Increasing the number of photorefractive keratectomy procedures from a single excimer laser gas fill.

Excimer laser ablative procedures are an expensive proposition for both the patient and the user. The high capital expenditure and the cost of consumables, notably the argon-fluoride gas, makes it imperative to achieve maximum utilization in terms of number of cases treated per fill of gas. This is particularly true in countries like India. The maximum number of cases can be treated by understanding not only the limitations of each fill of gas, but by proper patient scheduling and modifications to the treatment protocol. This paper outlines our modified protocol and the patient scheduling software that we developed to meet these criteria.

First 100 CustomCornea commercial eyes.

PURPOSE: With the advent of wavefront-guided custom abalation we not only try to reach a target of 20/20 vision, but strive for improvement in what has always been most important--the quality of this vision. METHODS AND RESULTS: Insights are presented, based on clinical experience at Durrie Vision with our first 100 commercial CustomCornea eyes. We highlight key points for preparing a clinical practice for this new technology, such as staff training, marketing, and pricing. We discuss technical aspects such as patient selection and target adjustment as they relate to the Alcon LADARWave system. CONCLUSION: In our practice we have thus far had clinical success with CustomCornea; patient acceptance has been high, and by closely monitoring our first few patients we were able to reduce the number of future enhancements.

Cost and demand analysis of excimer laser use: first World Wide Web Internet survey of the interest in refractive surgery.

PURPOSE: To determine the actual size of the refractive surgery market in the United States and to identify factors involved in the decision to have refractive surgery. SETTING: World Wide Web. METHODS: A survey was placed on the World Wide Web. Questions covered price sensitivity, preferred type of refractive procedure, and factors involved in the decision to have a refractive procedure. RESULTS: Average age of respondents was 34 years; refractions ranged from -0.50 diopter (D) to -12.00 D. The recommendation of ophthalmologist, friends, and relatives; the refractive surgeon's credentials; and office staff were critical factors in the decision-making. Sixty-six percent said they would have a refractive procedure if it were free. Only two said they would have photorefractive keratectomy (PRK) if it cost over $1500 per eye; none would have radial keratotomy (RK) if it were over $1500 per eye. Forty-eight percent rated their opinion of PRK as high to very high; 45% rated RK as high to very high. CONCLUSIONS: We conclude that the actual number of refractive procedures performed with the laser will be the same as before-between 100,000 and 250,000 annually. The survey suggests that PRK will share this potential market with RK, and the total number of potential patients converting to PRK may be considerably less than predicted unless the price falls to $500 per eye.

Refractive Surgery Survey 2001.

In February 2001, a questionnaire on the practice of refractive surgery was sent worldwide to all 8196 members of the American Society of Cataract and Refractive Surgery; 1511 responses (18.4%) were received. Although laser in situ keratomileusis (LASIK) was the most common refractive procedure reported, phakic intraocular lenses, clear lens extraction, and photorefractive keratectomy were also widespread. Nineteen percent of the respondents said they had had refractive surgery, and that group reported performing significantly more procedures than those who had not had a refractive procedure (P < .0001). The most common complication of LASIK was dry eyes, occurring in more than half of the cases in one fourth of the practices; however, only 30% of surgeons said they perform a Schirmer test before surgery. High-volume surgeons reported seeing fewer cases of flap striae (P = .002) and slipped flaps (P = .02) than low-volume surgeons. Seventy-seven percent said that wavefront LASIK ablation will increase the quality of vision and of those already performing wavefront ablation, 92% stated they believe it will improve outcomes.

Evaluation and diffusion of excimer laser treatment of myopia in the United States and in The Netherlands.

Excimer laser photorefractive keratectomy (PRK) is an experimental treatment to correct myopia (short-sightedness) that is diffusing into use without convincing evidence of safety and efficacy. It has been claimed that PRK may render conventional methods of correcting myopia, such as wearing glasses or contact lenses, obsolete. Since about 25% of the world's population is myopic, the consequences of this technology in terms of benefits, risks, and costs could be truly enormous. The fee for the procedure in various countries such as the United States, the Netherlands, and Australia varies from about US $1500 to US $2250 per eye. In the United States, the Food and Drug Administration, acting as authorized in the Medical Devices Act of 1976, has limited the use of PRK to patients participating in clinical trials. In the Netherlands, in contrast, where medical equipment is not regulated, the method has diffused without controls, although it is not reimbursed by health insurance agencies. The procedure has become controversial in the Netherlands because it is provided privately and has been aggressively and inappropriately promoted. The case illustrates the limitations of health policy concerning technologies provided privately and raises a number of social and political questions.

[Using the excimer laser in refractive eye surgery. Results of a survey of German ophthalmologists]. / Verwendung des Excimer-Lasers in der refraktiven Augenchirurgie. Ergebnisse einer Umfrage unter deutschen Augenärzten.

BACKGROUND: Little information about the cost-effectiveness of excimer laser operations is available. As the number and structure of providers of these services in Germany are relatively unknown, only rough estimations can be made about the number of operations. PURPOSE: In this study the market for excimer laser operations is defined, structured from an economic view and examined according to medium-term demand and supply trends. The aim of the study is an applicable estimation of the current level of dissemination and of existing economic conditions for providers of excimer laser operations. METHODS: In a postal survey 219 ophthalmologists in Germany were asked to provide the number of excimer laser operations they had carried out and the organizational and financial details of these services. The questionnaire was answered anonymously. RESULTS: One can conclude that the annual number of interventions is increasing, although less significantly than in the United States. In most cases, providers of German health insurance have rejected inclusion of this service in their reimbursement catalogue. CONCLUSIONS: As of yet, excimer-laser-related turnover has frequently not met expectations. However, because of modifications of technological, health-economic and demand conditions an increase in the number of operations within this area is expected in the future.

A review of selection criteria used by medical scheme advisers to approve or deny procedures with a cosmetic component.

OBJECTIVE: To review and apply statistical tests to the selection criteria used by two medical advisers to approve or deny applications for three common cosmetic or reconstructive procedures within a large group of medical schemes. DESIGN: A retrospective descriptive study which applied multiple regression analysis, frequency analysis, comparison of means and simple correlations to the data sets for three procedures. SETTING: Administrative records from the clinical files of medical advisers and the administrator's claims database. SUBJECTS: Data were reviewed for 1,143 members who, between January and December 1996, submitted applications for breast reduction, excimer laser refractive surgery, or otoplasty. MAIN OUTCOME MEASURES: The primary outcome measure was the statistical relationship between medical advisers' selection criteria and final decision. In addition, the financial implications of these cosmetic/reconstructive procedures were assessed. RESULTS: For the three procedures reviewed there was a statistically significant relationship between 5 of 13 preoperative criteria requested and the medical advisers' opinion. Excimer laser surgery was generally approved on the basis of the refractive error (myopia > -3.00; astigmatism > -1.5 dioptres); otoplasty was generally approved for children aged > or = 12 years; and breast reduction was usually covered for women with a sternal-nipple distance > 29.0 cm and with a cup size > or = DD. The other data submitted were similarly distributed between the approved and denied groups. CONCLUSIONS: Review of medical advisers' decisions is important in an era of protocols, guidelines and 'standard operating procedures'. Selection criteria for approval of applications for medically necessary cosmetic/reconstructive surgery must be reviewed and revised to provide a reliable, reproducible and statistically valid process.

Vision care: a compensation cornerstone.

Vision care is a benefit that provides advantages for both employers and employees, and it has become an essential element of most competitive benefit packages. Well-designed vision care programs offer participants choice, options, self-help and value. An option that employers may want to consider is reduced prices on laser vision correction procedures.