The State of the Refractive Surgery Industry (Read this Article!)

Hi Folks, this is a great article from the President and Ceo of Advanced Medical Optics also the owner of the VISX Laser. (enjoy)

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James V. Mazzo, President & CEO, Advanced Medical Optics

The past year ushered in tremendous growth and excitement in the refractive surgery industry, led by new technologies and reimbursement changes that are providing doctors and patients with an increasing number of options for quality vision treatment.

The landmark event of 2005 was the Centers for Medicare and Medicaid Services' (CMS) ruling that allowed Medicare patients to pay a premium to receive a presbyopia-correcting intraocular lens (IOL). This spurred tremendous interest in new refractive IOLs launched by AMO and others. On the laser vision correction front, the global markets continued to exhibit growth, driven by new technologies and expanded treatment ranges. Industry consolidation also continued in 2005, marked by AMO's mid-year acquisition of VISX, Incorporated, the world leader in laser vision correction.

Laser Vision Correction Procedure Growth

Procedure volume for laser vision correction in the USA grew in 2005, although not at quite the rate of the previous year. In 2004, however, growth was based on a comparison against 2003, which was a slow year. Also, in 2004, FDA approvals for wavefront-guided custom LASIK energized the industry. This helped drive a significant shift in 2005 in the mix of refractive procedures, with custom accounting for about half of all procedures in the USA. Other exciting developments included the release of sophisticated iris registration technology, which allows surgeons to achieve a new level of precision in LASIK treatment alignment.

Outside the USA, laser vision correction growth was also positive. AMO is helping to drive this growth by leveraging our large global cataract structure to grow the laser vision correction platform in select markets of Asia Pacific, Europe, and Japan. These are markets poised for significant growth in overall volume and the proportion of custom procedures as international surgeons become more familiar with the clinical benefits of wavefront-guided technologies.



The Outlook for Laser Vision Correction


The future is bright for the laser vision correction market. Manufacturers continue to develop new technologies and seek expanded treatment ranges, providing surgeons with an increasing number of options to offer patients and the ability to achieve optimal outcomes. At AMO, we are focusing our resources on seeking LASIK approval for the treatment of presbyopia in mid and low hyperopes, as well as low myopes. This could ultimately give surgeons an important tool for helping the massive baby boomer population- some 76 million strong in the US alone and known for reshaping habits, styles, and attitudes towards aging -find viable alternatives to reading glasses and bifocals.

The femtosecond laser will certainly play an important role in the future of refractive surgery. Not only has this technology filled a medical and marketing need with all-laser- LASIK, but it could also help usher in use of corneal inlays.

The mechanical microkeratome also continues to play an important role in the growth of refractive surgery. These have advanced markedly in recent years and offer standard deviations that rival laser flaps. In addition, epi-LASIK features offer increased flexibility to surgeons, allowing them to make either stromal cuts, as in traditional LASIK, or lift off the epithelium and ablate on Bowmans membrane. Again, what we see is the technology expanding options for patients and surgeons.

Emergence of Refractive IOLs

In the past, cataract patients may have been satisfied if their surgery gave them distance vision unimpaired by cataracts. After surgery, they were happy to get on with life in low-power bi- or trifocals. However, today's seniors are more active, and are looking to regain the functional vision they enjoyed when they were younger and less dependent on eyeglasses. This patient need is driving the convergence of refractive and cataract surgery.

The refractive IOL market is still in its infancy but is set for explosive growth with the CMS ruling. This is giving millions of cataract patients access to presbyopia-correcting IOLs and powering a swifter migration of cataract surgeons to refractive procedures. For example, at a recent continuing education symposium at the American Academy of Ophthalmology, 42% of the nearly 600 doctors in attendance expected between 5% and 20% of their 2006 lens implants to be multifocal IOLs. Another 24% expected multifocal IOLs to represent between 21% and 50% of their implants. These responses are a clear indication of how quickly this refractive IOL market is developing.

Movement to refractive implants is also changing the doctor/patient dynamic by shifting the focus of the discussion to one of lifestyle. Doctors are spending more time with patients to ascertain how patients spend their time, whether they are avid readers, tennis players, or frequent computer users. This is important because one IOL design may be better for near vision, while another may provide better intermediate or distance vision. All this information is essential in order for the surgeon to select the specific refractive technology, or blend of technologies, that will result in the best possible outcome for that patient.

In addition, surgeons interested in adopting refractive IOLs are reevaluating their office staffing and setup to make sure they are properly positioned to educate and interact with a private-pay patient who expects a high level of personalized service.

Future of Refractive IOLs


Patient needs will continue to drive the refractive IOL market forward. Today's multifocal IOLs represent a big step forward in this evolution, but they are only the beginning. AMO and various other industry players are dedicating significant R&D resources to deliver improved IOL designs, including accommodating lenses that mimic the normal focusing movement of the natural lens and customized IOLs, which can be tailored precisely to an individual patient's specific needs.

Capturing the Presbyopic Emmetrope

Another trend to watch is the development of surgical treatments for the presbyopic emmetrope. This is a massive segment of the population that has received little attention from refractive surgery to date. However, as an industry, we are moving closer to the time when managing presbyopia surgically will be a routine procedure. Some of the options include multifocal ablation technology, conductive keratoplasty, multifocal IOLs, accommodating IOLs, and corneal inlays.

Looking Forward

This is an exciting time for refractive surgery, as new technologies are reshaping the market and providing doctors with innovations to address a full range of patients' vision care needs. The population continues to age and roughly 60% of the world has some form of refractive error. The vast majority of this vision-corrected population still relies on eyeglasses or contact lenses, with roughly 3% opting for refractive surgical procedures to date. People are motivated to have refractive surgery and willing to pay for the procedures because freedom from eyeglasses not only improves their physical appearance, but it also enhances the quality and convenience of their daily lives.

The refractive industry is a healthy one, made up of large, global companies offering large product portfolios, and smaller players specializing in single-product technologies.

Some of these companies include AMO, Alcon, Bausch & Lomb, Eyeonics, and Intralase. Combined, these companies have increased spending on research and development by roughly 20% in absolute dollars over the past 2 years. AMO has increased its R&D spending by about 50% over the past 3 years alone. These numbers speak well to the vitality of the industry and will lead to many new advancements and opportunities. Most of all, it bodes well for the doctors and the patients they serve.

Well I hope you enjoyed this article, please check back as I will keep you all posted on more Lasik Industry news. I will keep all of you as up to date on the upcoming technology as possible. Please visit www.lasik.fm to "Logon, Listen and Learn about Lasik" Take Care

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