Eyeworld

113 OPHTHALMOLOGY BUSINESS October 2018 patients are presbyopic but are still years out from cataract develop- ment (cataract cases called into his office are referred elsewhere). Dr. Rebenitsch estimated that about 40% of his practice's revenue is from presbyopia treatments. "While laser vision correction is growing, it's not growing at quite the same rate as presbyopia," Dr. Rebenitsch said. Another thing that sets their practices apart is creating a con- cierge or boutique feel. "When we opened our practice, my wife and I started by making a list of the ways our current medi- cal system is impersonal and falls short of patient expectations," Dr. Brinton said. "It was long. We began by agreeing not to do any of those things on the list." For example, instead of a tradi- tional check-in counter, patients are attended to at what looks like a con- cierge desk at a hotel. When they sit down at a couch in the waiting room, there is a menu, which they can use to request a drink or snack. Tablets are provided for patients to use throughout the process, but in general, Dr. Brinton said that there is minimal waiting. "After diagnos- tic testing is complete we sit down for 20–30 minutes to discuss refrac- tive surgery options and go over their questions. Our consultation fee includes a second visit if desired to go over further questions. We have hours that make sense for patient generation of refractive surgeons, LASIK was the only option, and for those who offer only LASIK upward of 90% of patients presenting for vision correction surgery may be considered candidates. For us that number is 42%—a majority of pa- tients coming to our office for LASIK are having their eyes corrected with one of the other options," Dr. Brin- ton said. "I think these additional procedures have given refractive surgery a shot in the arm, particu- larly for the presbyopic population looking to live without reading glasses and bifocals. Now we have multiple effective treatments." For those interested in pursuing a career in refractive surgery, Dr. Brinton recommends a dedicated refractive surgery fellowship. "Most cornea-based fellowships focus on pathology and provide more limited exposure to refrac- tive surgery beyond LASIK. There are about a dozen fellowships like ours that give broad-based refrac- tive surgery training and provide fellows with extensive experience doing LASIK, SMILE, ICL, and inlay procedures as part of their training," he said. The availability of presbyopia- correcting treatments has been a major driver of practice success, Drs. Brinton and Rebenitsch said. Dr. Brinton said that as of 2018, more than half of refractive patients presenting to his office are seek- ing presbyopia correction. These Patients and their guests are given a private patient suite to use throughout the duration of their consultation and surgery appointments at Brinton Vision. Source (all): Jason Brinton, MD schedules, rather than traditional medicine hours," Dr. Brinton said. "I think we have to stop seeing this as an extension of traditional medicine; these services need to be provided in a way that is accessible to this generation." Similarly, patients to Dr. Rebenitsch's practice are offered water, soda, or coffee upon arriving, phones are answered with what he called a "ClearSight smile," and technicians are encouraged to get to know patients on a personal basis. He also said the practice employs seven members of counseling staff who devote a significant amount of time to each patient. After proce- dures are completed, Dr. Rebenitsch offers his personal cell phone number. "Our goal is to create a relation- ship before, during, and after the procedure, and to create excitement after the procedure to help drive word-of-mouth referrals as well," he said. Atmosphere ripe for growth Research (based on data from 1999 to 2004) in the U.S. population ages 12–54 years old found myopia prev- alence was 41.6%. 1 "Just myopia in the United States is about 30–50% of the pop- ulation. Of that, 80% or higher is eligible for refractive surgery, so the addressable market is enormous," Dr. Kugler said. "If you include those who have hyperopia and presbyopia … now it's close to 100% of the population who can benefit from refractive surgery, yet only 4% have had refractive surgery." What about the financial aspect of these elective procedures? "We need to make the econom- ic argument that refractive surgery is valuable and saves money over a lifetime vis-à-vis glasses and con- tacts," Dr. Brinton said. "Early on our staff agreed not to do 'free exams' or go the route of coupons, discounts, and spe- cial deals. Everyone pays the same amount for a given procedure. Pric- ing integrity is an important compo- nent of the trust we have with our patients." Patients pay a consulta- tion fee when they book their LASIK consult, and a typical LASIK proce- dure runs $6,400. LASIK and other refractive procedures present an attractive alternative to those who are spending hundreds and some- times thousands a year on glasses and contacts. Dr. Brinton said they have seen a significant increase in the number of patients in their 20s coming in for laser vision correc- tion. "Patients in this age range are seeing that they have more years to enjoy their eyesight and the most to gain by having their vision correct- ed in their early adult years." While the patient can benefit from what he called "life-changing procedures," Dr. Brinton said the practice approach is simpler as well. "Not contracting with insurance companies frees our staff up to focus on patient care," he explained. All three doctors said word of mouth has become their most powerful form of marketing. Yet the population, in general, doesn't have any idea that there is more to refractive surgery now than LASIK, Drs. Kugler and Rebenitsch said. "We still have a good portion of our patients who have never heard of most of our refractive options. Once that awareness is created, I don't know how we'll keep up," Dr. Rebenitsch said. "The opportunities are almost limitless," Dr. Kugler said. "Every year, there are more than 2 million children in the United States who become eligible for refractive surgery, so we're not even close to maintain- ing the inflow of new myopes. Even if we just did LASIK and not all the other procedures, we're not keeping up with the influx of people who have that as an option." EW Reference 1. Vitale S, et al. Increased prevalence of myopia in the United States between 1971–1972 and 1999–2004. Arch Ophthal- mol. 2009;127:1632–9. Editors' note: The physicians have no financial interests related to their comments. Contact information Brinton: jbrinton@brintonvision.com Kugler: lkugler@kuglervision.com Rebenitsch: lrebenitsch@gmail.com

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