Eyeworld

SUMMER 2024 | EYEWORLD | 51 R Relevant disclosures Kugler: None Rebenitsch: Carl Zeiss Meditec, Johnson & Johnson Vision, OSRX Pharmaceuticals, RxSight, STAAR Surgical Thompson: Alcon, Bausch + Lomb, BVI, Carl Zeiss Meditec, Johnson & Johnson Vision, Lenstec, Rayner, RxSight, STAAR Surgical Williamson: Bausch + Lomb, Johnson & Johnson Vision, STAAR Surgical Contact Kugler: lkugler@kuglervision.com Rebenitsch: Dr.Luke@ClearSight.com Thompson: vance.thompson@ vancethompsonvision.com Williamson: blakewilliamson@weceye.com said. "I think that what you're seeing is that a lot of patients who would have had LASIK a few years ago are now being recommended to have either an ICL or RLE, so that's a big reason for the apparent decrease in LASIK volumes that we're seeing." Dr. Kugler said that patients will come in asking about certain procedures, but he finds that there is low public awareness of RLE. When they hear about it, it's usually that they had no idea that it was a solution for them, he said, adding that some patients hear about it as an option because family or friends have had the procedure. He has seen similar experience with ICLs, where patients might know about this from family or friends. STAAR Surgical is doing some successful direct-to-consumer marketing around the ICL, he said. A lot of times they might not be a candidate for it, even though they come in asking about it, but there's public interest around RLE and ICLs. "I do think that the EVO ICL is appealing to people, particularly younger people who don't like the idea of something that's not reversible or upgradable," Dr. Kugler said. "This group likes the idea of something they can do now to fix their vision and adjust later should they need to." Rather than pitching every single option to patients, Dr. Kugler said he has a discussion with the patient, and this determines what he will recommend. Patients will never be able to understand the nuances of all these procedures, he said, and as the experts on these procedures, the onus is on us to recommend what is best for them. "Once we're clear on what the recommen- dation is, then we can talk about the risks, ben- efits, and costs. Patients appreciate a clear plan. They come to us for a recommendation and guidance, and I think they are more comfortable when we confidently know what's going to meet their needs." Dr. Kugler said there's still a place for LASIK. "LASIK is still the clear leader in preci- sion in terms of low power treatments. It's very precise. It's probably the most precise we have for astigmatism as well," he said. "If you have someone who needs that treatment, LASIK is very hard to beat." I think it's difficult, if not impossible, to have a refractive surgery practice without access to LASIK, Dr. Kugler said. To not have LASIK means that you cannot address those situations, he said, adding that you also cannot enhance SMILE without LASIK, and the same is true with IOLs. There are 10–15% of multifocal IOL procedures that require low diopter enhance- ments, and that is best done with LASIK, he said. "LASIK will continue to be important for the foreseeable future." Dr. Kugler said that he is seeing more consistency among doctors. "Ultimately, as a community of refractive surgeons, we continue to strive for a standard approach. Until that is achieved, it's important for each surgeon to be consistent with how they're using technology to help their nomograms be better and help staff better discuss expectations with patients," he said. "The biggest challenge we have in refractive surgery is we don't have agreed upon standards on how to apply the technologies con- sistently, and that's causing confusion among the public and holding us back as an industry. We all want patients to see as well as they can. I think in order to achieve the growth of refrac- tive surgery that we all would like to see, it's incumbent to have agreed upon standards that we can use together." Dr. Kugler performs RLE. Source: Lance Kugler, MD

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