Eyeworld

EW REFRACTIVE SURGERY 98 April 2016 by Ellen Stodola EyeWorld Senior Staff Writer Surgeons practicing in different areas around the world comment on LASIK O ver the years, LASIK has become a popular and reli- able procedure around the world. Arthur Cummings, MD, Wellington Eye Clin- ic, Dublin, John Chang, MD, Hong Kong, and John Kanellopoulos, MD, medical director, LaserVision. GR Institute, Athens, Greece, and clinical professor of ophthalmology, New York University Medical School, New York, commented on trends they see in LASIK around the world. Penetration of LASIK worldwide LASIK has been around for more than 20 years, and more than 40 million procedures have been per- formed since 1991, Dr. Chang said. "In most countries, LASIK is now a mature market, having enjoyed a rapid growth in the first 10 years and now leveling out," he said. He said that there are 3 kinds of patients: those who rapidly adapt and accept new technology and LASIK worldwide Eyes of patients undergoing LASIK. The procedure has been used for more than 20 years in millions of patients around the world. Source: Boruch Len have their surgery performed in the first 5–10 years; those who wait and have surgery in a mature market; and those who would never choose to have LASIK. LASIK seems to have peaked almost 10 years ago, and this was about 10 years since it was clinical- ly introduced internationally, Dr. Kanellopoulos said. There are several speculations as to why this has happened. One is that the economy has not fully recovered from the downturn that started in 2008 and led people to feel that their dispos- able income couldn't go toward an elective procedure such as LASIK. "Another reason is that LASIK has become a very universal pro- cedure," he said. "It is practiced by many low-cost centers, and it may be viewed by patients as a proce- dure that carries less allure." A third reason Dr. Kanellopoulos cited is that some of the serious LASIK complications have been broadly advertised, and people are aware that ectasia, infection, and dry eye may be associated with LASIK. "Nev- ertheless, it remains the mainstay of refractive surgery for myopia, astigmatism, and/or hyperopia," he said. "Technology has evolved, and I think LASIK penetration, although in lower numbers than the peak era of 2001 to 2004, is relatively stable globally." Dr. Cummings thinks LASIK is seen in about 2.2 people per 1,000, based on a market review recently done in Ireland. The data came from both U.S. and European analysis, he said. Where is it growing? LASIK may be growing in markets where it has been around for awhile, Dr. Cummings said. For instance, children of parents who had LASIK may now have it on their parents' advice. Numbers also seem to be growing where small incision lent- icule extraction (SMILE) is offered and where the clinic provides more than just laser eye surgery, he added. "Now we are treating young patients who become eligible for surgery in their late teens and early 20s," Dr. Chang said, adding that another group that is growing is those with presbyopia. "Patients who have enjoyed good vision with- out glasses are fed up with reading Refractive editor's corner of the world I t is no surprise to anyone in ophthal- mology that LASIK volumes have not recovered from the early 2000s high. But why haven't they? Is this a global or market-specific phenomenon? In this month's "Refractive editor's corner of the world," experts from around the globe as- sess root causes of the decline in adoption and provide recommendations on how we can potentially reenergize this life-changing procedure. Technology has advanced, patient satisfaction is at an all-time high, and accessibility is nearly 100% global; meta analyses have demonstrated the overall exceptional outcomes. This month's column provides unique insights into the current state and provides powerful recom- mendations on what it will take to change the tide for laser vision correction. Steven Schallhorn, MD, refractive editor

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