Driving Refractive Surgery Volumes in IndiaLaser Refractive Surgery was first introduced in India around 1991. But even before Laser Refractive Surgery was introduced, refractive surgery pioneers like Dr. P.S.Hardia, Dr.Prakash Kankariya, Dr. Anil Bavishi, Dr. S. Bharati and Dr. Vivek Pal already had flourishingrefractive surgery practices, mainly centered around Radial Keratotomy. Laser RefractiveSurgery removed some of the skill and uncertainty surrounding RK, and in a sense, maderefractive surgery both safer and more attractive for the average ophthalmologist. Theintroduction of LASIK in 1995 by Dr. Burjor Banaji accelerated this trend. Unfortunately, theinitial cost of LASIK equipment forced a situation, where only a select group of eye surgeonscould get access to laser refractive surgery. Today, even 17 years after excimer lasers werefirst introduced to India, there are only around 250 active laser clinics in the country, and lessthan 200000 laser refractive surgeries are performed every year. When you contrast thisfigure with the more than 5 million cataract surgery procedures done every year in India, thisdoes not seem like much.This large difference between cataract and refractive surgery shows up the limited reach of refractive surgery in India today. It also highlights a great opportunity. All the demographicand epidemiological evidence suggests that refractive surgery volumes should be higher thancataract surgery volumes. The demographic cohort eligible for refractive surgery (Age group18-60) is many times larger in our country than the cohort (Age group 60+) which typicallyrequires cataract surgery. The refractive surgery cohort is also growing much faster than thecataract cohort (i.e., about 3 times more kids will turn 18 this year, than people who will turn60). While only 20% of the refractive surgery demographic group has significant refractiveerrors which need treatment, it is also true that a lot of people will never have a cataract bythe time they expire. Thus, demography cannot explain the large difference in volumes between cataract surgery and refractive surgery.Cost could be one explanation. After all, a large part of the cataract surgery volumes are performed in charitable/semi-charitable/government setups where the patient hardly pays theeconomic cost of surgery. A large part of the private cataract surgery volumes, especially inthe larger cities are performed in a reimbursement/insurance environment. All of this is nottrue of refractive surgery, where all patients must pay a fairly high price, and there are fewreimbursement options. While cost is undoubtedly part of the explanation, it is not the entireexplanation. For one, a lot of people who are eligible for refractive surgery are independentincome earners, unlike cataract surgery patients who are often either reliant on inflation cutsavings, or the graciousness of their children. Another argument militating against a purelycost based explanation is the evidence of the thriving optical industry, where the high cost of nice (and expensive) glasses, frames and contact lenses does not seem to deter consumers.One only has to go to a city mall on a Sunday evening to see a lot of consumers whootherwise have a high discretionary spend who still wear spectacles.A strong argument is accessibility. After all, there is an eye surgeon or an optical shop at practically every street corner, and patients have a lot of choice. This is hardly true of refractive surgery. There is clear evidence that cities or areas which have a high density of refractive surgery centers have a high rate of refractive surgery (Ambala has 3 laser centers,Rajkot has 5, and while both are relatively small and not-so-prosperous towns, yet all thecenters seem to do really well). Accessibility also seems to remove some of the silly myths(even amongst ophthalmologists) surrounding refractive surgery-that it is only good for unmarried girls, that presbyopic and hyperopic are not good candidates for refractive surgery,
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