The future of refractive lens surgery and IOL implantation lies in “refractive cataract surgery,” consisting of enhancements that will give individual patients better visual function and improved quality of life compared with standard cataract surgery, said longtime refractive and cataract surgeon Richard L. Lindstrom, MD, in a keynote address at Friday’s Refractive Surgery Subspecialty Day meeting.
“It’s clearly a win for society … if we want to have a highly functioning elderly population,” Dr. Lindstrom said. “And refractive cataract surgery has made a meaningful impact on the quality of refractive cataract surgeons … in improving our skills. But it has also provided an opportunity for us around the world to increase our opportunity for revenue in an ever-demanding external environment.”
From premium and presbyopia-correcting IOLs to advanced diagnostics for precisely targeting post-op acuity, enhancements to conventional procedures increase the procedural costs for surgeons but also create a promising revenue stream, Dr. Lindstrom said.
Citing Market Scope research, Dr. Lindstrom estimated that the global revenue for ophthalmologists from refractive cataract surgery in 2021 will be $12.1 billion. Toric, presbyopia-correcting, and other premium IOLs accounted for 10.8% of all IOL implants in the United States in 2013 and 15.7% in 2020, and they are projected to increase to 16.2% in 2021, he said. Globally, they are expected to be used in 9.8% of cataract surgeries in 2021, he added.
Because patient satisfaction with refractive cataract surgery is high, the major limitation on patient demand for enhanced cataract surgery is the extra costs, he said. For instance, a Market Scope 2020 survey of U.S. cataract surgeons put these at about $700 per eye for limbal relaxing incisions, about $1,300 for a toric IOL, and $2,400 for a presbyopia-correcting IOL.
Enhanced refractive approaches are expanding to other areas of ophthalmology, he noted. “We’re starting to get refractive crosslinking, we’re starting to get refractive keratoplasty. And I would suggest that even our glaucoma associates and retina associates are starting to think about what impact the surgery has on the refractive status of their patients,” he said.— Linda Roach
Financial disclosures: Dr. Lindstrom, AcuFocus, Inc: C,O,P; Alcon Laboratories, Inc: C; Allegro: C,O; Alphaeon: C,O; Aprea Therapeutics: O; Arixa: O,C; Augustine Temperature Management: O; Avellino Labs: C,O; Aviana: O; Bausch + Lomb: C,O,P; Belkin Laser: C,O; Broadspot: C,O; Bruder: O; Centricity Vision: C,O; Checked-Up: C,O; Combangio: C,O; Confluence Acquisition Partners, Inc: O; CorneaGen: C,O; CXL, ESI: C,O; Digital Systems: O; Dose: C,O; E-Vision Medical Devices: O; E-Vision: O; EBV Partners: O; Egg Basket Ventures: O; Egg Factory: O; Equinox: C,O; Eton: O; Evolus: O; Excel-Lens, Inc: O; Expert Opinion: C,O; Eye Safe: C,O; Eyemaginations, Inc: C,O; Flying L Ventures: C,O; Freedom Software: O; FZioMed, Inc: O; Glaukos Corp: C,O; Gondola: O,C; Harrow Health: C,O,P; Health-E: C,O; Healthcare Transaction Services: C,O; High Performance Optics: O; Iantrek: O; IDoc, Inc: O; Imprimis: C,O; InjectSense: C,O; Innovega: O; iOR: O,C; Johnson & Johnson Vision: C; KalaRx Pharmaceuticals: C,O; Kedallion: C,O; KeraFlow: C,O; LENSAR: C,O; LenTechs: C,O; Lenticular Research Group: O; Lifeguard Health: C,O; Lumineyes: O; MD Backline: C,O; Melt: C,O; Minnesota Eye Consultants: C,O; NASA-Vision for Mars Program: C; Neurovision: C,O; New Sight Reality: O; Novabay: C,O; Nutraceutical Holdings: C,O; Ocular Optics: C,O; Ocular Surgery News/Slack: C; Ocular Therapeutix: C,O; Oculatec: O; Ocutryx: C,O; Omega Eye Health: C,O; Omega Ophthalmics: C,O; Omeros Corp: C; Orasis: C,O; Oysterpoint: C,O; PogoTec: C,O; Q Sensei: O; Quest: C,O,P; Revana: O; RxSight: C,O; Schroeder Ventures Fund II, III, IV, VI: C,O; SightPath: C,O; Silk Technologies: C; Solbeam, Inc: O; Strathsprey Crown: O; Stroma: O; SunPharma: C; Surface Pharmaceuticals: C,O; Tarsus: C,O; TearClear: C; TearLabs, Inc: C,O; TearOptix: O,C; Theroptix: O,C; Tissue Tech: O; Tracey Technologies: C,O; True Iris: C,O; True Vision: C,O; Versant Fund Side Fund: C,O; Vinci: C,O; Viradax: O; Vision Solutions Technology: C,O; Visionary Ventures: C,O; Zeiss: C.
Disclosure key. C = Consultant/Advisor; E = Employee; L = Lecture Fees; O = Equity Owner; P = Patents/Royalty; S = Grant Support.