By Kay Coulson
Practice Management Editor

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IS THERE A MAGIC BULLET?
LASIK has hit another rough patch. Right now, it is safe to say that unless you live in Texas, where oil money has insulated this decline, you are feeling the LASIK pinch. Refractive practices report that their leads are down 25% to 50%, and some say they are doing 30% to 40% fewer procedures than last year. Yet, even in this environment, some practices are thriving. How? What are they doing? Can you replicate their success? Where will you find your LASIK magic bullet?

STRATEGIES THAT WORK NOW
First let me say, there is no LASIK magic bullet! Let's face it — if the answer really was customized procedures or bladeless techniques or surgeon experience or interest-free financing, we would have seen some industry growth over the last 10 years. LASIK success comes from doing a lot of little things extraordinarily well. So, even though your inbox is clogged with webinars, seminars, and boot camps offering the magic formula for LASIK growth, be wary. I personally do not see market data that supports the idea of spending our way out of this economic downturn. Our margins are simply too thin. Second-quarter results from the nation's largest corporate LASIK provider proved that increased marketing did not grow procedures.

This company's volume fell 38%, it reported a net loss for the quarter, and it cut its marketing spending by 45% going forward.¹ This doesn't mirror the 2001 slump, when people had money but felt guilty spending it. Today, they simply don't have it. You can spend marketing dollars to extend patients' financing, you can slash fees, or you can offer gimmicky promotions — but will anyone respond? I would rather see providers scale back the noise and simply do a better job with every person who contacts their practices about LASIK going forward, because those individuals really want LASIK, regardless of fees and financing. Let's concentrate on capturing every single one of those folks and giving them such extraordinary vision that they can't help but tell everyone else they know.

There are two actions that will make a permanent, direct, profound effect on your LASIK volume:

• Deliver extraordinary vision results — every eye, every time.
• Make the patient feel involved, nurtured, and special while you're doing it.

Many of you will read these bullets and say, "But I already do that!" Respectfully, I maintain that you don't. You make excuses for why you can't deliver 20/20 vision, or more importantly, patient-preferred vision. You make excuses for why you can't deliver an extraordinary experience every single day to every single person. These self-defeating habits are what need adjusting. The practices that do expect exact results every time, and provide an extraordinary experience in the process, are thriving.

COMMENTS WELCOME
I look forward to your thoughts, comments, and opinions about this column over the coming year. I'd love to hear what you have to say about today's LASIK challenges. Stay tuned, stay positive, and stay motivated. We'll help you smooth this wild LASIK ride.

Kay Coulson is founder of Elective Medical Marketing, a consulting group based in Boulder, Colorado, that helps surgeons grow their elective vision service lines. Ms. Coulson may be reached at kay@electivemed.com.

1. LCA-Vision Inc. Q2 2008 earnings call transcript. Seeking Alpha Web site. July 30, 2008. http://seekingalpha.com/article/87997-lca-vision-inc-q2-2008-earnings-call-transcript.
Accessed August 5, 2008.

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I tell my staff that when patients visit our clinic for the first time, there are three things that prevent them from immediately signing up to undergo laser vision correction: number one is fear, number 2 is fear, and number 3 is fear. All the others are secondary. This is the primary lesson I have learned in my years as a practitioner.

People fear blindness; the thought of losing one's eyesight is paralyzing. Therefore, the most important objective for my staff and I is to overcome patients' fear barrier about the risk of laser vision correction harming their eyesight. We address this issue by making patients as comfortable as possible from the moment they step foot in our clinic. Because many of my staff and I have been on both sides of the laser, we strive to give our patients the kind of experience we would want. We begin by trying to make our office very nonthreatening. We do not have a waiting room; we have a reception area. We avoid any décor that looks medical. We do not wear white coats, and we only wear scrubs on the days we do procedures. We change back in to our normal office attire when we are finished with procedures, and we always wear this attire during consultations with new patients. When a patient first visits the office, we do not immediately rush him into a preoperative examination. We give him a tour of the office, beginning with our 400-Hz Alcon Allegretto Wave^® Eye-Q (Alcon Laboratories, Inc., Fort Worth, TX) laser and describe how quickly and safely it works.

FEAR OF PRICE
Although the current economy is making all consumers cost-conscious, I find that the issue of price takes a back seat to results, technology, and experience in laser vision correction. If you needed brain surgery, you would not choose the cheapest neurosurgeon, and people are equally protective of their eyesight. We convey to patients that we invest in providing the best technology, and we stress the safety and efficacy profiles of the Allegretto Wave laser. We do not hesitate to refer them to the FDA's web site for comparative data on excimer lasers.

THE CONSULTATION
When patients are ready to sit down for a consultation, we take the time to talk with them at length and answer their questions completely. We let them know that most of the office's staff have undergone the procedure, including myself, and so we identify with many of the thoughts and fears they are having. This level of care usually diffuses any combativeness that patients show due to fear, and we are able to establish a friendly relationship with them.

As part of the preoperative consultation, we show a 15-minute in-house video that describes the history and advantages of laser vision technology. It details how the Allegretto Wave laser was built from the ground up using wavefront principles, and that its optical engineers designed the laser to maintain the cornea's curvature as much as possible for a safer and more precise outcome. We tell them that the Allegretto's FDA approval was the first ever to show decreased halos, and glare and increased night vision. Patients are very receptive of this information. Also, because so many patients today are Internet-savvy, they have often read about our technology on our practice's web site (www.texaslasik.com) prior to their visit. They are always impressed by our 1% enhancement rate versus those with other laser platforms.

Because we want patients to have all their questions answered before their surgical visit, we encourage them to bring a family member or friend with them to their consultation. Having someone there with them helps patients relax, and that person often helps the patient remember questions to ask and the answers we have provided.

DAY OF SURGERY
On patients' surgical day, the most important thing we do to ease their jitters is describe what they are going to experience. We tell patients we are going to give them a little Valium to help them relax, and that they will be in the laser suite for only about 10 minutes. They are usually surprised to learn that most of the 10 minutes is for preparation, and that the actual duration of the ablation will be 10 seconds or less, on average. That single fact alleviates a lot of fear, since most people feel confident that they can keep their eyes fixated for at least a few seconds. It is a much more manageable length of time than the 1 to 3 minutes that older laser technologies required.

A staff member escorts our patients into the laser suite and holds their hand during the actual procedure. After the surgery, we ask patients to keep their eyes closed as much as possible for the first 4 post-operative hours. After this period, I personally call my patients to reassure them and answer any final questions. My staff and I always review their medications and post-operative instructions at the day 1, week 1, and month 1 visits. We also have all of our post-operative instructions available on our web site.

Charles Moore, MD, is the Founder and Medical Director of International EyeCare in Houston, Texas. He is the National Medical Monitor for Alcon. Dr. Moore may be reached at (713) 984-9777; crm@texaslasik.com.

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