WO R R I E S
Technology will play a role in reducing consumers’
Figure 1. Although the vast majority of prime LASIK candidates fears. Ophthalmic technology is expanding the refrac-
would like to be rid of their spectacles,the 4.2 million Americans tive surgery category beyond lasers to include nonlaser
treated thus far represent a cumulative penetration of just 7% approaches (conductive keratoplasty [CK; Refractec,
through 2004.(Data on file with Intralase Corp.and MarketScope Inc., Irvine, CA]), implants (IOLs), and even inlays
[St.Louis,MO]). (Permavision; Anamed Inc., Lake Forest, CA). These
MARCH 2005 I CATARACT & REFRACTIVE SURGERY TODAY I 77

2. COVER STORY
technologies have the potential to make refractive sur- diversity of refractive options becoming available and
gery more acceptable to the masses by increasing treat- their consistently and comparably excellent results.
ment options for all consumers while continuing to Ironically, poor marketing might be the primary culprit
raise the bar regarding both safety issues and the effica- in keeping refractive surgery from reaching its market
cy of results (Figure 2). potential.
Indeed, the explosion in refractive surgery technology
puts a pressure on providers that didn’t exist with the
“one size fits all” mentality associated with LASIK.
“Unmanaged, the messages delivered
Nomograms for treatment will have to incorporate by providers through their advertis-
lifestyle and vision task needs on par with age and ing and educational efforts run the
refractive error. Certainly, the complexity involved in
future refractive procedures will create a significant bur-
risk of creating even more confusion.”
den on the surgical protocol.
As an alternative to promoting new surgical tech-
N E W T E C H N I C A L T E R M I N O LO G Y nologies over older ones, surgeons will need to develop
The increased complexity facing surgeons translates what I term marketing protocols with the same level of
into a potentially negative situation for consumers. In attention they give to surgical protocols to improve
addition to new choices afforded by evolving technology, their clinical results. The concept of diagnose, recom-
new descriptors of procedures will emerge such as tempo- mend, treat can be applied to the marketing process
rary, removable, and (eventually) adjustable. This develop- involved with each prospective patient. That is, sur-
ment in refractive surgery is good, but, if left unmanaged, geons will need to gather a lot of data on each patient
the messages delivered by providers through their adver- in order to understand his or her specific goals and
tising and educational efforts run the risk of creating fears. Because the data collection occurs prior to the
even more confusion in the marketplace and delaying recommendation of a treatment course, this approach
consumers’ decision making as they try to figure out will not be as easy as running an advertisement that
which procedure is best for them. touts LASIK’s benefits and waiting for the phone to ring.
Refractive surgeons’ entire approach to marketing com-
N O M O R E “O N E S I Z E F I T S A L L” munications—from external advertising and promo-
No single procedure will be “best” in the way that tions to internal counseling and written materials—will
technology has evolved thus far. The tried and true need to be extremely focused to segment and target
marketing messages are likened to raised bets in Texas the different subgroups of patients who will be most
Hold ‘em: the laser was promoted as better than RK, likely to benefit from a particular refractive technology.
LASIK as superior to PRK, and now wavefront-driven
LASIK as better than standard LASIK. Those messages NEW MARKETING FOR A NEW MARKET
are rapidly wearing thin with consumers because of the In the days when the only tool refractive surgeons
had was the hammer called LASIK, every patient looked
like a nail. During the past decade, we have gained ex-
tensive insight and knowledge about what marketing
tactics do and do not work for refractive patients. Re-
fractive surgeons now have a growing list of tools at
their disposal, and their marketing protocols will need
to be formalized and disciplined in order to select the
right tool for the job. ■
Shareef Mahdavi draws on 20 years of med-
ical-device marketing experience to help com-
panies and providers become more effective
Figure 2. Until now, refractive technology has evolved in a lin- and creative in their marketing and sales
ear fashion. In the future, there will be multiple good options efforts. Mr. Mahdavi welcomes comments at
for patients, requiring surgeons to become much more disci- (925) 425-9963 or shareef@sm2consulting.com. Archives of
plined in how they promote and discuss technology with his monthly column may be found at www.crstoday.com.
patients.
78 I CATARACT & REFRACTIVE SURGERY TODAY I MARCH 2005