December 2020

REFRACTIVE

Patterns in LASIK cases since reopening practices


by Ellen Stodola Editorial Co-Director


Dr. Faktorovich gives patients a choice to wear a mask or not during their procedure. All patients are screened with a COVID-19 questionnaire prior to entering the clinic and their temperature is checked. Disposable surgical blankets are used to cover patients.
Source: Ella Faktorovich, MD

Dr. Chang with a masked LASIK patient prior to surgery. Surgeons should take steps to prevent the fogging of femtosecond laser applanation cones on patients who wear masks during the procedure, Dr. Chang said.
Source: Daniel Chang, MD

A busy day of LASIK at the Waring Vision Institute in Mt. Pleasant, South Carolina. Interest in laser vision correction has increased since COVID-19, and the reasons are multifactorial, Dr. Waring said.
Source: George Waring IV, MD

Intraoperative photo of an end of surgery LASIK flap floated back into perfect position
Source: Sarah Nehls, MD

After being forced to close for several months because of the COVID-19 pandemic, many ophthalmologists had to make adjustments to practices in the clinic and surgery when they reopened. EyeWorld spoke to several surgeons about what they’ve seen in terms of LASIK numbers since reopening, with many noting that they’ve actually seen an uptick in this procedure.
Ella Faktorovich, MD, said she’s been keeping track of LASIK numbers, reasons behind these numbers, and why patients choose refractive surgery for years. She uses a questionnaire that asks patients why they want refractive surgery and why now.
Like many, her practice closed in late March and reopened in early June. She noted that she’s had about a 40% increase in refractive surgery volume since that time, which she said, “is remarkable compared to the time prior to that.” She said that some of this volume is from patients who were unable to complete the procedure prior to the shutdown, but she’s also noticing more new patients coming in interested in LASIK.
While the potential for glasses fogging up while wearing a mask is a motivating factor, Dr. Faktorovich said it is not the number one motivating factor for these patients. “According to the data that we generated from the questionnaires patients answer when they come in, the main reason is that patients have time now to do it,” she said.
Dr. Faktorovich said the fact that many people are now working from home is likely a huge factor. Patients don’t necessarily have more time because many are actually working more at home rather than less; however, they have more flexibility. “They can fit a consultation in during the middle of the day,” Dr. Faktorovich said, adding that many patients are no longer commuting, are no longer traveling for work or leisure, and generally feel that they have more time. “The working from home concept is, according to the questionnaires, the main reason patients are coming in now,” she said.
Dr. Faktorovich also mentioned that people want to pursue outdoor activities without glasses. With travel being limited, many are using this time to do things outside.
The reasons for pursuing refractive surgery are quite different now than what Dr. Faktorovich saw pre-pandemic. She said the top three reasons previously were: the desire to not be bothered by contacts, the desire to finally be stable, and patients reaching a point to be able to afford the procedure. She noted that she doesn’t see bothersome contacts being brought up as much and said this could potentially be attributed to patients being less likely to wear contacts when working from home.
In addition to patient motivations for LASIK shifting, Dr. Faktorovich noted changes in the process when the patient comes in for the procedure. With new precautions, she said that family and friends are now required to wait outside, which has helped streamline the process. “Now I think we can really focus on the patient,” she said.
Daniel Chang, MD, noted that Q3 of 2020 was his most productive quarter of LASIK in several years. This year, he performed nearly 25% more cases in Q3 than the average Q3 volume of the preceding 3 years. He is definitely noticing an increase in interest in LASIK. “I’ve heard some of the discussion among colleagues and from industry as well,” he said.
Dr. Chang thinks this could be due to a variety of factors. He said that people aren’t traveling and spending money. They aren’t going to sporting events or entertainment venues, so they have more money they want to spend, he said.
“Also, they’ve been at home with nothing to do and are researching and getting around to things they’ve thought about doing,” Dr. Chang said.
Dr. Chang added that many patients are worried about the chance of COVID infection with contact lenses, and LASIK would remove that concern.
He thinks the renewed interest in LASIK at this time is a combination of these factors.
Dr. Chang is finding most patients who are coming in interested in LASIK are new patients, though he noted that a few have consulted previously.
Dr. Chang said he’s also seeing interest in refractive IOLs. Though this is a different age group, demographic, and income profile than those interested in LASIK, Dr. Chang thinks this is a positive trend for elective procedures in general.
Sarah Nehls, MD, has seen an uptick in LASIK cases, specifically new patients seeking out this procedure. She said this is an interesting trend, and mask wearing gives those with glasses a new reason to pursue LASIK. They start to think about alternatives to improve their vision during their workday or when they’re out where they need to wear a mask, she said.
Dr. Nehls also thinks extra time could be a factor, where it may be less difficult to take the time off that is needed for refractive surgery. “They have more flexibility in their schedule,” she said, adding that many may also be making time for more outdoor activities where not needing glasses or contacts could be an advantage.
George Waring IV, MD, has also seen an increase in his LASIK cases. Through the mandatory shutdown, Dr. Waring said his practice remained active with virtual LASIK consults, and he was surprised by the amount of interest during the pandemic in self-pay procedures.
The reasons for the interest are likely multifactorial, but Dr. Waring said many people are thinking about what’s really important to them. Being unable to travel and not spending money, this has given many people time to reflect on things they want to do in life that they were too busy to do. “As a result, many people are interested in opportunities for health and wellness and things to simplify their lives,” he said.
While the value of vision correction is well known to refractive surgeons, not everyone in the public is aware, so this gave the public more time to reflect on that value and opportunity, he said.
Dr. Waring added that the possibility of not being able to obtain glasses or contacts in the future may have also played a role, in addition to the nuisance of glasses fogging associated with mask wearing.
With all of these factors at play, Dr. Waring said he’s seen an uptick in volume. He added the more people who undergo vision correction, the more advocates you have for it as well.

ASCRS Refractive Surgery Clinical Committee alert

In July, the ASCRS Refractive Surgery Clinical Committee released an alert about the increased risk of femtosecond laser flap creation complications while patients wear masks. It noted that there is the possibility of fogging open femtosecond laser applanation cones if patients wear a mask during the procedure.
Dr. Waring noted that patients wearing masks in the clinic and OR is new, so it was good to be able to identify and address these issues. This problem with the use of femtosecond lasers and masks is one that is remedied mostly with a piece of tape over the bridge of the nose, he added.
Dr. Chang also commented on the alert from the ASCRS Refractive Surgery Clinical Committee. Though he said he hasn’t seen this issue himself, Dr. Chang said he will usually pull the patient’s mask down so that their nose is exposed at the time of the surgery. You can tape the mask down to the middle of their face or you can pull it down past their nose, but awareness and identifying the potential problem is the key, he said.
Dr. Nehls said she did have a case where fogging occurred. She had not previously seen it but in retrospect realized what it was. This patient ended up with a flap that was too thin, she said.
As a result, Dr. Nehls said changes were made at her surgical center. This patient in particular had been wearing a very large N-95 mask, and he had insisted on wearing his own mask. Now, the surgery center has a rule that patients must wear masks from the surgery center, Dr. Nehls said, and they tape the nose and across the cheek. She hasn’t experienced this complication since the surgery center made the change.
Dr. Nehls said she had an “ah ha” moment when this alert was distributed by the clinical committee. She said she may go back and treat that patient, possibly recutting the flap.

About the physicians

Daniel Chang, MD
Empire Eye and Laser Center
Bakersfield, California

Ella Faktorovich, MD
Pacific Vision Institute
San Francisco, California

Sarah Nehls, MD
University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin

George Waring IV, MD
Waring Vision Institute
Charleston, South Carolina

Relevant disclosures

Chang: None
Faktorovich: None
Nehls: None
Waring: None

Contact

Chang: dchang@empireeyeandlaser.com
Faktorovich: ella@pacificvision.org
Nehls: nehls@wisc.edu
Waring: georgewaringiv@gmail.com

Patterns in LASIK cases since reopening practices Patterns in LASIK cases since reopening practices
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