Advanced testing: should we rethink...

DR. KERRY SOLOMON CAROLINA EYECARE PHYSICIANS

Advanced testing: should we rethink this

Kerry D. Solomon, MD Managing Partner: Carolina Eyecare Physicians

Medical Director: Carolina Eyecare Research Institute Adjunct Professor: Medical University of South Carolina

Charleston, South Carolina


Financial disclosures

• Alcon Labs • Abbott Labs • Allergan • AqueSys • Bausch + Lomb • Glaukos

• Haig Streit • Mati Therapeutics • Nidek • PRN Nutriceuticals • Versant Ventures • Wavetec • Zeiss


Routine cataract surgery

• Remove a cloudy lens • Replace it with a clear IOL • Fit the patient for corrective glasses postop


Healthcare Opportunities

• Aging population, over age 65 growing 2x rate of under 65 • Technology advances

- Toric and Presbyopia correcting IOL’s - Laser assisted cataract surgery - A broad, diverse, well capitalized pipeline of new products

• Consumerism - baby boomers want quality of life - expect life improvements from therapies

• Escalating costs a catalyst for patient shared responsibility (“Defined Contribution Plan”) • Significant unmet needs

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Source: Leerink, SV Life Sciences

$3 trillion per annum (USA) or 20% of GDP Ophthalmology = 3% ($70 Billion today) $100 Billion 2020


US Presbyopic Population

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Average Age of US Cataract Patient

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Trends: earlier diagnosis & treatment before substantial vision loss

• In 2011, almost 800,000 surgeries will be performed on patients 55-64 years old • New surgical approaches available to improve UCVA for many patients • Established LASIK market validates that patients will pay for surgically improved vision


Who are the Baby Boomers?

• Baby boomers turned 65 in 2011

• Control over 80% of personal financial assets

• Control more than 50% of discretionary spending power

• Spend $500 million on vacations per year

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The Field Has Changed

• The medical milestone of cataract will be increasingly re-defined by lifestyle requirements

• Younger, active patient population will seek a surgical resolution

much earlier than previous generations • An individualized surgical plan must be designed and executed to

meet patient’s refractive goals • The market size is growing

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Does the Patient Have Pre-existing Astigmatism?

Patient’s Goal

Less Reliance on Spectacles

Distance Monofocal IOL

Toric IOL

Distance & Near Presbyopia Correcting

Monovision Spectacles

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Important to Explain

What’s covered

-Cataract removal -Placement of a lens implant -Glasses prescribed for daily activities -May see some things without glasses if no astigmatism Enhancements NOT covered**

What’s not covered

Advanced testing Astigmatism Tx Presbyopia Tx Intraoperative Aberrometry Longer coverage postop Enhancements

Astigmatism Presbyopia

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Quality of Life Issues What is the patient’s goal?

• Improved quality of vision – covered

• Less dependence on glasses / contact lenses – Refractive goal (not

covered)


Refractive Cataract Reality

• Lasik predictability: 95% +/- 0.5 diopters

• What is the likelihood of being +/- 0.5 diopters with cataract surgery in your practice?


Warren Hill

60-65%: majority of surgeons 75-80%: top 6% of surgeons 90%: top 2% of surgeons


Refractive Cataract Reality

• 20-40% of patients undergoing cataract surgery will not be within 0.5 diopters of spherical outcome

• 2-4/10 patients will need an enhancement if they desire to be less dependent on their glasses/contact lenses after cataract surgery


1. Advanced testing 2. Advanced technology

3. Track outcomes 4. LASIK enhancements

Refractive packages


Surgical plan

ORA

OCT Topo


Advanced testing package

• Corneal topography • OCT macula • Manual K’s • Corneal pachymetry • Repeated biometry


Patient’s refractive

goals

Standard/ Advanced

testing Surgical plan Fine tune the

plan

Standard process

Glasses No glasses: distance No glasses: distance/near.

Biometry Topo OCT Manual K’s.

Monofocal IOL LRI/Femto arcs ATIOL

Glasses LASIK/ASA

A process is necessary to avoid confusion


Nail the Refraction

• Accurate biometry • Meticulous surgery • Track outcomes


Challenges Faced by the Surgeon

Provide the best surgical options Understand who are the best candidates Provide patients with good information so they can

make good informed decisions Make a recommendation to the patient


Challenges we are faced with:

• Cataract surgeon / refractive cataract surgeon

• Routine cataract surgery / refractive cataract surgery


Challenges we are faced with:

• Declining reimbursements

• Growing population • Increasing patient

expectations (refractive)

• How do we deal with; – Refractions – Advanced testing – Refractive packages – Lasik enhancements


Comprehensive Ophthalmology Practice 2013 and beyond

Cataract Surgery

FS Cataract

AT IOLs

Dry Eye Center

MIGS iStent

PRK/LASIK


Thank You

Advanced testing: should we rethink...

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