From “MedMarket Diligence, LLC, Report #G125, “Ophthalmology Surgical, Device and Drug Markets Worldwide, 2007.” See report description, table of contents here.
[tag]Refractive surgery[/tag] is performed using a number of surgical techniques. The term refractive surgery refers to any and all [tag]ophthalmology[/tag] procedures that reduce refractive error, for example; myopia, hyperopia and astigmatism. Each of these procedures is designed to minimize the patientâ€™s dependence on eyeglasses and contact lenses. Although there are many options to improve refractive error making it a complex field for the surgeon, while at the same time offering a broad range of options to treat each patientâ€™s unique needs, some approaches will grow at a greater rate while other refractive surgery options will be cannibalized by these faster growing techniques or they will be relegated to serving the needs of niche populations. For those techniques that serve a particular niche population, manufacturers will struggle with how to maintain visibility for these sub-population therapies while ensuring that clinical competence will be maintained at a level to allow the surgeon to deliver the outcomes that are feasible.
Numerous factors will come into play as the market for refractive surgery evolves. Among these are:
- Clinical Outcomes â€“ documented clinical advantage will not only encourage physicians to embrace new approaches to refractive surgery, it will help clinicians to determine the subset of patients that are most likely to benefit by one technique over another.
- Physician Education â€“ the speed with which surgeons can be trained on the new techniques
- Access â€“ how rapidly will the market adopt the technology that is necessary to perform the procedure and how quickly will the market be penetrated
- Patient Education â€“ the ability of physicians and marketing efforts by manufacturers to inform patients of various options
- Cost â€“ Significant differences in price to the patient as well as cost associated with training and equipment by physicians and ambulatory care centers
- Reimbursement â€“ insurers’ willingness to pay for such procedures will continue to be a factor in a patientâ€™s decision to undergo refractive surgery
The various types of refractive procedures are indicated below.
- [tag]LASIK[/tag] â€“ Laser Assisted In Situ [tag]Keratomileusis[/tag] â€“ a laser or microkeratome is used to create a flap so that the cornea can be accessed to use an excimer laser to modify the shape of the cornea.
- Epi-LASIK â€“ Epithelial LASIK â€“ uses a keratome to remove the epithelial surface of the cornea rather than a microkeratome or femtosecond laser as in conventional LASIK. Once the flap is created and folded out of the way, an excimer laser is used to sculpt the underlying corneal tissue.
- [tag]LASEK[/tag] â€“ Laser Epithelial Keratomileusis â€“ similar to LASIK, however, instead of creating a flap, alcohol is used to loosen the epithelium to create a flap and to give the surgeon access to the cornea. Once the cornea is re-shaped, the flap is replaced.
- Wavefront LASIK â€“ sometimes referred to as Custom LASIK â€“ uses a computerized device to correct for an individualâ€™s specific visual aberrations. This not only corrects for lens power, but for subtle imperfections that lead to astigmatism as well as other higher order aberrations (hales, glare and blurry images).
- CK â€“ Conductive [tag]Keratoplasty[/tag] is a direct threat to laser vision correction in moderate hyperopes. The procedure uses radio frequency energy to shrink collagen in the periphery of the cornea, thus steepening the cornea. This technique may also be used to correct for under or over-correction following LASIK.
- PRK â€“ Photorefractive [tag]keratectomy[/tag] â€“ a laser is used to reshape the outside of the cornea to correct refractive errors. Unlike LASIK, it does not involve the creation of a corneal flap. It is appropriate for patients who are myopic, hyperopic or astigmatic.
- P-[tag]IOL[/tag] â€“ Phakic Intraocular Lens â€“ a lens is placed in front of the natural lens to correct visual limitations.
- RK â€“ Radial [tag]Keratotomy[/tag] â€“ a refractive surgery procedure for myopia which places radial incisions in the peripheral cornea to reshape its surface and improve visual acuity. It has largely been replaced by PRK, LASIK and Custom LASIK.
As of September 2006, LASIK is the dominant choice for the performance of refractive surgery, although Custom LASIK seems to have the edge when it comes to clinical outcomes. The only factors holding Custom LASIK from overtaking LASIK are access, which is somewhat of a cost issue, and, perhaps more importantly â€“ the significant cost differential to the patient.
P-IOLs are a promising technique for certain subsets of patients, however, they have neither the awareness among patients, nor the educated physician base to capitalize on their potential. This is, in some way due to the size of the companies that offer P-IOL technology and their investment in market development programs that include both physician and patient education. As larger players enter this segment, it is likely that the investment in marketing programs will create opportunity for each of the manufacturers in this segment.