EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/87458
34 34 EW REFRACTIVE SURGERY October 2012 A bullish outlook for lasers Device focus by Michelle Dalton EyeWorld Contributing Writer Market Scope (St. Louis) data suggests 80% of new laser sales are Allegretto lasers. After the introduction of the Allegretto, "patients did start having even better outcomes, and since then, no major technological advancement has occurred," Mr. Stubenbordt said. Mr. Ziemer said Korea, Taiwan, Japan, and China are driving the Asia-Pacific replacement market. In Spain, however, where overall un- employment hovers around 25% and for younger people unemploy- ment is closer to 40%, "there is almost no business in the private refractive market," Mr. Ziemer said. Larger laser chains "always look to improve their technology," which presents potential growth areas as well, he said. Mr. Mahdavi said the rise of the Laser growth is being driven by the femtosecond for refractive cataract surgery and a burgeoning replacement market "S urvival of the fittest" aptly ap- plies to businesses in a global down- turn like the one that's currently ongoing, but several laser manufacturers and analysts be- lieve the excimer and femtosecond markets are in the midst of a true turnaround. Frank Ziemer, president and chief executive officer, Ziemer Oph- thalmic Systems, Port, Switzerland, said with countries like Spain and Greece possibly being forced out of the euro, it's "next to impossible" to predict the European economic picture even 6 months from now. "We believe that companies have to offer better laser technol- ogy," he said, adding in Europe it may take 4-6 months to identify potential clinic customers. At Bausch + Lomb (Rochester, N.Y.), Calvin W. Roberts, M.D., executive vice president and chief medical officer, said he's "very bull- ish" on the laser market—especially in the replacement laser market. Bausch + Lomb and Technolas Perfect Vision (TPV, Munich) are currently co-promoting the Victus Femtosecond Laser Platform. "The sweet spot for us is presbyopia," he said. "Our excimer business in Europe is very good. SUPRACOR from TPV is not approved in the U.S., we expect substantial growth once it is approved." Over the next 10 years, there will be a resurgence in consumer demand for LASIK, said Shareef Mahdavi, president, SM2 Strategic, Pleasanton, Calif. "We're seeing innovations on top of incremental improvements and a much better acceptance on the consumer level," he said. The recent global recession has created a large pent-up demand for refractive surgery, said Paul M. Stubenbordt, founder, Stubenbordt Consulting, Roanoke, Texas, but he's still a bit on the bearish side. "Right now, it's an anomaly with how well the U.S. laser market is doing," he said, with no single geographic region in the U.S. faring better than any other, although the Northeast seems to have recovered more quickly than other areas. The femtosecond market, on the other hand, is all about product in- novation and is where the excimer market was about 15 years ago, Mr. Mahdavi said. "Excimer was about corneal reshaping, but we've got a much more versatile tool in fem- tosecond technology. It's driving a replacement market with excimer lasers," he said. Dr. Roberts said between the "great new technology that's coming out" and consumer desires to have a laser-based presbyopia treatment, numerous markets are showing great potential. Bausch + Lomb is "very big" in Southeast Asia, with Singapore a main area for refractive surgery growth, Dr. Roberts said. Australia and China are growth areas as well, as the Chinese "have not really embraced refractive surgery, but it's a huge contact lens market for us." Excimer markets Consumer demand will drive the ex- cimer market, as the devices are less expensive and more efficient, Mr. Mahdavi said. He predicts a large growth market in India and China, with the U.S. a predominant replace- ment market. "Consumer demand isn't what is was in 2007, so physicians have been holding back on purchasing decisions," he said. "So now the question is whether they outright replace older units or upgrade what they currently have?" He cites both the Allegretto (Alcon, Fort Worth, Texas) and the VISX custom treat- ment (Abbott Medical Optics, Santa Ana, Calif.) as a cause for the growth. "Right now, VISX has a majority of units placed—about 62%—but only 51% of the overall procedures performed," he said, adding middle class in less developed na- tions (India, China) will also help spur the refractive industry, but warned a lower cost entrant may be welcomed in some Asian countries (notably, China). Overall, with the aging Gen Y population coming into the "sweet spot" for LASIK, Mr. Mahdavi pre- dicts within the next 5 years, LASIK will once again reach the peak levels surgeons saw in 2000 and 2007. Femtosecond market Mr. Stubenbordt called 2012 a funny year. "Everything is doing well, but it shouldn't be. Cataract volumes are pretty stable, and the femtosecond laser has given physicians a new rea- son to talk about actively marketing cataract surgery. We're seeing a large impact on cataract volume for physi- cians who have bought the newer lasers—about 15%." Because femtosecond technol- ogy has not been on the market very long, Mr. Ziemer said, "Worldwide there is a great potential market and clinics that need femtosecond technology," both in refractive and cataract procedures. Stuart Raetzman, head of global commercial strategy, Alcon, is bull- ish about the femtosecond potential in refractive cataract, as the technol- ogy "delivers increased precision and customization while improving predictability, reliability, and repro- ducibility of patient outcomes." By his calculations, Mr. Mahdavi said about 25% of current femtosec- ond refractive cataract users "are not making money, but patients like the