41 EyeWorld Asia-Pacific | September 2024 Lance Kugler, MD Dr. Kugler has also seen a shift in his practice regarding LASIK volumes. “I think the data from the Refractive Surgery Council is the most accurate data available on LASIK volumes in the U.S. because it is anonymously audited data from the manufacturers, and it reflects the actual number of procedures that are being done,” he said. While the numbers are down from a year ago, he said there’s more to it. If we look at our own data, we’re seeing a pretty substantial shift from LASIK to IOL-based procedures, such as ICLs, and refractive lens exchange, Dr. Kugler said. “I think that what you’re seeing is that a lot of patients who would have had LASIK a few years ago are now being recommended to have either an ICL or RLE, so that’s a big reason for the apparent decrease in LASIK volumes that we’re seeing.” Dr. Kugler said that patients will come in asking about certain procedures, but he finds that there is low public awareness of RLE. “When they hear about it, it’s usually the case that they had no idea that it was a solution for them,” he said, adding that some patients hear about it as an option because their family or friends have had the procedure. He has seen similar experience with ICLs, where patients might know about this from family or friends. STAAR Surgical is doing some successful direct-to-consumer marketing around the ICL, he said. A lot of times they might not be a candidate for it, even though they come in asking about it, but there’s public interest around RLE and ICLs. “I do think that the EVO ICL is appealing to people, particularly younger people who don’t like the idea of something that’s not reversible or upgradable,” Dr. Kugler said. “This group likes the idea of something they can do now to fix their vision and adjust later, should they need to.” Rather than pitching every single option to patients, Dr. Kugler said he prioitizes having a discussion with the patient, as this determines what he will recommend. REFRACTIVE SURGERY “Patients will never be able to understand the nuances of all these procedures,” he said, “and as the experts, the onus is on us to recommend what is best for them. Once we’re clear on what the recommendation is, then we can talk about the risks, benefits, and costs. Patients appreciate a clear plan. They come to us for a recommendation and guidance, and I think they are more comfortable when we confidently know what’s going to meet their needs.” Dr. Kugler said there’s still a place for LASIK. “LASIK is still the clear leader in precision in terms of low power treatments. It’s very precise. It’s probably the most precise we have for astigmatism as well,” he said. “If you have someone who needs that treatment, LASIK is very hard to beat.” I think it’s difficult, if not impossible, to have a refractive surgery practice without access to LASIK, Dr. Kugler said. To not have LASIK means that you cannot address those situations, he said, adding that you also cannot enhance SMILE without LASIK, and the same is true with IOLs. There are 10–15% of multifocal IOL procedures that require low diopter enhancements, and that is best done with LASIK, he said. “LASIK will continue to be important for the foreseeable future.” Dr. Kugler said that he is seeing more consistency among doctors. “Ultimately, as a community of refractive surgeons, we continue to strive for a standard approach. Until that is achieved, it’s important for each surgeon to be consistent with how they’re using technology to help their nomograms be better and help staff better discuss expectations with patients,” he said. “The biggest challenge we have in refractive surgery is that we don’t have agreed upon standards on how to apply the technologies consistently, and that’s causing confusion among the public and holding us back as an industry. We all want patients to see as well as they can. I think in order to achieve the growth of refractive surgery that we all would like to see, it’s incumbent to have agreed-upon standards that we can use together.”
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