Resident laser in situ keratomileusis surgical training in United States residency programs.

To determine current trends in resident laser in situ keratomileusis (LASIK) training in the United States, a comprehensive survey was sent to the residency coordinator, chairman, or refractive surgery director of all 113 ophthalmology training programs in the U.S. accredited by the Accreditation Council for Graduate Medical Education. The response rate was 64%. Of the respondents, 54% were from programs in which residents performed LASIK surgery, typically as third-year residents; residents in these programs performed a mean of 4 LASIK surgeries (range 1 to 10 surgeries) during residency. The Visx Star was the most commonly used excimer laser platform and the Hansatome the most commonly used microkeratome. Most programs had 1 attending physician teaching the residents refractive surgery, which was typically performed at the main residency facility. Most programs had significant discounted pricing (>50%) for resident-performed LASIK.

Revive dead patient files.

Many practices, particularly those specializing in elective surgery, are unaware that they have in their possession voluminous untapped marketing leads. For many of these practices, employing the services of a firm that specializes in outbound medical marketing calls can be a cost-effective and hassle-free way of converting these leads into consultations and procedures.

[Complications after laser in situ keratomileusis (LASIK): results of a meta-analysis on incidences and expectable costs]. / Komplikationen nach Laser-in-Situ-Keratomileusis (LASIK): Ergebnisse einer Metaanalyse zu Inzidenzen und Folgekosten.

PURPOSE: Laser in situ Keratomileusis (LASIK) is considered to be safe and effective for the treatment of moderate myopia. Nevertheless, the treatment can result in complications, associated with additional costs for treatment of the latter and an associated reduction of the primary treatment's overall cost efficiency. METHODS: To both identify clinically relevant LASIK-associated complications and to estimate their expectable incidence and treatment cost-profile, a quantitative meta-analysis of trial publications between 1995 - 2004 was implemented. Inclusion criteria were a minimum sample size of 25 eyes, a reported preoperative patient refraction between - 1 und - 14 dioptres and the documentation of an at least 6 months recall period. For each reported complication its "meta incidence" (point estimate and 95 % confidence interval) was estimated. Furthermore, for each complication a clinical pathway for its treatment was modelled assuming a worst case scenario; the treatment costs for this pathway were simulated. The resulting costs for the treatment of one complication were then averaged by the expectable incidence of the respective complication; the maximum "expectable" costs for the respective complication's treatment were then summed up to correct the overall LASIK direct costs. RESULTS: A total of 30 trial reports was included into the meta-analysis; in total, 21 clinically relevant complications were identified (31 % intraoperative complications, among which 19 % were microkeratome-associated, versus 69 % postoperative complications, among which 87 % were classified as long-term postoperative). The most frequent complication was "light sensations" with a meta incidence of 46 % (95 % confidence interval 42 - 50 %), the most cost intensive complications were those requiring clinical re-treatment (overall meta incidence 24 % and expectable cost increase of 449 euro per primary LASIK procedure). In summary the total direct costs of 2426 euro per eye for the initial LASIK procedure may be increased by a total of maximum 648.30 euro, according to a maximum "expectable" cost increase of 27 % per primary LASIK due to complications. CONCLUSION: At least the worst case scenario introduced into this investigation demonstrated an economically relevant order for the expectable LASIK complications and the associated additional costs for complication treatment.

Self-pay markets in health care: consumer Nirvana or caveat emptor?

As consumers face more incentives to make cost-conscious medical care decisions, some policymakers cite self-pay markets as models for consumer shopping. An analysis of the LASIK market revealed limited shopping overall, despite the fact that patients pay the full cost. For other self-pay procedures, consumers shop even less, for reasons ranging from urgency, to costs of obtaining price quotes, to quality concerns that prompt many consumers to rely on word-of-mouth recommendations. Given that consumer shopping is not prevalent in most self-pay markets, we expect the extent of shopping to be even more limited for many services covered by insurance.

Primeiro censo brasileiro em cirurgia refrativa / First Brazilian refractive surgery survey

OBJETIVO: Realizar o primeiro censo brasileiro de cirurgia refrativa. MÉTODOS: Entre agosto de 2001 e fevereiro de 2002 foram enviados questionários para 7.890 oftalmologistas brasileiros, com questões sobre aspectos demográficos, tendências, padrões de práticas, instrumentos, cuidados pré-operatórios e mercado da cirurgia refrativa. RESULTADOS: Novecentos e vinte questionários (11,67 por cento) foram devidamente respondidos. O laser in situ ceratomileuse é a técnica preferida para correção de dioptrias entre +5,00 e -7,00 D. O excimer laser mais utilizado é o Nidek® EC 5000 e o microceratótomo mais freqüente é o Hansatome. Outros aspectos como: demográficos, procedimentos, técnicas, tendências, volume cirúrgico, cuidados pré-operatórios e mercado também foram analisados. CONCLUSÃO: A partir desta pesquisa, pode-se observar e monitorar aspectos demográficos, padrões de práticas, tendências, tecnologia e mercado da cirurgia refrativa no Brasil e compará-las com outras pesquisas semelhantes em outras partes do mundo.

Clinical benefit, complication patterns and cost effectiveness of laser in situ keratomileusis (LASIK) in moderate myopia: results of independent meta analyses on clinical outcome and postoperative complication profiles.

PURPOSE: Laser in situ keratomileusis (LASIK) means a patient investment of 2426 Euro per eye, which usually cannot be funded by European health care insurers. In the context of recent resource allocation discussions, however, the cost effectiveness of LASIK could become an important indication of allocation decisions. Therefore an evidence based estimation of its incremental cost effectiveness was intended. METHODS: Three independent meta analyses were implemented to estimate the refractive gain (dpt) due to conventional LASIK procedures as well as the predictability of the latter (%) (fraction of eyes achieving a postoperative refraction with maximum deviation of +/- 0.5 dpt from the target refraction). Study reports of 1995 - 2004 (English or German language) were screened for appropriate key words. Meta effects in refractive gain and predictability were estimated by means and standard deviations of reported effect measures. Cost data were estimated by German DRG rates and individual clinical pathway calculations; cost effectiveness was then computed in terms of the incremental cost effectiveness ratio (ICER) for both clinical benefit endpoints. A sensitivity analysis comprised cost variations of +/- 10 % and utility variations alongside the meta effects' 95% confidence intervals. RESULTS: Total direct costs from the patients' perspective were estimated at 2426 Euro per eye, associated with a refractive meta benefit of 5.93 dpt (95% meta confidence interval 5.32 - 6.54 dpt) and a meta predictability of 67% (43% - 91%). In terms of incremental costs, the unilateral LASIK implied a patient investion of 409 Euro (sensitivity range 351 - 473 Euro) per gained refractive unit or 36 Euro (27 - 56 Euro) per gained percentage point in predictability. When LASIK associated complication patterns were considered, the total direct costs amounted up to 3075 Euro, resulting in incremental costs of 519 Euro / dpt (sensitivity range 445 - 600 Euro / dpt) or 46 Euro / % (34 - 72 Euro / %). Most frequently reported LASIK complications were "central islands / over- / undercorrection / regression" (meta incidence estimate 24%) and "haze" (15%), which were identified by means of an independent meta analysis. CONCLUSION: Bearing incremental costs of 519 Euro per gained refractive unit in mind, the conventional LASIK procedures showed an encouraging cost effectiveness range; the latter estimate may serve as a rationale for future allocation discussions in ophthalmology.

[First Brazilian refractive surgery survey]. / Primeiro censo brasileiro em cirurgia refrativa.

PURPOSE: To perform the first Brazilian refractive surgery survey. METHODS: Between August 2001 and February 2002, a questionnaire was mailed to 7890 Brazilian ophthalmologists. The questionnaire presented questions about demographic aspects, technology, instruments, market, trends, practice patterns and cost of refractive surgery. RESULTS: Nine hundred and twenty questionnaires (11.67%) were answered. LASIK is the preferred technique for correction between +5.00 and -7.00 D. The mostly used excimer laser is Nidek EC 5000, and Hansatome is the mostly used microkeratome. Others aspects like: demographic, techniques, practice patterns, trends, market, and pre-, intra- and postoperative care, were analyzed. CONCLUSION: With this survey, the Brazilian ophthalmologists can observe and monitor these aspects of refractive surgery in Brazil, and compare them with others surveys.

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.

[Refractive benefit and incremental costs of LASIK: results of a cost benefit study in two universities' LASIK departments]. / Refraktiver Nutzen und inkrementelle Kosten der LASIK: Ergebnisse einer Kosten-Nutzen-Studie an zwei universitären LASIK-Zentren.

BACKGROUND: No data is available to date on the cost effectiveness of laser in situ keratomileusis (LASIK) with regard to the German-speaking health care system. Hence we compared the clinical outcome and cost data of two German LASIK centres in respect of procedure cost effectiveness from the patient perspective. MATERIAL AND METHODS: A retrospective cohort study was implemented at the University Hospitals of Mainz and Mannheim. Data on refractive outcome were obtained from the LASIK centres' patient documentation, cost data on the surgery as well as on eyeglasses etc. before and after the surgery were obtained from patient interviews. The primary endpoint of this investigation was the individual incremental cost effectiveness ratio linking direct cost with the LASIK associated refractive gain. RESULTS: Clinical and economical data of 178 patients (Mainz: 45, Mannheim 133) was evaluated. After biplanar simultaneous LASIK 71% (Mainz) and 73% (Mannheim) reported, that they did not need eyeglasses etc. any longer after surgery; 31% (Mainz) versus 13% (Mannheim) had to undergo LASIK re-treatment. Median direct cost for the surgery was reported to be 3000 euro; (Mainz) versus 3910 euro; (Mannheim); the corresponding LASIK associated refractive gain was +5.6 D (median Mainz) versus +4.2 D (median Mannheim), resulting in median incremental cost effectiveness ratios of 667 euro; (Mainz) versus 831 euro; (Mannheim) per gained refractive unit. This investment has to be related to median annual cost of 250 euro; for eyeglasses etc. before surgery and 0 euro; afterwards. CONCLUSION: Depending on the performing surgical centre, German LASIK patients have to face a median investment of 667-831 euro; per gained refractive benefit unit. This incremental cost benefit ratio can be regarded as a surrogate parameter for comparison with alternative surgical or conservative treatment strategies in myopia.

Socioeconomic aspects of laser in situ keratomileusis, eyeglasses, and contact lenses in mild to moderate myopia.

PURPOSE: To compare the societal costs and consequences of 3 strategies to correct mild to moderate myopia: laser in situ keratomileusis (LASIK), eyeglasses, and contact lenses (CLs). SETTING: Instituto Oftalmológico de Alicante, Alicante, Spain. METHODS: A Markov model was set up to compare the present value of LASIK, eyeglasses, and CLs. A structured questionnaire was administered to 40 consecutive patients with mild to moderate myopia to collect resource information including direct medical and nonmedical costs as well as indirect costs (transportation, time spent, hotel, eyeglasses, CLs, LASIK, cleaning products, visits to ophthalmologist/optometrist/optical center, and adverse events linked to LASIK and CLs). The time period ranged from 10 to 30 years with a 5% discount rate. The Spanish population was used as the basis for the economic data. Full sensitivity analyses were conducted. RESULTS: Based on the time period, LASIK saved from 18 to 278 km in distance to care centers compared with eyeglasses and from 405 to 1436 km compared with CLs. The time to care for visual acuity was similar between LASIK and CLs, but up to 1180 additional hours were spent by CL users. Laser in situ keratomileusis saved from 4.69 to 12.07 eyeglasses and from 28 to 84 eyeglass cleaning packs. With LASIK, there were 18 to 50 visits to the optical center compared with 41 to 117 visits with CLs. Laser in situ keratomileusis saved 4.7 to 12.2 visits to correct visual acuity compared with eyeglasses and CLs. It prevented 95 to 295 per 10 000 cases of CL-related keratitis. Contact lenses were always more costly than LASIK, which was always more costly than eyeglasses. The 2 sensitivity parameters were time period and discount rate. CONCLUSIONS: Laser in situ keratomileusis was less costly than CLs and more expensive than eyeglasses, although the potential nonmonetary benefit of LASIK over eyeglasses was not taken into account.

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.

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.

[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.