Eyeworld

ophthalmology "It's a good way to learn before you have [new technology] avail- able," Mr. Chayet said. "We coop- erate with a few doctors across the border already as part of our day-to- day operations. They love working with us because they get to learn about the new technology before some of their peers do. I think in the future there will be more opportunity for this kind of collaboration." Dr. Chayet said the percentage of Americans who are pursing ophthal- mic procedures outside the U.S. is so small, he doesn't think it impacts the bottom line of U.S. ophthalmic practices. "I think we're at a tipping point where medical travel is becoming more popular," Mr. Woodman said. "Doctors are hearing about it more, even if it might not be hurting their industry, and I do think it is a time when doctors of all disciplines should be more sensitive about people requiring care overseas [due to cost]. I think it's time for doctors to become more collaborative." Inbound patients The type of collaboration Dr. and Mr. Chayet envision among doctors performing the procedure and those in the patient's home country is what Dr. Wang and the Aier Eye Hospital group—with 300 locations in China, Hong Kong, Europe, and now the U.S.—hope to establish in the U.S. for medical tourists from China. The hospital group is establish- ing Aier-USA at the Wang Eye Insti- tute in Nashville, which it acquired in April 2017. Dr. Wang explained in a Forbes article earlier this year that Aier-USA will seek to serve U.S. patients in more rural areas of the considered medical tourists (49%, he estimated, are from the U.S., while the other 1% come from other countries). For patients considered medical tourists, Mr. Chayet said roughly 80% are coming to CODET for LASIK/refractive surgery while 20% are coming for cataract/IOL surgery. Before arriving at CODET, Dr. Chayet said the patients are provided with preoperative instructions—such as not wearing contact lenses, if they're coming for refractive sur- gery, or not wearing makeup—to help ensure the preoperative process onsite runs smoothly to remain on schedule for surgery. Refractive procedures, which are often bilateral, are frequently performed the same day as the preoperative visit. Cata- ract surgery, on the other hand, is performed the day after preoperative evaluations, and if bilateral cata- ract surgery is required, the second operation takes place 48 hours later. Patients can go home on postop day 1 after their last procedure. Though rare, there are times when patients might arrive at CODET only to find they are not candidates for the procedure they wanted. "That's a very important part of our business model. We won't perform surgery on just anyone," Mr. Chayet said, noting that patients are forewarned of this possibility. "We have the volume to be able to pick and choose. Our reputation was built on only performing surgery on the best candidates." Dr. Chayet said he thinks there is an opportunity for international doctors receiving medical tourists to work with physicians in the patient's home country for preoperative assess- ments and postop care. the list for medical tourism, Arturo Chayet, MD, CODET Vision Insti- tute, Tijuana, Mexico, and Ming Wang, MD, founder, Wang Vision Institute, Nashville, Tennessee, and CEO, Aier Eye Hospital-USA, think there is a market for it. Outbound Americans According to the aforementioned executive briefing about trends in medical tourism, the most common reason Americans cite for engaging in medical tourism is cost savings. Mr. Woodman provided a few cost com- parisons, but noted there is "scant reliable international research for vision procedures." However, Dr. Chayet said he doesn't hear price as being the main reason for medical tourists coming to CODET. Most patients come for a procedure they cannot receive elsewhere and because they trust CODET's reputation, he said. "One of the reasons why medical tourism has been so popular here is oftentimes we have access to tech- nology that's not available in the U.S.," said Daniel Chayet, CEO and president, CODET Vision Institute. "We do a lot of clinical trials and work with startups, so we have access to a lot of technology the startups develop once it's approved for com- mercial use. "The most recent example is we have access to the AcrySof IQ PanOptix IOL [Alcon, Fort Worth, Texas]. It's not available in the U.S., and we've been performing surgery on many patients who are coming from the U.S. looking for the latest but who don't have access to it," Mr. Chayet said. According to Dr. Chayet, about 50% of CODET's patients are from Mexico, while the other 50% are December 2017 • Ophthalmology Business 13 continued on page 14

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