Marketing Pearls: Is the market ready for the promotion of presbyopia-correcting IOLs?
By Lance Kugler, MD
I was recently waiting in a doctor’s office, thumbing through an issue of Newsweek and reflecting on how frustrating it is when doctors are running late, when I noticed a full-page advertisement for the Crystalens HD. This advertisement was not in an ophthalmology journal or periodical, but rather in one of the most commonly read weekly magazines in the country. The target of the ad was clear: people who had been told that they are developing cataracts and may need surgery soon. I asked myself, “Is this a good thing for our patients? What should our attitude be, as ophthalmologists, to this direct-to-consumer marketing?”
A recent article appearing on Medianewsline.com outlined a broader direct-to-consumer ad campaign that Bausch and Lomb recently announced. “The advertising encourages patients to talk to their ophthalmologist about whether they are candidates for Crystalens or to visit the Crystalens website to learn more about this exciting vision correction alternative," said Amy Jacobs, Director of Global Marketing for the Crystalens.
I was told several months ago by a lens sales rep that direct-to-patient IOL marketing was coming soon, and the news came as no surprise to me given the emphasis on such practices by the pharmaceutical industry in recent years. But I think that presbyopia-correcting IOL consumer marketing will have much different consequences, perhaps to the detriment of the industry.
Consider that Crystalens was approved by the FDA in 2003, followed by ReStor and ReZoom in 2005, yet combined these lenses account for only 6.2% of the total number of IOLs being implanted (source: MarketScope, March 16, 2009). Although reliable data is difficult to obtain, two leading manufacturers of presbyopia-correcting IOLs estimate the percentage of surgeons who actively use presbyopia-correcting IOLs is between 20-25%, and the percentage of surgeons who occasionally use these lenses is between 40-45%.
Now consider what will happen when patients read an ad in Newsweek (or elsewhere) and then ask their non- presbyopia-correcting IOL using cataract surgeon (one of the 55-80% majority) if they can have the lens. How many of these surgeons will be prepared to deal with the question? Possible solutions include: 1. Refer the patient to a colleague with presbyopia-correcting IOL experience, 2. Discourage the technology, despite the possibility that the patient may in fact be a suitable candidate, 3. Become a presbyopia-correcting IOL surgeon.
Most surgeons are not eager to refer a surgical patient elsewhere, thus option 1 is not realistic. Option 2 is certainly reasonable, as there remains sufficient controversy within the field as to appropriate indications for presbyopia-correcting IOL implantation, but marketing is powerful and patients may seek another opinion. Option 3 carries its own set of challenges, as surgeons who have avoided presbyopia-correcting IOL technology have done so for a reason. Perhaps they do not feel comfortable with the indications or have the technology required for the pre-operative evaluation and astigmatism management. Perhaps they are reluctant to deal with the required out-of-pocket billing, unreasonable patient expectations, chair time, and change in practice philosophy.
Regardless of the reasons behind the delayed acceptance of presbyopia-correcting IOL technology by surgeons, direct-to-consumer marketing places these surgeons in direct opposition with some of their own patients and many of their colleagues. This is different than direct-to-consumer pharmaceutical marketing, like Restasis for example, as the learning curve required for physicians to manage patient inquiries for such products is minimal. In contrast, presbyopia-correcting IOL technology requires development of new skills and the acquisition of expensive equipment (IOL Master, corneal topographers, excimer laser for post-op enhancements, etc.) for many practitioners.
Consider the recent generation of presbyopia-correcting IOLs have been available since 2003. Ophthalmologists who trained prior to that time had no formal exposure to the technology during their training. Even today, there are very few residency programs that provide significant exposure to these technologies, and the experience required for appropriate clinical management. Rarely does a resident graduate with the skills required to surgically manage astigmatism to the degree required for a successful presbyopia-correcting IOL outcome. Most program directors realize the deficiency, but struggle to find solutions. The obstacles are similar to those limiting refractive surgery experience during training, specifically the paucity of cash-paying patients at academic institutions and the high liability associated with elective procedures. There is also limited educational emphasis on advanced optics. Board examiners tend to be more concerned with the function of a “lens clock” or round-topped bifocal segments than the principles of irregular astigmatism, high-order aberrations, and Fourier analysis.
In our free-market economy, manufacturers have every right to market their products. In the case of presbyopia-correcting IOLs, however, surgeons must bear the brunt of consumer demand. For those of us who actively use presbyopia-correcting IOL technology this may be of great benefit to our practices. For surgeons who do not use this technology, however, the effect will be less desirable. When confronted by their patients, non-presbyopia-correcting IOL using surgeons will likely disparage the technology thus generating an increase in negative publicity. Others may give in and use the technology before they are comfortable doing so, thus risking unsatisfactory outcomes and further negative publicity. The net effect of the marketing campaigns may therefore be counterproductive.
Resources are better spent on education of cataract surgeons on the appropriate application and approach to presbyopia-correcting IOL technology. The optics curriculum required of ophthalmology residents also must be revamped and updated to be more clinically relevant for 2009 technology. Astigmatism management should be routinely taught to residents and considered standard of care. Educational programming through organizations such as the AAO and ASCRS should focus on a comprehensive approach to presbyopia-correcting IOLs, including preoperative evaluation, surgical technique, postoperative evaluation, and the required business/marketing strategies. The manufactures may help by offering support for perioperative management, such as discounted procedure fees for presbyopia-correcting IOL patients requiring excimer laser surgery enhancements.
There is no question that as cataract surgery and refractive surgery merge, the future of our field is dependent upon presbyopia-correcting IOLs. It is not difficult to envision presbyopia-correcting IOLs becoming the standard of care. Given the current resistance to the technology by a majority of cataract surgeons, however, direct-to-consumer marketing may be premature. As ophthalmologists, we should oppose such tactics to the degree that we can, and offer other priorities to which resources may be directed to benefit our patients and secondarily the presbyopia-correcting IOL industry.
A recent article appearing on Medianewsline.com outlined a broader direct-to-consumer ad campaign that Bausch and Lomb recently announced. “The advertising encourages patients to talk to their ophthalmologist about whether they are candidates for Crystalens or to visit the Crystalens website to learn more about this exciting vision correction alternative," said Amy Jacobs, Director of Global Marketing for the Crystalens.
I was told several months ago by a lens sales rep that direct-to-patient IOL marketing was coming soon, and the news came as no surprise to me given the emphasis on such practices by the pharmaceutical industry in recent years. But I think that presbyopia-correcting IOL consumer marketing will have much different consequences, perhaps to the detriment of the industry.
Consider that Crystalens was approved by the FDA in 2003, followed by ReStor and ReZoom in 2005, yet combined these lenses account for only 6.2% of the total number of IOLs being implanted (source: MarketScope, March 16, 2009). Although reliable data is difficult to obtain, two leading manufacturers of presbyopia-correcting IOLs estimate the percentage of surgeons who actively use presbyopia-correcting IOLs is between 20-25%, and the percentage of surgeons who occasionally use these lenses is between 40-45%.
Now consider what will happen when patients read an ad in Newsweek (or elsewhere) and then ask their non- presbyopia-correcting IOL using cataract surgeon (one of the 55-80% majority) if they can have the lens. How many of these surgeons will be prepared to deal with the question? Possible solutions include: 1. Refer the patient to a colleague with presbyopia-correcting IOL experience, 2. Discourage the technology, despite the possibility that the patient may in fact be a suitable candidate, 3. Become a presbyopia-correcting IOL surgeon.
Most surgeons are not eager to refer a surgical patient elsewhere, thus option 1 is not realistic. Option 2 is certainly reasonable, as there remains sufficient controversy within the field as to appropriate indications for presbyopia-correcting IOL implantation, but marketing is powerful and patients may seek another opinion. Option 3 carries its own set of challenges, as surgeons who have avoided presbyopia-correcting IOL technology have done so for a reason. Perhaps they do not feel comfortable with the indications or have the technology required for the pre-operative evaluation and astigmatism management. Perhaps they are reluctant to deal with the required out-of-pocket billing, unreasonable patient expectations, chair time, and change in practice philosophy.
Regardless of the reasons behind the delayed acceptance of presbyopia-correcting IOL technology by surgeons, direct-to-consumer marketing places these surgeons in direct opposition with some of their own patients and many of their colleagues. This is different than direct-to-consumer pharmaceutical marketing, like Restasis for example, as the learning curve required for physicians to manage patient inquiries for such products is minimal. In contrast, presbyopia-correcting IOL technology requires development of new skills and the acquisition of expensive equipment (IOL Master, corneal topographers, excimer laser for post-op enhancements, etc.) for many practitioners.
Consider the recent generation of presbyopia-correcting IOLs have been available since 2003. Ophthalmologists who trained prior to that time had no formal exposure to the technology during their training. Even today, there are very few residency programs that provide significant exposure to these technologies, and the experience required for appropriate clinical management. Rarely does a resident graduate with the skills required to surgically manage astigmatism to the degree required for a successful presbyopia-correcting IOL outcome. Most program directors realize the deficiency, but struggle to find solutions. The obstacles are similar to those limiting refractive surgery experience during training, specifically the paucity of cash-paying patients at academic institutions and the high liability associated with elective procedures. There is also limited educational emphasis on advanced optics. Board examiners tend to be more concerned with the function of a “lens clock” or round-topped bifocal segments than the principles of irregular astigmatism, high-order aberrations, and Fourier analysis.
In our free-market economy, manufacturers have every right to market their products. In the case of presbyopia-correcting IOLs, however, surgeons must bear the brunt of consumer demand. For those of us who actively use presbyopia-correcting IOL technology this may be of great benefit to our practices. For surgeons who do not use this technology, however, the effect will be less desirable. When confronted by their patients, non-presbyopia-correcting IOL using surgeons will likely disparage the technology thus generating an increase in negative publicity. Others may give in and use the technology before they are comfortable doing so, thus risking unsatisfactory outcomes and further negative publicity. The net effect of the marketing campaigns may therefore be counterproductive.
Resources are better spent on education of cataract surgeons on the appropriate application and approach to presbyopia-correcting IOL technology. The optics curriculum required of ophthalmology residents also must be revamped and updated to be more clinically relevant for 2009 technology. Astigmatism management should be routinely taught to residents and considered standard of care. Educational programming through organizations such as the AAO and ASCRS should focus on a comprehensive approach to presbyopia-correcting IOLs, including preoperative evaluation, surgical technique, postoperative evaluation, and the required business/marketing strategies. The manufactures may help by offering support for perioperative management, such as discounted procedure fees for presbyopia-correcting IOL patients requiring excimer laser surgery enhancements.
There is no question that as cataract surgery and refractive surgery merge, the future of our field is dependent upon presbyopia-correcting IOLs. It is not difficult to envision presbyopia-correcting IOLs becoming the standard of care. Given the current resistance to the technology by a majority of cataract surgeons, however, direct-to-consumer marketing may be premature. As ophthalmologists, we should oppose such tactics to the degree that we can, and offer other priorities to which resources may be directed to benefit our patients and secondarily the presbyopia-correcting IOL industry.
posted by MedRounds Publications at 6:59 PM
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