I have extensive experience with the ALLEGRETTO WAVE excimer laser – I had the first one in the US, and I am now on my fourth upgrade. I was one of the principle investigators in the ALLEGRETTO Eye Q’s clinical trial. I believe that using the ALLEGRETTO Eye Q laser in conjunction with an outcomes-based nomogram (DataLink; SurgiVision Consultants Inc., Scottsdale, AZ) allows me to achieve emmetropia more easily. Here are my favorite counseling points for converting patients who are interested in either a laser or lenticular treatment.

Excellent patient outcomes. Patients seek out my practice because I use the WaveLight ALLEGRETTO Eye Q and they have learned about its predictable outcomes. I inform them that 93% of patients in the platform’s FDA trial achieved 20/20 or better, and my personal rate is 97%. The ALLEGRETTO WAVE’s combination of unique wavefront-optimized treatment profile, speed, and accuracy allows me to obtain the best results for my patients.

Low enhancements. The system’s low enhancement rate is a huge plus for consumers. Patients do not view enhancements positively, and they spread the word about a practice’s enhancement rate, good or bad. My enhancement rate with the ALLEGRETTO Eye Q is less than 1%.

Fewer visual symptoms. Patients are pleased to hear that the ALLEGRETTO Eye Q generates minimal nighttime glare and halos postoperatively and will lessen over time.¹ The wavefront-optimized treatment profile maintains the ideal prolate shape and neutral aspheric balance of the cornea, thereby minimizing glare and halos. My staff and I spend a lot of time educating patients about the benefits of the wavefront-optimized treatment. Sometimes, I will draw them a diagram to explain how most lasers treat in an oblate pattern, which potentially induces more corneal aberrations than the prolate shape.

Treatment speed. Being able to tell a patient that their LASIK treatment will take less time than pouring a cup of coffee gives them a lot of confidence. Many patients get anxious about maintaining focus during the treatment, even if they are told that the ALLEGRETTO Eye Q’s tracker will accurately follow their eye. Eliminating patients’ fear of undergoing the procedure helps them schedule surgery faster.

Safety. When I encounter patients who are interested in intraocular surgery but perhaps are not ideal candidates, I stress the safety profile of a corneal ablation procedure over intraocular surgery. The ALLEGRETTO Eye Q also has an impressive safety profile among excimer lasers. I also find the ALLEGRETTO Eye Q laser ideal for enhancing the postoperative refraction of refractive cataract patients. Achieving emmetropia in this patient population, I feel, is a must and is a real practice builder.

Counseling also encourages conversions. Although the ALLEGRETTO Eye Q’s high-quality outcomes, safety and reliability profile, and low enhancement rate makes it easy to convert patients to corneal refractive surgery, anything we can do to dispel patients’ reservations about the procedure will help them make the decision to undergo surgery. In addition to educating patients about the wavefront-optimized treatment option, my staff and I are careful to set their expectations about the postoperative healing process. I consider the healing profile to be 1 month for every diopter of myopia and 3 months for every diopter of hyperopia. I coach patients to expect mild corneal dryness and visual symptoms for a period of time after their surgery, and I explain that their refraction will not fully stability for approximately 6 months. I find that if I can alleviate patients’ anxiety and set their expectations, they will have a much better perception of the quality of their outcome.

Finally, when a patient comes back for a follow-up visit, I always ask them for their observations about their vision. I am careful not to say the word complaint, because of its negative connotation. If they describe any symptoms, I reassure them to let the natural healing process progress so that their outcome is maximized.

Thomas G. Abell, MD, is Medical Director of AbellEyes Refractive Solutions in Lexington, Kentucky. He was a clinical core investigator for the ALLEGRETTO WAVE laser and is a member of the Alcon Clinical Advisory Board. Dr. Abell may be reached at (859) 373-0300; drabell@abelleyes.net.

1. The ALLEGRETTO Patient Information Handbook, 2003.

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Ultimately, there are only two things that matter in building your LASIK service line: (1) Is refractive surgery a professionally rewarding specialty for you? (2) Is LASIK increasingly profitable for you to perform?

Results
Success with LASIK must be measured in two ways to create sustainable growth. The first measurement is surgical results. How accurately do you deliver vision? This can be evaluated with refractions and acuities. What vision did the patient start with, where did he end up, and how close is this result to what you targeted? You must implement a results-tracking system that ensures the measurement of every eye at key points in time. Without that information, you simply cannot have an accurate nomogram for surgical planning or laser programming. Without exception, no practice I have consulted with delivered LASIK results as accurately as it thought it did if the surgical staff was not using outcomes tracking software and a real-time nomogram.

Service
Second and perhaps more importantly, you must measure your patients’ perceptions of their results and translate these findings into improvements in your service. A LASIK patient satisfaction survey, administered appropriately, will give you vital feedback on the patient experience in your practice. Often, a 20/20 patient is upset and never refers, and a 20/30 patient is thrilled and refers three people, based on the experience he or she had with you or your staff.

Administer your survey so that patients feel protected and valued when they provide unfiltered critiques. Do not survey patients at their 1-day postoperative visit – they all love you then. Do not give the survey in the office before a postoperative visit – no one feels comfortable sharing an issue or complaint before seeing the surgeon. Present the survey in a way that protects the patient’s privacy and encourages candor. We provide ours in printed form upon check-out at the 10-day postoperative visit with a stamped, self-addressed envelope for later return. Or, we will provide an e-mail link if we want to survey a large group at once.

Structure your survey to examine every area of your practice for weakness. Ask specific questions about vision, what the patient is most pleased with, which areas did not meet their expectations, suggestions to improve visits, and the treatment by staff members (including the surgeon, optometrists or counselors, technicians, and front-desk personnel).

Be open to changes
Most importantly, you must be willing to accept and act on the results of your surveys. In my experience, a practice may solicit satisfaction data, and then refuse to accept it when the results do not mesh with their perception of truth. I often hear retorts such as “I know my patients love me. I know my results are better than that. My techs don’t know how to refract. No one pushed those visions.There was no way to make that person happy. No one here would ever treat a patient that way. That survey isn’t representative of our patients.” Yet, these patients are living in your community and talking with acquaintances about the vision you gave them. The true measure of patient satisfaction is if they send you new patients. Although it may seem that virtually everyone you’ve treated this year came from a patient referral, this number is a fraction of what you could have seen with higher satisfaction ratings.

Let me reinforce this concept with the numbers from an average laser center. It performed an average of 67 refractive procedures each month in 2008, for a total of 450 people. Until the bottom fell out of LASIK, the average center was performing LASIK on about 600 people annually. Based on my experience, I know that 25% to 55% of new patients are referred from prior patients, so the 450 people treated last year will send 100 to 250 new patients this year. This number may startle you, because you think 80% to 90% of your patients come from referrals. They don’t. The best centers generate just over half of their surgeries from past patients; the remainder comes from external marketing.

The average laser center in the US is located amidst a population of 116,000 adults between the ages of 20 and 54. So, even if you believe your market is more competitive (it generally isn’t) or your patients are somehow different (they generally aren’t), we can agree that somewhere in this huge population, 450 more people can be encouraged to walk through your door for LASIK.

Ask, believe, and act
The power to improve LASIK volume lies within your own walls. With all of your skill in customer service, extraordinary technology, and true patient need, you ophthalmologists have the ability to get 70% or 80% or 100% of last year’s patients to refer at least one of their friends or family members. But, you have to listen when they tell you how. What would happen to your volume if 100% of your patients actually sent you one or even two new patients? This is your leverage. Not consumer confidence. Not stimulus spending. Just 450 people from last year or 600 from the year before who had such a great experience that they motivate 500 new people to visit you this year. You must deliver stellar vision in such a personable, enjoyable, and unexpected way that your patients cannot wait to tell their friends.

Patient Satisfaction is your tool to examine what you do well and unearth what you must do better. You simply have to ask, believe, and act on this information. When you do, LASIK, regardless of the economy, will grow.

Kay Coulson is President of Elective Medical Marketing (www.electivemed.com), a consulting firm based in Boulder, Colorado, that helps surgeons grow their elective vision service lines. Ms. Coulson may be reached at kay@electivemed.com.

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