Eyes front


2009 heralded more interesting developments for ophthalmology. OTEurope asked some of Europe's leading key opinion leaders for their thoughts on the news and developments that generated most excitement or had most significance in the Cataract & Refractive sector

Dr Jorge Alio: "The worldwide decay of corneal refractive surgery, specifically Lasik, was the most negative issue that happened in 2009 and how to increase the numbers and the visibility of this technique for our patients, to make it attractive for them again, is the challenge of 2010."

Dr Rafael Barraquer: "In 2009 the economic crisis became evident in Spain, although it had started the year before. This has been felt by every sector and especially in refractive surgery. While being a private hospital, our centre has been hit rather moderately, possibly thanks to a comprehensive and patient-centred approach to ophthalmology – we try to reach everyone, from the glamorous niches to the rare conditions and even the desperate, and to every level of society. Actually, we may have been helped by a trademark effect –in times of crisis, people tend to resort to the established and reliable names. In any case, we have learnt that every patient has to be earned and excellence requires that everybody –especially in a 300+ organization - must be rowing in the same direction. It also helped following my grandfather's Ignacio Barraquer motto: "Let's treat our patients the way we would like to be treated in their place."

Dr David Spalton: "The biggest surgical challenge is the management of the subluxated cataractous lens, I still am unsure if these are best managed by Cionni rings/ Ahmed segments or by a lensectomy and Verisyse IOL."

Dr Paolo Fazio: "I carry on a solo private practice devoted to refractive and anterior segment surgery with surgical facilities in a public healthcare affiliated hospital. About half of my surgical volume is privately paid, half covered by social security.

"Despite the economical downturn, I did not have any reduction in patient volume or type of service required. On the other hand, social security paid practice has become more and more burdened by bureaucracy so that I would have to spend three more times the effort devoted to the surgery to comply with all the papers. I had to hire more help so that the net revenue from this part of my practice is now less than before.

"In order to compensate for that, I steered my practice more towards premium lens implantation (not covered by public insurance) such as multifocal, toric lenses so that almost all of my cataract surgery is now refractive surgery."

Dr Sunil Shah: "The expectations of the patients – managed with good counselling and excellent documentation of what has been discussed."

Dr Pavel Kuchynka: "In the Czech Republic cataract surgeries are completely covered by the government, but the reimbursement has fallen to around 300 Euros per eye which includes the hospital fees, IOL, and physician time. What I am trying now, as a president of the Czech Society of Refractive and Cataract Surgeons, is to stop this trend and to provide our health care system with an opportunity for copayment by the patient regarding premium IOLs."

Dr Christoph Faschinger: "I am working in the Department of Ophthalmology, at the Medical University of Graz. We perform approximately 4000 cateract operations a year, 1 in 3 are outpatient (which is very much the norm for Austria). Due to lack of money the possibilities to perform ultra-modern surgery are different to those in private hospitals. We have a waiting list for cataract operations of more than 1 year for inpatients and six months for outpatient cataract procedures. We have limited opening hours in the three operation theatres and human resources are shifted to intravitreal injections (1,500 a year). No solutions yet."

Dr Omid Kermani: "The most significant economic challenge to my practice was the impending decrease in numbers of refractive surgical procedures. After all, the economic crisis has been inflicting job security and consumer behaviour in Germany as well. The first two quarters of the year were weak, but not as bad as reported from other countries. In summer we adapted our marketing strategy, calling out special seasonal offers. This was mainly done via Google ads, in-house ads and a specially designed landing page on the internet. Hereby, we could increase our case numbers and open new market shares in the low price segment. We could increase the procedure numbers in the third and fourth quarter. Overall the year showed an increase of 15% compared to last year. The baseline is, that we had higher (marketing) costs, less income per procedure (since average prices decline) but more work since the numbers of surgical procedures increased.

Dr Erik L. Mertens: "The situation in my clinic was very specific because I moved to a bigger place with multidisciplinary units such as dentistry, plastic surgery, optometry, pharmacy and a hair implant clinic. In this way numbers were up significantly in a bad economic climate.

Dr Paolo Vinciguerra: "This year the most challenging area was managing patient expectation. People read in newspapers and start to think that everything is possible, easy, fast recovery and at no risk. Patient education is becoming the hardest area in this year."

Dr Johan Blanckaert: "The most challenging was the fact that I had to replace my 5 year old excimer laser.

"Not only 5 years is a short period but up to April 09 the number of LASIK patients remained the same but just when we needed to invest in a new laser the numbers dropped dramatically due to the economic crisis.

"You cannot say we solved it because we anyway went ahead with our decision to replace the laser but it couldn't have come at a worse period.

This made me think of the current decisions of the firms (Zeiss, Heidelberg) to divide their technology into different machines for different segments. So, you need to buy multiple same technology machines to examine all segments. Anterior segment OCT and posterior segment OCT, IOL master and anterior IOL master, HRA – HRT etc. This is a very costly situation for practices. Can we imagine our hospitals buying an MRI for the neck, an MRI for the belly, MRI for the head etc.

"We solved this by investing in machines which have the technology for anterior and posterior segment examinations like the Optovue (anterior and posterior imaging, glaucoma, macula examinations software) or multiple examination methods like Pentacam, (pachymetry, anterior and posterior topography etc...)."

Dr Jorge Alio: "IOL innovations have been in the area of new multifocal lenses and accommodative ones. The Synchrony lens is, among all the lenses available, the one that best approaches the modern solution of presbyopia through refractive lens exchange. On the other hand, new multifocals such as the Oculentis Mplus, with rotational asymmetrical optics are important innovations that will bring an important amount of attention during 2010."

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