Compared with myopic treatments, hyperopic laser vision correction has always been more challenging for refractive surgeons, both from a technical standpoint and also because patients’ visual recovery takes longer. Since my colleagues and I at Durrie Vision in Overland Park, Kansas, bought the Allegretto Wave Eye-Q laser (Alcon Laboratories, Inc., Fort Worth, TX) 3 years ago, our hyperopic laser treatments have been easier to perform and more effective for our patients.

EASE OF TREATMENT WITH WAVEFRONT OPTIMIZED
The Allegretto Wave laser uses an optimized ablation profile that places more pulses in the midperipheral/peripheral cornea to compensate for energy loss and lower fluence. This profile preserves more of the cornea’s natural aspheric shape compared with conventional laser treatments and thus minimizes spherical aberrational changes in both hyperopic and myopic ablations. The hyperopic optimized ablation profile produces a less abrupt transition zone, which reduces the induction of negative spherical aberration and results in better contrast sensitivity and excellent visual outcomes, even in higher levels of hyperopia compared with other excimer laser platforms.

The laser’s optimization software allows my staff and me to treat a wide range of patients quickly. Because most patients do not have a significant amount of preoperative higher-order aberrations, they therefore do not require a wavefront-guided treatment. Thus, we avoid the extra steps in the preoperative workup that wavefront-guided treatments require. Additionally, unlike other excimer lasers, the Allegretto Wave Eye-Q laser is able to treat high hyperopes (up to 6.00 D with 5.00 of astigmatism).

The Allegretto Wave Eye-Q operates at 400 Hz, and my average ablation time is less than 10 seconds for both myopic and hyperopic treatments. This short fixation time for patients improves the accuracy of the ablation, not to mention patients’ comfort. Furthermore, because we do not have to dilate their pupils for surgery, our Allegretto Wave patients experience an immediate postoperative wow factor. The wow factor for our hyperopic patients is slightly less than for our myopic recipients, but it is significantly better than what we had seen before we began using the Allegretto Wave laser.

OPTIMIZING HYPEROPIC OUTCOMES
We tailor our laser vision correction plans to each patient. My technicians and I conduct a complete preoperative evaluation and thoroughly educate our patients about their ocular status. Then, we inform these individuals of their surgical options and recommend the one we feel suits them best and explain why. We believe that patients want us to recommend a treatment; the decision is too complex for them.

Because many of our hyperopic laser vision correction patients are presbyopic, we routinely treat them with a form of monovision (what we call blended vision). We explain to these individuals that they will notice a dramatic increase in their near vision and will be very pleased with their reading vision immediately after surgery. We caution them that their distance vision may take maybe a little longer to stabilize; however, we have seen rates of 20/20 distance UCVA much earlier, even at day 1, with the Allegretto Wave than with other lasers. My colleagues and I conducted a study comparing the hyperopic laser vision treatments using the Allegretto Wave versus our previous laser, the LADAR4000 (Alcon Laboratories, Inc.). The percentage of our patients who achieved 20/20 UCVA on postoperative day 1 was 65% for the Allegretto Wave wavefront-optimized group compared with 20% for the LADAR4000 wavefront-guided group. Furthermore, the Allegretto Wave results continue to improve, with 84% of eyes 20/20 or better and 96% of eyes within ± 0.50 D of their intended correction at 6 months.

SUMMARY
In short, the Allegretto Wave Eye-Q laser has improved our practice’s patient flow and outcomes in both myopic and hyperopic treatments. We are able to treat a broader range of hyperopes with the wavefront-optimized profile, and their refractions stabilize faster than corrections done with other lasers. I feel that the Allegretto Wave laser has made hyperopic laser vision correction more viable for my practice.

Jason E. Stahl, MD, is in private practice at Durrie Vision in Overland Park, Kansas, and is Assistant Clinical Professor for the Department of Ophthalmology at Kansas University Medical Center in Kansas City. Dr. Stahl is a consultant for Alcon Laboratories, Inc., and is a member of the Allegretto clinical advisory board. Dr. Stahl may be reached at (913) 491-3330; jstahl@durrievision.com.

Back to top

Refractive surgeons know that their most enthusiastic patients are the ones who visit at days 1 and 10 postoperatively. These individuals are amazed with the change in their vision, and they want to tell the world what an incredible experience LASIK is. This is why I am astounded at how quickly these individuals forget their surgeon’s name. I discovered this phenomenon when my practice used to conduct weekend LASIK screenings at a high-end mall in Colorado. People who had undergone LASIK would stop by our kiosk and want their spouse, child, or friend to ask us about LASIK and be evaluated. More often than not, when we asked these visitors who had performed their surgery, they couldn’t remember! They were thrilled to recommend LASIK to others, but they were indifferent about their specific surgeon. Needless to say, this discovery was an eye-opener for the surgeons and optometrists in our practice. You need to periodically remind your patients of what a skilled surgeon you are so that they are motivated to remain loyal to your practice.

SATISFACTION DOES NOT EQUAL LOYALTY
A satisfied customer is not necessarily a loyal customer; it takes more to generate a person’s willing recommendation. According to a white paper published by Service Management Group,1 a recognized authority in measuring the customer experience for multi-unit or chain retail businesses, less than half of satisfied customers expect to return to a business, and only 30% would recommend that business to others. Thus, you need to make it easy for former patients to remember your practice when they discuss their procedure with others.

GIFTS THAT BENEFIT YOU
Many practitioners offer patients a token gift at the 1-day postoperative visit, but patients are so excited about their vision that these gifts often have limited impact and value. However, there are two items I recommend giving patients that can help remind them of the service you provided.

• 1. Vision Verification Cards Create Loyalty
  Also known as the Get Out of Jail Free Card, this item (Figure 1) proves that the person underwent refractive surgery and no longer needs visual correction to drive. It is signed by the surgeon and can be used until the patient renews his driver’s license. On the back of the card, I suggest that you type the patient’s preoperative refraction and keratometry readings, which will be essential later on when the patient is contemplating cataract surgery. Because most people keep their Vision Verification card in their wallet, it ensures that patients never forget your name or how to reach you.
  
  
• Buddy Bucks Encourage Referrals
  Provide a few Buddy Bucks to all patients at their 1-day visit. Buddy Bucks are valid for 90 days and entitle the bearer to a $100 discount off an elective procedure. Whenever a patient is asked how his surgery went, he can easily hand the inquirer a Buddy Buck. This program is extremely inexpensive to implement, simple for the staff and doctor to remember, and incredibly motivating for recipients.

LASIK AT TEN DAYS POSTOPERATIVELY
At the 10-day visit, some of the LASIK patient’s post surgical euphoria has begun to wear off, so it is important for you to keep their referral momentum alive. You also want to make sure you have lived up to the patient’s expectations. My experience in the industry has shown that patients appreciate seeing their surgeon or an optometrist at this visit. I also suggest that you personally present the patient with an attractive gift bag containing the following:

• A camisole or T-shirt that reads “Guess What I’m Not Wearing” and displays your practice’s logo. We have also used “Got LASIK” Ts to similar effect. The key to this gift is to provide something that your patients actually like and will use to promote your services. Coffee mugs and gift baskets are nice, but they never make it out of the home or office and thus fail to intrigue others to ask about LASIK. Instead, do something a little quirky and fun to stimulate interest in your practice.
• A satisfaction survey so you can truly assess how you exceeded the patient’s expectations, where you need improvement, and the practices they considered in comparison.
• A handwritten thank-you note from you (the surgeon) and perhaps your counselor.
• Business cards for all the necessary contact people in your office.

RETAINING PATIENTS' LOYALTY
When inquiring candidates tell you that a friend or family member sent them, get the referring patient’s name. At the end of each month, run a report of all the patients who referred a current surgical patient and send him or her a handwritten thank-you note with a small gift card from Starbucks, Target, Barnes & Noble, etc. In a world where simple courtesies are mostly forgotten, this small and civilized gesture creates a powerful and lasting impression about your practice.

Christoper Lasch, the noted American historian, moralist, and social critic, said, “It is the logic of consumerism that undermines the values of loyalty and permanence.” The very nature of elective vision promotes consumerism, comparison, and a quest for the new-and-improved. You must maintain a connection to your patients so that they reward your quality care by recommending you to others. A commitment to old-school civility, including good manners and a well-intentioned thank-you, will do just that.

Kay Coulson is the Founder of Elective Medical Marketing (www.electivemed.com), a consulting group based in Boulder, Colorado, that helps surgeons build their elective vision service lines. Visit www.electivemed.com for patient education and practices development tools discussed in this article. Ms. Coulson may be reached at kay@electivemed.com.

1. http://www.servicemanagement.com/default.asp, Accessed November 17, 2008. Visit here to receive your complimentary copy of “Five Things We Learned from Talking to 100 Million People.”

Back to top