Ophthalmic Surgeon Report

Q1-2009 Ophthalmic Surgeon's Quarterly: Survey Overview

2009-07-01T13:17:36Z

Thank you for participating in our recent survey of ophthalmic surgeons. This edition of our report includes expanded survey results and analysis for both refractive and cataract surgeons. We’ve also included write-in responses from refractive surgeons who were asked what new services they may have added to their practices in response to declining demand for refractive procedures in the current economic environment.

]]>
This edition of our survey report is based on our analysis of 523 surveys received from US refractive and cataract surgeons. More than 39 percent of responding surgeons referred to themselves as combination refractive/cataract surgeons, and more than 38 percent called themselves cataract surgeons. The remaining 22.2 percent reported limiting their practices to refractive surgery.

In general, response rates for Market Scope surveys are better among high-volume practices. More than 39 percent of responding surgeons reported performing 100 or more procedures during the first quarter of 2009, although we estimate that these high-volume surgeons make up only 11 percent of all cataract and refractive surgeons.

Our Q1-2009 survey responses demonstrate the current global recession’s continuing impact on demand for refractive procedures.

At the same time, IOL procedure volume increased, but both PC-IOL implantations and refractive lens exchange (RLE) declined from tallies in the first quarter of 2008. Out-of-pocket costs for PC-IOLs and RLE have become a disincentive for patients who are more financially cautious during this economic downturn. We have also added new box and whisker charts on procedure fees in both cataract and refractive sections of this report. The new charts track high, low, and median fees for an array of procedures and plot the range for fifty percent of surgeons’ responses.

Our survey for the second quarter of 2009 has been mailed, and we greatly appreciate your on-going participation. Thank you for helping us collect this valuable information during recent quarters. We look forward to the opportunity to work with you during the survey periods ahead.

Q1-2009 Ophthalmic Surgeon's Quarterly: Demand for Refractive Surgery Still Depressed, but Q1-2009 Procedures Beat Our Forecast

2009-07-01T13:17:35Z

Record low consumer confidence and tight credit continued to dramatically reduce demand for refractive surgery, but the number of Q1-2009 procedures was somewhat higher than our forecast, suggesting that demand may have reached bottom in Q4-2008.

]]>
US laser centers, surgeons, and manufacturers continue to struggle to reduce costs while preserving capacity in hopes that economic conditions will soon improve and spur greater demand. An uptick in the Conference Board’s Consumer Confidence Index at the end of April and a slowing rate of unemployment growth provided some welcome encouragement that better times may be ahead.

Nonetheless, Americans continue to face declining home values and high unemployment levels, and, though stock portfolios and retirement funds may have improved, they are far from recouping the losses in the 2008-2009 decline. These factors continue to dissuade many prospective patients from scheduling a refractive procedure until greater economic security returns.

US laser refractive procedures declined 36.4 percent to approximately 231 thousand in 2009’s first quarter, from about 362 thousand procedures in Q1-2008. However, procedures increased 41 percent when compared with the seasonally weaker Q4-2008.

Surgeons’ survey responses indicated weak performance at most practices during 2009’s first quarter. Just over 81 percent of surgeons reported that procedures had declined when compared with last year, while 14.7 percent reported no change in procedure volume and only 4.2 percent reported that procedures had increased. This is a slight improvement over Q4-2008 when 89.1 percent reported declining procedure volume and 7.3 percent reported volume was unchanged.

Refractive surgeons reported that the number of non-laser refractive procedures, including CK, refractive lens exchange and phakic IOLs, also declined 37.1 percent and were roughly in line with decreases in laser refractive surgery. In addition, an estimated three thousand procedures were performed on US patients who traveled to Canada or Mexico for refractive surgery.

Q1-2009 Ophthalmic Surgeon's Quarterly: Refractive Technologies

2009-07-01T13:17:34Z

We asked surgeons about their rates of use of various refractive technologies, including surface ablation and non-laser refractive procedures during Q1-2009.

]]>
Surgeons who responded to Market Scope’s survey reported performing surface ablation in 12.7 percent of all refractive procedures in the first quarter of 2009. Rates of surface ablation have varied in recent years. Surface ablation received a boost in 2005 and early 2006, triggered by concerns over corneal ectasia, and rates were relatively constant and in the range of 14 percent to 16 percent in late 2006 and in 2007. Then surface ablation rates declined through 2008, likely due to both surgeons’ better understanding of which patients are at risk for corneal ectasia and the overall reduction of risks due to thinner LASIK flaps and improved diagnostic equipment. However, in Q1-2009 the surface ablation rate has risen again, though not to the range that occurred in 2006 and 2007.

Surgeons also reported that 55.9 percent of their LASIK procedures were wavefront guided and 20.7 percent were conventional LASIK in Q1-2009. Wavefront-optimized LASIK was used in 23.3 percent of cases.

Q1-2009 Ophthalmic Surgeon's Quarterly: Wavefront-driven LASIK

2009-07-01T13:17:33Z

We asked surgeons what percentage of their laser refractive surgical patients underwent wavefront-driven surgery during Q1-2009.

]]>
Customized wavefront-driven LVC (WFL) declined slightly to 54.4 percent of all laser refractive procedures performed in Q1-2009 from 57.5 percent of all procedures performed in Q1-2008. Despite this decline, WFL procedures increased from the 52.9 percent share of all laser refractive procedures reported in Q4-2008. At wavefront-capable centers, WFL procedures reached 71.3 percent of total procedures, up from 64.4 percent in Q1-2008 and 67.4 percent in Q4-2008.

Q1-2009 Ophthalmic Surgeon's Quarterly: Phakic IOLs

2009-07-01T13:17:32Z

Surgeons were asked if they offered phakic IOLs as a refractive surgical option during Q1-2009.

]]> We asked combination refractive and cataract surgeons if they offered phakic IOLs as a refractive surgical option during the first quarter of 2009. Twenty-three percent of these surgeons reported offering phakic lenses.

Q1-2009 Ophthalmic Surgeon's Quarterly: Refractive Lens Exchange

2009-07-01T13:17:31Z

Surgeons were asked if they offered refractive lens exchange during Q1-2009.

]]>
We asked combination refractive/cataract surgeons if they offered refractive lens exchange (RLE) during Q1-2009. Thirty-two percent reported offering these procedures.

Q1-2009 Ophthalmic Surgeon's Quarterly: Pharmaceutical Use in Refractive Procedures

2009-07-01T13:17:30Z

We asked in what percent of laser refractive surgery cases did responding surgeons prescribe/use pharmaceuticals or dry eye medications during Q1-2009.

]]>
Surgeons reported using anti-infectives post-operatively in 97.5 percent of cases, pre-operatively in more than 44.4 percent of cases, and intra-operatively in 82.8 percent of cases. Steroids were used post-operatively in about 95 percent of cases, and intra-operatively in more than 66 percent of cases. NSAIDS were used intra-operatively in more than 60 percent of cases.

Surgeons reported that dry eye therapeutic Restasis was used pre-operatively in just over 23 percent of cases and post-operatively in more than 28 percent of cases.

According to surgeons’ responses, over-the-counter artificial tears were used in more than 91 percent of cases, post-operatively; 40 percent of cases, intra-operatively; and just under 32 percent of cases, pre-operatively.

Q1-2009 Ophthalmic Surgeon's Quarterly: Surgery Location

2009-07-01T13:17:29Z

We asked surgeons about the locations where they performed their refractive surgeries during the quarter. We also analyzed refractive procedure numbers by location.

]]>
Survey respondents reported that about 59 percent of refractive procedures were performed in surgeon-owned surgery centers in Q1-2009. Corporate-owned centers were the site of 34 percent of reported procedures during the quarter, while 7 percent of refractive procedures took place at institution-owned facilities.

Based on survey responses, we estimate that about 136 thousand refractive procedures took place in surgeon-owned surgery centers in Q1-2009, while approximately 78 thousand took place in corporate-owned centers. These tallies are down from Q1-2008 tallies of 214 thousand and 128 thousand, respectively, but up from 96 thousand and 56 thousand, respectively, in the previous quarter.

Q1-2009 Ophthalmic Surgeon's Quarterly: Pricing Strategies

2009-07-01T13:17:28Z

We asked surgeons about their average per-eye price for various refractive procedures during the quarter.

]]>
Pricing strategies shifted slightly in favor of charges based on technology or technique, with surgeons reporting just under 53 percent of procedures billed in this manner and just over 47 percent of laser-based procedures billed under a single-price model. Many surgeons consider the same-price model a simpler approach for staff to explain and for patients to understand, but survey respondents reported moving away from this approach during Q1-2009. Reasons for this shift include efforts to attract new patients into the process with a lower price point and reactions to competitive-price advertising in some market areas.

Eighty-three percent of responding surgeons who employed a same-price strategy charged from $1,501 to $2,500 per eye for LVC. About 10 percent charged more than $2,500, while 7 percent charged $1,500 or less.

Prices for laser refractive surgery have gradually trended upward quarter to quarter since mid-2006, with the exception of the fourth quarter of 2008 when LVC’s average price declined to $2,070 from $2,087 in Q3-2008. However, the upward trend has returned in Q1-2009, with an average reported price of $2,124, up from the previous quarter and up from $2,075 in 2008’s first quarter.

Responding surgeons reported a range of procedure fees for various refractive procedures during the quarter.

This is a box and whisker chart that displays high, low and median fees reported by surgeons, which are represented by the horizontal tick marks. Fifty percent of the fees for any given procedure fall within the range represented by the teal boxes—in other words, the boxes include fees from the 25th percentile through the 75th percentile.

Q1-2009 Ophthalmic Surgeon's Quarterly: Referral Sources

2009-07-01T13:17:27Z

We asked surgeons about referral sources for refractive patients during Q1-2009.

]]>
Surgeons reported that just under 51 percent of their patients were referred by other patients. Optometrists referred 16.2 percent of patients, while an additional 12.1 percent used radio, TV and newspaper advertising to make their choice of surgeons. The Internet was the source for 12.2 percent of patients. Employers and health insurance providers referred only 6.2 percent of patients.

Q1-2009 Ophthalmic Surgeon's Quarterly: Marketing

2009-07-01T13:17:26Z

We asked surgeons about their marketing emphases during the quarter.

]]>
When asked about their primary marketing emphases, 63.6 percent of surgeons gave surgeon’s experience and reputation the highest rank. Surgeons ranked technology a distant second with just under 30 percent of surgeons giving the category a nod. Surgical outcome was third with 27.9 percent listing it as a primary marketing emphasis. Price was listed as a marketing emphasis by 7.1 percent of surgeons, up from 4.9 percent in 2008’s fourth quarter.

* Multiple choices were allowed. We have also calculated these responses using a new metric—we’ve included answers from only those who responded to this particular question, rather than the entire pool of responders. This accounts for the departure from results in previous Surgeons’ Quarterly Survey Reports.

Q1-2009 Ophthalmic Surgeon's Quarterly: Advertising

2009-07-01T13:17:25Z

We asked surgeons about their advertising spending in the first quarter of 2009.

]]>
Surgeons reported that advertising spending increased during Q1-2009. Responding surgeons spent an average of $183.47 per procedure, up from the $154.73 spent in 2008’s first quarter and up from the $166.07 spent in Q4-2008.

Surgeons’ responses varied significantly regarding advertising spending, with 16 percent of surgeons reporting that they spent less than $50 per procedure and 11.5 percent reporting that they spent $300 or more. More than 33 percent reported spending $101 to $200.

Fifty-seven percent reported that they planned to increase advertising spending—up significantly from the ten percent who planned to increase spending in Q4-2008. Only 13 percent planned to decrease spending. Thirty percent of surgeons reported that they planned to maintain their advertising spending at current levels.

Surgeons were asked to rate the effectiveness of common marketing methods on a scale of 1 to 5, with 1 representing the least effective and 5 representing the most effective method. Internet search ads were given the highest rating, a 3.17. Radio advertising followed close behind at 3.04, and television advertising was rated 2.99. Direct mail was rated least effective at 2.56.

Q1-2009 Ophthalmic Surgeon's Quarterly: Conversion Rates

2009-07-01T13:17:24Z

We asked surgeons whether or not they tracked conversion rates in the first quarter, and, if they did so, what those rates were.

]]>
Conversion rates are key measures of the effectiveness of internal marketing. These rates represent the number of patients scheduling consultations divided by the number of patients contacting the office to inquire about laser surgery, as well as the number of surgical cases divided by the number of patients who have consultations. Fifty-seven percent of survey respondents reported that their practices tracked conversion rates during 2009’s first quarter.

Practices that tracked conversion rates reported that 71.2 percent of those who called the office about laser surgery ultimately scheduled a consultation, and 70.9 percent of those who had a refractive surgery consultation scheduled surgery. The percentage of phone calls to consults increased very slightly when compared with Q1-2008, while the percentage of consults to surgery increased more than 5 percent.

Q1-2009 Ophthalmic Surgeon's Quarterly: Forecast

2009-07-01T13:17:23Z

We forecast that refractive procedures for the full year of 2009 will show a decrease when compared with 2008 procedure volume.

]]>
To recap, demand for all refractive surgery during the first quarter of 2009 was down 37.0 percent when compared with the first quarter in 2008. Weak demand is expected to continue into the second quarter of 2009 due to the troubled economic conditions that have delayed decisions for many prospective LVC patients. However, there are early signs of improving consumer confidence, which indicates that an upturn in demand may occur in the second half of 2009. We have increased our forecast to 830 thousand for the full year of 2009. Nonetheless, this represents a year-over-year decline of 19.8 percent when compared with 2008 totals.

Q1-2009 Ophthalmic Surgeon's Quarterly: Write In Comments

2009-07-01T13:17:22Z

We requested write-in comments from refractive surgeons in response to one of our survey questions. A sampling of responses appears below.

]]>