Eyeworld CME Supplements

EW_NOV 2016 Supported by Abbott Medical Optics

This is a supplement to EyeWorld Magazine that doctors can take a test after reading and receive CME credits for.

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Supplement to EyeWorld November 2016 Exploring the next generation of laser refractive outcome goals, and practice Supported by Abbott Medical Optics Accreditation Statement This activity has been planned and implemented in accordance with the accreditation require- ments and policies of the Accreditation Council for Continuing Medical Education through the joint providership of the American Society of Cataract and Refractive Surgery (ASCRS) and EyeWorld. ASCRS is accredited by the ACCME to provide continuing medical education for physicians. Educational Objectives Ophthalmologists who participate in this activity will: • Describe how next generation diagnostics and ablation profiles will impact patient safety, efficacy, and overall outcomes for the modern refractive practice. Designation Statement The American Society of Cataract and Refractive Surgery designates this enduring materials educational activity for a maximum of 0.75 AMA PRA Category 1 Credits. ™ Physicians should only claim credit commensurate with the extent of their participation in the activity. Claiming Credit To claim credit, participants must visit bit.ly/2e4sDHP to review content and down- load the post-activity test and credit claim. All participants must pass the post-activity test with a score of 75% or higher to earn credit. Alternatively, the post-test form included in this supplement may be faxed to the number indicat- ed for credit to be awarded, and a certificate will be mailed within 2 weeks. When viewing online or downloading the material, standard internet access is required. Adobe Acrobat Reader is needed to view the materials. CME credit is valid through April 30, 2017. CME credit will not be awarded after that date. Notice of Off-Label Use Presentations This activity may include presentations on drugs or devices or uses of drugs or devices that may not have been approved by the Food and Drug Administration (FDA) or have been approved by the FDA for specific uses only. ADA/Special Accommodations ASCRS and EyeWorld fully comply with the legal requirements of the Americans with Disabilities Act (ADA) and the rules and regulations thereof. Any participant in this educational program who requires special accommodations or services should contact Laura Johnson at ljohnson@ascrs.org or 703-591-2220. Financial Interest Disclosures Michael Gordon, MD, has received a retainer, ad hoc fees or other consulting income from Alcon Laboratories and Presbia. Colman R. Kraff, MD, has received research funding from Abbott Medical Optics. Edward E. Manche, MD, has an investment in- terest in Calhoun Vision and Seros Medical LLC. He has received research funding from: Abbott Medical Optics, Allergan, Avellino Laboratories, and Ocular Therapeutix. Dr. Manche has received a retainer, ad hoc fees, or other consulting income from Abbott Medical Optics. Karl G. Stonecipher, MD, has an investment interest in Strathspey Crown. He has received a retainer, ad hoc fees, or other consulting income from, and is a member of the speakers bureaus of: Alcon Laboratories, Allergan, Bausch + Lomb, Presbia, Refocus, and Shire. Dr. Stonecipher is a member of the speakers bureaus of Abbott Med- ical Optics and Nidek. He has received research funding from: Alcon Laboratories, Allergan, Baus- ch + Lomb, Presbia, and Refocus, and he has received travel expense reimbursement from: Allergan, Bausch + Lomb, Presbia, and Shire. Staff members: Kristen Covington and Laura Johnson have no ophthalmic-related financial interests. by Karl Stonecipher, MD Accelerating LVC adoption: Successful growth strategies for your refractive practice optimizing our website's search engine performance. Without an optimized website you will lose the millennial quickly. Market Scope respondents rated websites as their most effective marketing tool. 1 Patient education To educate patients, we use a range of tools, including tablets and videos, which drive patients to our website, and encourage them to read the latest research. Surgeons need to counter com- mon misconceptions about LVC. For example, patients may be concerned about post-LASIK dry eye. However, when Price et al. performed a 3-year survey in patients with LASIK vs. contact lenses, LASIK did not signifi- cantly increase dry eye and patients were more satisfied. 6 In the beginning of the process, we explain that presbyopia will even- tually change their vision and that can be corrected when they have cataract surgery, if applicable. We don't discuss this with a 22-year-old, but we start the conversation when patients are 35 to 40 years of age. Patients also need to know an enhancement does not mean the procedure has failed but that we need to fine-tune their results. If this concept is not explained early, it will lead to a long conversation Excellent outcomes also attract new patients. New technology allows us to treat patients who were previously ineligible and provides better outcomes on postoperative day 1. 5 When we achieve 20/15 visual acuity after surgery on the next morning, patients experience a "wow" factor that we reinforce, comparing their previous and cur- rent vision on the eye chart. This visit is also the perfect time to ask patients whether friends or family members might be interested in LVC. However, millennials like fash- ion eyeglass frames, so they may be less interested in LVC, but they do not want to wear glasses for certain activities. Therefore, we explain that they can still wear glasses after LVC but will not need them. Although this seems obvious, sometimes individuals do not register this concept. In fact, websites now sell nonprescription glasses as a fashion accessory. To reach millennials through so- cial media, we have an employee in this age group who mines potential candidates through Facebook and Twitter. If we offer free exams and can encourage the patient to come in for an evaluation, roughly 70% to 75% of candidates choose to have the procedure. We are also Baby boomers interested in LVC have either had the surgery or are beyond the optimal age range. How- ever, patients in my practice who had LASIK from 1995 to 2000 often return early for cataract surgery with premium intraocular lenses because they do not want to wear reading glasses, similar to results reported by Yesilirmak et al. 4 Although millennials may show less interest in LVC and often lack the income for out-of-pocket procedures, I think they offer the most potential in growing our LVC practices. Segmented strategies Market segmentation is a useful tool in reaching potential LVC candi- dates. However, when we target groups through different means, it is important to convey the same messages, or we must segment our marketing dollars toward genera- tion-directed advertising. Word of mouth and physician referrals account for our highest numbers among older patients, so we usually attract millennials by talking to their parents or grand- parents. We also email information about LVC specials to our patients who received the procedure 10 or 15 years ago, advertising LVC as a graduation or holiday gift for their children or grandchildren. Economic and demographic changes are transforming the LVC market F or the first quarter of 2016, Market Scope estimated that laser vision correction (LVC) and non-laser refrac- tive procedures combined showed a 13.7% increase year over year. 1 However, even these positive statistics illustrate that 2015 demon- strated a decline. Moreover, if we recall the peak refractive procedure volume, it is little more than half of what it once was. When Stein et al. gauged interest by examining the Google query rate for "LASIK" from 2007 to 2011, they found it decreased in the United States by 40%. 2 Economic and demographic changes, as well as other factors, have transformed the LASIK mar- ket. The U.S. millennial population (born between 1982 and 2000) now exceeds the baby boomer popula- tion (83.1 million vs. 75.4 million, respectively). 3 Karl Stonecipher, MD continued on page 69

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