Eyeworld

OPHTHALMOLOGY BUSINESS 112 October 2018 by Liz Hillman EyeWorld Senior Staff Writer do better educating our communi- ties about the value of seeing clearly every waking moment." Also, with seven refractive pro- cedures now on the market—LASIK, PRK, SMILE, ICL, refractive lens ex- change, intracorneal inlays, and re- fractive cataract surgery—Dr. Kugler pointed out that the numbers might show fewer people getting LASIK (the procedure that has become almost synonymous with the term "refractive surgery") because they are getting other procedures more suited to their needs. How do refractive-only practices see success? The short answer to this question is specialization and customer service, according to Drs. Brinton, Kugler, and Rebenitsch. Dr. Brinton sees refractive surgery as a subspecialty of ophthal- mology like glaucoma, retina, and pediatrics. "With rapidly advancing technology and new procedures, there are increased benefits to pursuing subspecialty fellowship training and focusing on the field of refractive surgery. The technology involved with LASIK and the mod- ern vision correction procedures we perform today is increasingly com- plex. Practitioners who specialize in our field and offer the full range of refractive procedures are seeing a great deal of growth. "There is so much more that we can do now. For the previous cataracts. Since then, newer tech- nologies in cataract surgery, such as the femtosecond laser and refractive IOLs, have given cataract surgery the additional opportunity for elec- tive income. "People who used to emphasize [refractive surgery], market it, rec- ommend it, have lost interest in it and focused their efforts elsewhere, and that's a huge reason it's under- appreciated today," Dr. Kugler said. Another factor, Dr. Kugler thinks, is changes in demographics. The baby boomers who were driving growth in refractive surgery in the 1990s and 2000s are now of an age where refractive lens exchange or cataract surgery might be bet- ter options for them. Generation X, which came after them, was a smaller group of people. However, generation Y and the millennials coming in next are a huge group, Dr. Rebenitsch said, and they're now of the age where refractive surgery could be an option for them. Then there was marketing. Dr. Kugler said there was a time when refractive surgery marketing focused on use of the femtosecond laser vs. blades, the latter of which might have scared off potential patients. Dr. Brinton thinks that the refractive surgery market hasn't done itself justice on the communication front in years past. "It's how we talk about it and communicate the benefits of refrac- tive surgery," he said. "We need to Lance Kugler, MD, at the helm, still sees the opportunity for growth in refractive surgery. "The ground is fertile for growth, there are tremen- dous opportunities, and through collaboration, the growth is inevita- ble," Dr. Kugler said. Luke Rebenitsch, MD, became a partner at ClearSight LASIK, Okla- homa City, in 2015 and bought the practice outright when his partner retired earlier this year. "Since I joined the practice, our topline revenue has increased about 100%," he said. Why the seeming slump? If these three ophthalmologists are having success in practices focused only on refractive surgery, why does there seem to be the perception of a so-called slump nationwide? Dr. Kugler has some theories. "There was a downturn in LASIK volume that coincided with the recession, but there were a lot of fac- tors that led to the downfall around that time. Some of it was financial; people had less expendable income and made other choices. But that part of it would have rebounded by now, so other factors are proving to be more of an issue than the reces- sion," he said. One of those factors is fewer doctors offering refractive surgery. With the economic downturn, Dr. Kugler speculates that many oph- thalmologists who once highlighted refractive surgery began focusing on Practices specializing in only elective refractive procedures are seeing tremendous growth R efractive surgery is not what it was in its heyday of the late 1990s to early 2000s—or is it? While technologies and tech- niques have no doubt continued to improve, there are, in addition, a whole host of new refractive proce- dures available, expanding options well beyond what could be offered 10 years ago. In terms of number of patients receiving refractive surgery, Richard Lindstrom, MD, Minne- apolis, in the 2018 Steinert Lecture at ASCRS Refractive Day, said that as far as LASIK numbers, those have not yet recovered since their decline in the Great Recession. However, practices focusing solely on elective refractive sur- gery report significant growth and success in recent years. Jason P. Brinton, MD, opened the doors of Brinton Vision in St. Louis nearly 2 years ago and has seen "tremen- dous growth" in terms of a patient base, which is served by 24 full-time employees and growing. "We are running as fast as we can. Last week we posted a job to hire a second surgeon," Dr. Brinton said. Kugler Vision, which opened in 2011 in Omaha, Nebraska, with Practices focused on refractive The reception area at Brinton Vision was designed to create a calm, spa-like atmosphere. Brinton Vision's Vision Correction Suite houses a surgical microscope, bed, four phaco systems, and five lasers, including two femtosecond and two excimer lasers.

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