With advancements in technology and a growing patient demand for spectacle independence, refractive surgeries offer a valuable opportunity to expand ophthalmic practice, enhance patient satisfaction, and improve profitability. However, successfully integrating these procedures requires a structured approach that prioritizes clinical expertise, patient education, technological advancements, and strategic growth.

A Growing Demand

In 2010, according to a World Health Organization (WHO) report, 285 million people worldwide were visually impaired; of these, 39 million were classified as blind. At that time, the leading causes of visual impairment were uncorrected refractive error (42%) and cataracts (33%). Less than a decade later, in 2019, WHO reported that 2.2 billion people globally were visually impaired, with 1 billion cases being preventable or untreated.

Given these numbers, it is striking that while cataract surgery is well-integrated into most ophthalmology practices, refractive surgery still lags behind in accessibility and adoption. This disparity highlights the need to integrate refractive procedures more effectively within ophthalmic practice, ensuring better visual outcomes for patients while expanding treatment options for surgeons.

The demand for refractive surgery is increasing, driven by multiple factors that include advancements in technology, increased patient awareness, more active lifestyles, and greater financial accessibility. A growing number of patients across all age groups—young individuals, middle-aged people with presbyopia, and seniors in the cataract age group—are actively seeking vision-correction options to reduce their dependence on glasses or contact lenses. With higher disposable incomes, improved surgical outcomes, and broader insurance coverage, refractive surgery is no longer viewed as a luxury but rather as an essential enhancement to quality of life. Ophthalmologists who recognize this shift and adapt accordingly will be well-positioned to meet this growing demand.

A Successful Refractive Surgery Practice

Investing in training, technological precision, and patient-centered care ensures that refractive surgery evolves beyond a niche offering into an integral part of modern ophthalmic practice. Continuous education on everything from basics to the latest advancements is a must for surgeons and staff.

Bridging the Gap in Training

To position refractive surgery effectively—globally and within private practices—comprehensive training for both young and established ophthalmologists is essential. There is a huge, ongoing need for training in refractive surgery, especially with the constantly increasing advancements and new technology that is exploding in this field. Refractive surgery encompasses both cornea-based and lens-based procedures. While cataract surgery is thoroughly covered in ophthalmology residency programs, training in refractive cornea and lens-based surgeries remains inadequate. Even after a technically excellent cataract surgery, patients may experience suboptimal uncorrected visual acuity for distance and/or near vision. Although ocular pathology may be a contributing factor in some cases, the primary reason for this outcome is a lack of awareness and less importance attributed to achieving minimal to zero dependence on corrective lenses by both surgeons and patients.

Investing in Technology

Updating oneself on newer advancements and technologies in laser vision correction (LVC) techniques, lens-based refractive procedures, intraocular lens (IOL) options, presbyopia management strategies, therapeutic refractive surgery (such as topography- or wavefront-guided PRK/PTK), and advanced, yet easy-to-perform treatments for keratoconus (such as corneal allogeneic intrastromal ring segments, or CAIRS) can provide tremendous value-add to the practice. Being aware of all options—and having the skills to match a patient to the most suitable of those options—increases patient confidence, yields better results, and gives one’s refractive practice a stronger position in the market.

Patient confidence grows by leaps and bounds when they realize that they are in the hands of a knowledgeable, skilled, and well-versed surgeon with a good practice system in place. With the exploding myopia epidemic, these skills become even more critical. Ophthalmologists must be equipped to guide patients toward safe and effective surgical solutions that offer optimal visual outcomes.

Optimizing Procedure Selection

Establishing a thriving refractive surgery practice requires a multifaceted approach. Success does not come from offering a single procedure for a one-size-fits-all strategy. Instead, surgical choices should be tailored to each individual patient rather than dictated by a surgeon’s familiarity or available technology. The decision between LVC and phakic IOLs or refractive lens exchange (RLE) should be based on objective patient factors rather than on the surgeon’s default preference. Delivering customized, safe, and effective solutions leads to satisfied patients who naturally become advocates for your practice.

Optimizing Patient Selection

Among refractive procedures, careful patient selection is key. Different patients have different needs, and cases involving extreme refractive errors, borderline eligibility, or coexisting pathologies should be handled with caution. Every patient must be counselled carefully and realistic expectations should be established. Those with unrealistic expectations or demands should clearly comprehend and accept the possible outcomes of refractive surgery. If they do not, surgery should be removed as an option to prevent a post-operative mismatch between patient expectations and visual outcomes. Clear communication of benefits and risks is therefore a must for establishing a trusted and reputable practice.

Building Infrastructure

A good refractive infrastructure should be built with all essential diagnostic and therapeutic requirements. Different platforms for femtosecond lasers, excimer lasers, aberrometry, wavefront-guided systems, phacoemulsification machines, dry eye evaluation, IOL calculators, advanced imaging systems, etc., should be evaluated and put in place. In cases where financial constraints prevent a single practice from investing in a full setup, collaborative partnerships with nearby clinics can allow shared access to key equipment, reducing capital expenditure while maintaining high standards of care.

Optimizing Workflow Efficiency

The entire patient journey—from initial appointment-setting to post-operative visits—must be simple, void of stress, and time-efficient. Streamlined diagnostic pathways for refractive surgery candidates helps facilitate the process for patients and staff while optimizing workflow efficiency. Comprehensive pre-, intra- and post-operative care protocols should be established and adhered to for optimal safety. Staffing models should support pre- and post-operative care effectively.

Assembling a Winning Team

A high-performing team plays a crucial role in the success and reputation of a refractive surgery practice. Knowledgeable and friendly staff who address patients’ concerns inspire confidence and create a welcoming environment. Optometrists skilled in refraction, scanning, and pre-operative evaluations ensure accurate data collection. Laser technicians and biomedical engineers who maintain equipment and ensure a highly reliable and well-functioning refractive suite contribute to reliable surgical outcomes. Well-trained operating room staff who understand both surgical workflows and the surgeon’s specific techniques further enhance procedural efficiency. Ensuring a high-quality operating environment with a well-equipped microscope and immediate access to necessary adjunct devices adds significant value to the overall practice.

Establishing essential referral networks for managing complications or ensuring continued post-operative care for out-of-town patients is crucial. This not only reinforces patient confidence in the surgeon’s ongoing involvement but also ensures they receive the highest standard of care.

Understanding Market Trends

Brand Positioning

Implementing the right marketing strategies ensures targeted outreach to the appropriate audience. It is important to emphasize safety, precision, and patient outcomes of refractive surgery while also addressing common myths and misconceptions.

The economic, personal, and professional benefits of refractive surgery for patients is huge. Glasses create inconvenience and limits to usage. Contact lenses can provide good vision, but they also bring inconvenience, limited usage, and risks associated with daily wear (which is less than the one-time risk of undergoing refractive surgery). Along with the significant expenditure of having to frequently replace glasses and contact lenses, these disadvantages give patients incentive for undergoing refractive surgery—which has high satisfaction rates and excellent safety and efficacy records.

Marketing Channels

Hiring professional experts to leverage print, broadcast, and online marketing to engage prospective patients is essential for practice growth and brand building. This includes developing educational content like testimonials, blogs, and videos, and engaging with local communities through partnerships and seminars. Sharing referrals and reviews from satisfied patients and building co-management relationships with optometrists can all help in positively positioning and growing your practice. Let happy patients be your biggest advocates.

Specialized Services

In competitive markets, distinguishing a practice through specialized services is essential. Offering pre-surgery insurance options, enhanced intraoperative care, post-operative packages, and exclusive deals on follow-up care can enhance patient experience and satisfaction. Financial planning and pricing models should balance patient affordability with practice growth and profitability. Transparent pricing, comprehensive all-inclusive packages, and flexible payment plans improve accessibility to surgery. Additionally, insurance and financing partnerships can make refractive procedures more affordable, effectively addressing the challenges of elective surgery costs.

Measuring Success

Tracking patient outcomes is essential. A robust monitoring and feedback system should be in place to continuously assess visual results and patient satisfaction. Regular evaluation of these metrics ensures quality improvement, and constructive patient feedback can help refine practices for better overall care.

Adapting to Market Changes

Finally, staying up to date with emerging technologies, industry trends, and local market developments while continuously refining marketing strategies and maintaining competitive positioning is essential for maintaining growth and excellence in a refractive surgery practice.

Conclusion

Establishing a successful refractive practice requires continuous learning, staying current with technological advancements, upholding high safety and efficacy standards, and creating a seamless, patient-friendly experience. Offering specialized services, leveraging diverse marketing strategies, implementing flexible financial options, and maintaining a robust feedback system are all essential for sustained growth and excellence. OM 

Soosan Jacob, MS, FRCS, DNB, is director and chief of Dr. Agarwals Refractive and Cornea Foundation; senior consultant in cataract and glaucoma services at Dr. Agarwals Group of Eye Hospitals in Chennai, India; and president-elect and secretary of the International Society of Refractive Surgery. She is internationally recognized for her innovative techniques in refractive surgery, keratoconus management, complex cataracts, and advanced corneal procedures.