Presbyopia – How to embrace the biggest laser eye surgery market in the world

Why laser eye surgeons should embrace presbyopic laser eye surgery

The presbyopic market. Some consider it unsuitable for laser refractive surgery, preferring more traditional options like refractive lens exchange and corneal inlays. Other consider it the future of laser eye surgery, and I count myself in the latter camp.
So what’s the truth? Should refractive surgeons consider the presbyopic market in the laser eye surgery marketing mix? Or should they leave this market to at worst, reading glasses and at best, intraocular surgery? In this video (and the transcript below), I argue the case for complementing your practice marketing efforts by offering presbyopic LASIK. I won’t comment on the medical advantages or disadvantages of either approach. There are many more qualified voices from whom to seek counsel on that subject. What I will do, however, is share my views from a marketing perspective. Agree or disagree? I welcome your comments below.

In this video, you’ll learn

  • Why the presbyopic market is too big for laser eye surgeons to ignore
  • How laser eye surgery markets differ from each other
  • How marketing approaches must vary to attract different patients


Hi, I’m Rod Solar from LiveseySolar Practice Builders, and today I’m here to talk to you about Presbyopia, the market for Presbyopic correction, precisely how you can win from the most significant laser eye surgery market in the world.

I gave this talk in Lisbon at the ESCRS 2017 back in September and, got excellent responses. People felt it was very informative and something that they can take away from to look at expanding their practice and offering a broader portfolio of services to enlarge their laser eye surgery market.

So this talk would be very similar to what I gave in Lisbon, so if you were there, this would be a great review.

If you were not there, then this is an excellent opportunity to take advantage of watching the whole segment, which I believe is going to be about an hour long. (Ed note: It turns out to be an hour and a half.) 

I hope you do stick with me. It’s a fascinating talk, and I think it will help you rethink perhaps how you market your business in laser refractive surgery. So let’s begin.


An Introduction to LiveseySolar (aka “why listen to us about the laser eye surgery market?”)

So first is just a little introduction to us. We’re LiveseySolar. Obviously, if you’re on this website you probably know a bit about who we are, but just very, very briefly we’ve been healthcare marketing specialists focussing on growing refractive healthcare businesses for quite a while.

We got our start back in 1997 and had been working in the field since that time. Now, we’ve worked with lots and lots of different clinics, hospital groups and independent surgeons operating out of separate facilities.

Our expertise ranges in the UK, all over Europe, Canada, the US and also UAE and various other countries in the Middle East as well.

So we’ve got an excellent proposition for our clients where mostly what we do is we assess their business, and if it’s likely to do so we’ll offer them an opportunity to grow their business within three months, and that can be extremely beneficial especially since many companies are plateauing.

Laser refractive businesses; once they’ve grown to a certain level, they more or less stay flat for quite a bit of time. There are some macro reasons for that which I’ll get into today in this talk, but also there are some ways of getting out of that rut, some of which we’ll also talk about in this talk as well.

Our clients in the laser eye surgery market

Here’s a brief overview of our client list. These are clients that we have worked for in the past and with whom we also currently work.

I just want to bring your attention to first of all the vast majority of these clients are in Ophthalmology. We even do some work in Plastic Surgery, Cosmetic Surgery, Dental Surgery.

Essentially the binding thread if you will that connects all of these is that they’re offering elective surgical procedures at high investment prices.

So, we work with all sorts of pricing in the laser eye surgery market. However, the companies that tend to do best with us are those that offer more premium or sub-premium pricing.

The reason for that is because they have a great interest in competing against low price providers and usually they can use our services to help them compete, help them sell better and help them get more people to choose them instead of their low price competitors.


I want to bring your attention first of all to one of the companies here at the top left-hand corner of the video which is ZEISS.

ZEISS has asked us to become their professional development consultant for their customers in Europe and so we’re working with them on specific pilot projects to build practices and clinics that own and operate ZEISS laser, specifically in the area of Presbyopia.

So it goes without saying that because they’re a client of ours some of the things that I will talk about today may… Well, they’re very similar to the kinds of things that ZEISS markets, so I wanted to bring to light – that potential conflict – regarding the advice that I give.

However, you can use the advice that I provide in this talk with any surgical procedure associated with the Presbyopic community, Gen X-ers, Baby Boomers and beyond. It doesn’t have to be ZEISS products, but that is an area that we’re working in and know a lot about.

I also want to bring your attention to Optegra and that I wanted to say we got a lot of experience with Optegra by working with their call centre and increasing their conversion rates from roughly about 24% upwards to about 50%. As you can imagine, that change in conversion rate doubles the business.

So we’re very, very happy with our multi-year association with Optegra and the kind of results that we achieved there. But the reason I bring them to the fore at this moment is that their market is mainly composed of folks who are Presbyopic.

Optegra focusses on offering and marketing a service called Clarivu. Clarivu is their brand name for what is effectively a refractive lens exchange procedure. I don’t need to tell you all about what that is, but mostly their primary market is folks with reading glasses, varifocals, bifocals and those who’ve perhaps tried monovision contact lenses, and monovision laser.


So the upshot of that is that I had an opportunity to listen to recorded calls from thousands of customers and enquiries who had these problems and I heard a lot of their, descriptions and how they talk about their issues.

I learnt a lot of information about how they conceive and perceive their problem. And it’s entirely different from the typical problem that you might be more familiar with which is your basic myopia, hyperopia and astigmatism that you get from patients seeking laser refractive surgery, those who are 45 and under.

There was a great deal of difference and variety that we experience there especially for people who were looking at getting their vision corrected for the Presbyopia and also considering a lens based procedure where a surgeon would go into their eye, remove the existing lens and replace it with an artificial lens.

That, as you can imagine, is a slightly different conversation than what is the kind of conversation that might you might have with somebody seeking laser eye surgery which is considered safe and quite effective and whose risk profile is considerably smaller.


We are not talking about patients here who are interested in cataract surgery who have the choice to either have an intraocular lens procedure or go blind or substantially lose their vision until at such point they, can’t operate.

We’re talking about people who have a choice, and this is an entirely elective procedure for Presbyopes, and they have a solution that’s relatively cheap in many cases and easy to acquire.

So we’re talking about a different kind of mindset, and that’s where I’ve got a lot of experience in understanding how to convert these individuals, so I bring a lot of that experience forward to help my clients today when dealing with all types of Presbyopic patients.

I also want to bring your attention to London Vision Clinic. London Vision Clinic is another client who we’ve had a relationship with since 2002 and these folks were the pioneers behind the introduction of what they called laser blended vision – which eventually became PRESBYOND®. Many people still call it laser blended vision.

Working with ZEISS, they developed the procedure, a laser refractive procedure that accomplished an ability to blend the distances to create a blend zone between the near vision and the distance vision which has a considerably higher tolerance rate than monovision. The procedure also has a tremendous adoption rate here in London for London Vision Clinic, now at least half of their patients are adopting laser blended vision for their choice.

It’s a procedure that’s been around for quite some time. It’s had a lot of testing, and it’s now being rolled out throughout Europe and Zeiss is looking into rolling it out in Asia as well, and it’s pending approval in the US.


So we’re looking at an enormous laser eye surgery market opening up, and we believe that this, in fact, could be the future of the laser eye surgery market.

That may sound like a bit of a bold statement especially considering that these days most of the people that you’re talking to, if you are a laser eye surgeon, are Millennials and now you’re being bombarded with messages from consultants telling you how to market to Millennials.

I’m not going to say that that’s a bad idea. I think that’s a brilliant idea. I think you need to understand how to market to Millennials better. At the same time, we need to consider not throwing out the baby with the bath water. We should also consider the fact that all the learning that we’ve developed over the years of talking to Baby Boomers and Gen X-ers – well, we’ve got to just slightly modify that but still include that in our patient mix if we want to grow dramatically beyond the Millennial population. The Millennial population has its inherent issues and the issues that I’m going to get into today involve two main things:

Number one is population, and number two is discretionary income.

Both of those issues – I’ll get into specifics around Europe – but the kinds of issues I’m talking about here in Europe are in fact only worse in the United States and Canada. That is especially true when it comes to discretionary income and perhaps potentially less intense in Asia, but these are areas where we still have to look into and still have to study.

But, we certainly know that if as a laser refractive surgeon you’re intending on basing your entire future on a laser eye surgery market that is smaller than the Gen X-ers and Baby Boomers combined and also has much less money regarding discretionary income you might have a tough go at it concerning growth.

Many practices that I’ve spoken to have experienced exactly this. They’ve noticed that laser eye surgery has never quite recovered from the boom years of the mid-2000s.

Many people expect that a business would grow and grow and grow over time as more patients get out there and talk about it, adoption increases and more friends and family come to your clinic; what we see instead is we see a flat line in the adoption of the procedure, so that’s industry-wide.

Of course, there are some bright spots where specific clinics will break that mould, and we help them to do that. However the vast majority of clinics out there are finding that they just can’t seem to grow those procedure numbers year by year.

And I am one of the few people advising the industry who has pointed out that perhaps there’s an issue with the Millennial laser eye surgery market in the sense that maybe they can’t afford what we’re offering. Anyway, I’m sure that opinion will be more common in the future as people begin to see the stats, but we’ll get into the details of that as we go.


This is our footprint with regards to where our clients are located. As you can see we’ve got quite a wide degree of experience, quite a wide range of experience in the laser eye surgery market across Europe, the Middle East and the Americas and the majority of our experience is in locations around the United Kingdom where we have focussed mainly over the last 20 years.

So let’s get into the talk itself.

NOTE: The best way to answer that nagging question about practice growth or marketing or patient volume in the back of your mind is to book a free 15-minute compatibility call. Get some options and go away with a clear idea of what’s possible.

What’s this talk about?

Well, I’ve already talked about why the Presbyopic laser eye surgery market is too big and too rich for laser refractive surgeons to ignore and I’ll get into the particular reasons for that,

  • how laser eye surgery markets differ from each other,
  • how they differ with regards to the channels where they get their information and therefore their advertising,
  • how they differ to the marketing message that they respond to, how they differ with the kind of interactions that they want to have with doctors,
  • how they differ with the way that they approach large investments and payments,
  • who pays, who decides and
  • How they differ with regards to who they involve in the decision-making process.


There are lots to discuss concerning how they differ. It goes well beyond Millennials prefer text messages, and Baby Boomers prefer email. That is true, but it goes well, well beyond those simple differences that you’ve probably heard about so far and we’ll get into some of those as we go.

How marketing approaches must vary to attract different patients is also a subject of this talk. We’ll get into a specific breakdown of the types of tactics that work for not only Millennials of which we hear so much about but also Gen X-ers and Baby Boomers and also Traditionalists.

We’ll also discuss how many of you are going to have to start leaving behind some of the tried and tested and – quite frankly – dying approaches to marketing that was the traditional fare and replace it depending on who your laser eye surgery market is. You’ll replace it with either the kinds of channels and media that Baby Boomers and Gen X-ers enjoy or the kinds of channels that Millennials tend to live in.


It’s up to you regarding which laser eye surgery market you go for. My advice is to go for a broader mix and to expand your business by offering different products for different groups. But what that invites is this whole discussion that is I think new to laser refractive surgery, which is the concept of market segmentation and also differentiating one’s approach with one’s tactics to appeal to those different segments of the market. But I’ll get into that as we go.

The Presbyopic opportunity

Let’s first talk about the Presbyopic opportunity.

Many of you will know this information because you’ve been dealing with Presbyopes for a very long time, but perhaps it’s useful to try to compare it with the typical laser eye surgery market.

The size of the presbyopic laser eye surgery market

Let’s talk about the size first of all.

The estimate of this population range between 1.3 to 1.8 billion people worldwide. As you can imagine, that’s an enormous number.

Of course, not all of those people can afford laser eye surgery. That’s not what we’re talking about, but we are talking about a tremendous number of potential patients that could. Just the ones who can afford it could turn this whole thing around.

It could be a sea change with regards to how we look at the typical and the average laser eye surgery patient.

If we only can reach them and offer them something that works – and I believe now we have both. So this is the big group we’re talking about here.


From the European perspective which is what we know best – two out of every five Europeans today are already Presbyopic. I consider myself among those folks. I started wearing glasses about one and a half years ago for my close up vision, and I believe that this might have an impact regarding why I’ve become very interested in this space.

Of course, I’ve worked with lots of clinics who have focussed on Presbyopes and serving them as a primary target laser eye surgery market, but there’s nothing quite like having the problem yourself.

I’ve never worn glasses before. It’s the first time I’ve ever needed these. I have about four pairs, a couple of +1, a couple of +1 1/2 for the night time reading and also, you know, whenever I need to kind of look at something that’s smaller like reading a novel for example.

And I’m finding them tolerable however there are moments when I feel very much like I would rather not have them, and I’m not alone.

In fact, I’ve already seen my Generation X friends who are older than I am – and those who are Baby Boomers -complaining on Facebook and elsewhere about their surprise that they now need reading glasses – and that’s the nice term they use for them.

I don’t know why they’re surprised. I mean, I’ve known for many, many years that this was coming. I suppose it’s because I’m in the industry. But for many of them, it’s a total shock, and it is also one of the first signs, especially among those of us who are healthy and active, that we’re ageing – that we are getting older and that time applies to us.

We feel like we’re in our 30s – most of us, those of us who exercise, those of us who eat well, those of us who get out and have, you know, active relationships – we feel like we’re in our 30s.

They keep saying 40s is the new 30s and that 50s are the new 40s. However, there is a biological change that takes place that despite all our psychological adaptations we just simply can’t get around. At least not yet. So this is a huge, huge surprise to many and a big shock to some.


Demographic aspects

Let’s talk a little bit about the different demographics now just so we get a level set on the types of folks that we’re talking about and who they are, just so that we’re clear on the generations that we’re talking about.

So, first of all, there are four generations that we hear most about, there are in fact five. There’s another one coming up just behind Millennials which we won’t talk about at the moment because they’re nowhere near the age at which time they become consumers and specifically laser eye surgery patients. So let’s talk a little bit about the different types.

We have Millennials of which many of you know. Generation Y is also another word for Millennials. That’s Y by the way, not the question why.

We then have Generation X – and the reason they call it Generation Y is that it follows X. Generation X was a term developed by one of my… I don’t know him, but he was one of the folks that I grew up with. His name was Douglas Coupland, and he wrote a book called Generation X which termed the word and coined the phrase. It’s probably his biggest claim to fame. He was a Vancouver novelist and wrote a book called Generation X. And the idea is he couldn’t easily identify where this generation stood – “Who were these people who came after the Baby Boomers?” and that’s where they got their name.


Baby Boomers, of course, come from the idea of the boom that followed the tremendous increase in birth rate that occurred after World War II and these folks born after 1945 all make up that group.

They were the largest boom of babies to be born at any one time, and this had a lot to do with soldiers returning from the second World War and deciding “Okay, life is short, let’s make babies!” and there we go. And many Generation X-ers are children of the early Baby Boomers.

For example, my parents are Baby Boomers and Millennials are children of the youngest Baby Boomers and in some cases are also older Generation X-ers.

We also have some Generation X-ers who are children of Traditionalists as well. Families were much larger in the past and women had children over a longer period because they didn’t go and get into careers of their own so much.

Traditionalists are the folks who were born before 1945, before the war and we see the war as a huge turning point for many, many reasons I won’t get into. This isn’t a history lesson although I do give a course on identifying and marketing to the four generations which I encourage you to look at if you’re interested.

Let’s define the years of birth – just for reference.

Millennials are 1980 to 2000, and just before I get too far into the dates of birth here, there’s disagreement among demographers, it’s just how it works. Also, there’s a good reason for that because Millennials might be slightly at a different starting point regarding the commonalities that they share, depending on where they grew up.

You know, history doesn’t happen at the same pace in every place, and different countries will have different generational starts and stops, and it’s simply because different countries are at different levels of development with different levels of technology adoption.

But generally speaking, Millennials are born between 1980 and 2000.

Generation X-ers were born between 1965 and 1979. I’m in that generation, and I was born in 1971.

Baby Boomers were born 1946 to 1964, so these were the hippies. These were the folks who grew up in the 70s and the 60s and were the first sort of generation that set the tone for the rest of us as, what’s the word, homo-consumerist if you like as opposed to homo sapiens.

So off they went, and we followed in large part in their footsteps however Millennials aren’t quite following in the same footsteps.


Traditionalists were born 1945 and before, and these are folks who experienced I would suggest the most change. There has never been a time in history where change has been more rapid and more extreme than what the Traditionalists have experienced over the last 80 years.

So there we have it. Those are the generations, and they’re very different.

Obviously there are Millennials, especially on the cusp, who act more like Generation X-ers. There are Generation X-ers who act more like Millennials and so on and so forth. Again these are not hard solid lines; they are more lines that are characterised as shades of grey if you like.

The age in 2017 – at which time I’m giving this talk – this is a handy reference for you if it’s a little easier to think about them this way.

They’re 17-year-olds to 37-year-olds for Millennials. Now as you can imagine there’s a significant difference between a 17-year-old and a 37-year-old in most normal cases and that’s why we can’t necessarily look at all Millennials as all the same, just like we can’t look at Generation X-ers as all the same.

And I would say Millennials there’s probably, even more, differentiation because we all know that between 17 and 37 we do quite a bit of growing up and big life decisions are significant in that phase. Whereas between 38 and 52 there’s perhaps a little less variability, but, there’s still some variability. Baby Boomers are 53 to 71 at the moment, and then Traditionalists are 72 and older, so that’s just for reference.


The EU population of the 28 countries that currently compose the EU, we’ve done the math here, and we’ve identified that Millennials are roughly 132 million in number. Generation X is 110 million, so they’re the smaller group. Baby Boomers are 122 million.

There are more Baby Boomers but Baby Boomers being 53 and 71 have a higher chance of dying than Millennials do, so you see their numbers decline.

And Traditionalists are 68 million, close to 69 when you round it up.

Now, one immediately would look at this, and would conclude that Millennials are the biggest demographic and therefore we must target them if we want to have the best chance of succeeding.

But I want to alert you to the fact that when you take 110 million and 122 million and add those together, it doesn’t take a math genius to figure out that those numbers are considerably higher than the 132 million we have with Millennials. I’ll be getting back to that very key statistic as we go throughout the programme.


Income is another very important statistic. Now, much has been made of the idea that Millennials have fewer opportunities economically than generations that precede them and that’s entirely true, and there are many reasons for this.

Millennials have higher debt loads, by and large, especially those Millennials who had to pay for education. Now I know in Europe in many cases education is paid for by the state, however in the UK they introduced paid education many years ago, and we see a considerable debt load among Millennials in the UK, which leads of course to intergenerational inequality.

We also see that in the US there is considerably more debt load because they’ve had the system of having to pay for their education – which is much more expensive as well – for many, many years now. The same thing goes for Canada.

So Millennials have a huge debt load, and that doesn’t affect their income of course. But it does affect a Millennial’s discretionary income, and that’s the money, the subset of one’s income that goes towards discretionary expenses. Discretionary expenses which include things that have nothing to do with households, you know, and food, the basics of life, but rather the things that one wants to do when one has a little extra money – like laser eye surgery.

So we have this issue here with Millennials who have less income, their wages have not increased dramatically over the last 40 years. They remain fairly stagnant. And Millennials also got into the workforce at a time that was probably one of the worst economic downturns in our history.

So we have some serious issues surrounding the economic power; the spending power of Millennials. So this is going to play a part, and we have to be conscious of that especially when considering offering products to them. Do we either reduce our prices which is something we don’t want to do, do we? Or, do we look at expanding our laser eye surgery markets and pricing somewhat differently so that we can bring our overall average price up and then market something to Generation X and Baby Boomers who can afford it.


So let’s get into Generation X. At the moment we have 27468 (euros) as their average mean income. Again these are all Euros because we’re talking about European statistics. That’s a significant jump. We’re talking about almost €5,000 there.

And then a little higher up there are Baby Boomers. So at least in Europe Generation X-ers are doing almost as well as Baby Boomers. That’s not so much the case elsewhere, but certainly, here in Europe, we see that similarity.

And there might be a correlation between the amount of social state involvement in the sense that we don’t have to pay for a lot of things and didn’t have to pay for a lot of things that the state covers, one of those things being primary healthcare. Across Europe, it’s pretty much socialised medicine, so that reduces the number of expenses we have to make, but it doesn’t affect our income.

One of the big issues around Generation X and Millennials in the US and Canada is that they got into the workforce on mass because what we’re talking about here they’re the children of Baby Boomers. So what they did is this: Millennials and Generation X-ers created an over-supply of labour which ended up encouraging companies to hire them at lower and lower rates, and this is one reason why wages haven’t kept up with inflation.

So we have some serious intergenerational inequality issues that we can’t, unfortunately, wait to address. That’s for governments to address. We have to adapt to these changes. Of course, you know, your vote is your own but I think I’d know what I’d be thinking about regarding what works for all of us is to get more equality among these generations as opposed to less.


Baby Boomers, they were among the richest generation in history and not only are they making higher amounts of mean income, but they’re also probably the ones who have the most wealth.

So they don’t need to just go to what they’re getting paid for on a regular basis to find their discretionary income. They have something called savings which is really quite a foreign concept to those of us who are younger. Savings isn’t something that many Millennials have to speak of.

There’s this myth that the old and grey are poor and destitute. That is an outdated myth that is not borne by the statistics. As you can see Traditionalists are earning, in fact, the most and one of the major reasons for this is the fact that pensions just simply have not eroded. Instead, pensions have been very well protected.

One of the things we know about voting statistics is that folks over 70 are some of our most politically active voters. They’re going to go out there, and they’re going to vote for governments who are going to keep their pensions, their social security, and their benefits intact.

And if we look at government spending we typically see, especially when it comes to healthcare, we see a tremendous amount of or a much larger fraction of spending oriented towards the older voter than the younger voter and the main reason for that is because younger voters don’t vote so much.

So that’s a lesson for some of you there, but the idea here is that yes Traditionalists have managed to maintain a lot of their wealth and maintain their mean income. So, yes, they’re doing okay.


In fact, I read a statistic recently that in Canada the average Traditionalists is nine times more wealthy than the average Millennial. So let that sink in for a moment. Especially next time they say or you hear a Traditionalist say to you, you know back in my day we could have houses. Well, there’s a good reason for that Gramps.

So yes we have a couple of disparities here that either is going to have to be addressed or we’re going to see some serious challenges for certain businesses who focus entirely on Millennials, a.k.a. all laser eye surgeons today.

When it comes to myopia, we see an upward trend as we age. There’s no surprise here. The statistics for this, by the way, are down below in the references. This also includes data from all over, not just Europe but also Asia.

Hyperopic incidence also rises as we age, so we got a bit of complexity surrounding the Baby Boomers as well, especially for those laser refractive surgeons who currently don’t touch hyperopes, which I hope changes as well. I mean it’s just a question of skill, and technology, and that intersection of practice will allow you to expand your treatment areas to have the confidence to treat hyperopes as well. We’ve seen many, many hyperopes very happy as a result of their surgery.


Now we come to Presbyopic patients. Now, of course, we have zero percent incidents among Millennials and around the age of 40, this is no news to you. I know I’m speaking to those who know a lot more about this than I do, but around the age of 40 then we start to get symptoms that require us to wear these guys (reading glasses).

So now we’re in the Presbyopes and around the age of 50 is the red line at which time everybody is Presbyopic. Everybody experiences these symptoms, of course with a few outliers but let’s say that – statistically – everybody experiences Presbyopic symptoms by the time they reach 50 years of age.

So, Baby Boomers, every single one of them is Presbyopic, yes, and every single Traditionalist is Presbyopic. Now I just want you to consider this:

  • Who’s got the need?
  • Who’s got the money?
  • Who’s got the numbers?

It’s A, B, C. It’s very simple. Those folks who have a little less need are the Millennials, they have a little less money, and they have a little less money when you compare it to Generation X-ers and Baby Boomers.

So we’ve got significant differences among the populations here, so I question why are we all focussing entirely on offering laser eye surgery to Millennials?

I know why; because that’s what the technology allows us to do. However, things are changing. Things have changed. I have been involved with laser eye surgery refractive practices which have been marketing laser blended vision for over a decade, and we’ve got loads and loads of happy patients who are singing the praises of this surgery. It’s an opportunity that’s just sitting there waiting to be taken.


The largest generation

This chart shows us graphically what I’ve been talking about. Millennials are indeed the largest generation but when compared to Baby Boomers and Generation X-ers if you stack that green line on top of that yellow line it almost doubles that orange line and that pretty much applies to most of the main countries in Europe which we tend to look at most.

About Millennials and their Income

When you look at the income again we have Millennials with much less income and this… You know, I discussed one of the events with a German surgeon who was telling me “Look, you know, our Millennials have lots of money.” Well yes, sure the Millennials that come into your practice have lots of money but this does not describe the Millennial generation as a whole, and we can’t simply just grow businesses with those who already come to us. We have to look for more. And so, yes, we have to be thinking about the other generations. Either that or we have to reconsider how we price some of our options for our less financially endowed individuals.


Baby boomers & Gen X are larger together

Baby Boomers and Generation X are larger together (than Millennials), and Baby Boomers and Gen X have higher incomes (than Millennials), and that’s the main point that I’m trying to make and this applies pretty much across the board.

Baby boomers and Gen X have higher incomes

So it’s something that we have to be conscious of, and it’s something that we have to change, but at this moment we have to adapt, and we have to take advantage of these market conditions to grow our businesses and retain substantial and sustainable growing businesses.

We’ve talked about income. Let’s talk about spending now. Now I’m just going to show you this chart here. The key areas we’re going to look at is spending power as shown by discretionary income purchases like theatre and cinema, travel abroad, dining out and spending on new cars.

I’m just going to show you these two graphs now. Now as you can see from Millennials their spending power has declined mainly and whereas Baby Boomers’ has increased over the same period.

The Millennials spend half as much on theatre and cinema whereas Baby Boomers spend two times as much.

The Millennials spend £922 less on foreign travel per person than Boomers, whereas Boomers spend 1.3 billion more on foreign travel than they did in 1999. So they’re just spending more and more and more.

Dining out, Millennials spend 18% less whereas Baby Boomers spend 33% more.

Millennials have an 80% drop in purchases of new cars, especially among the under 30s, whereas we only see an 8% drop in new purchases of cars among Baby Boomers.

So even in areas where folks are struggling to sell a product we’re still seeing Baby Boomers still buying many of those products like new cars.


So, yes, we’ve got not only a low amount of income among Millennials but a low discretionary income, therefore a smaller spending power.

Again the biggest reasons for this are the fact that housing costs are through the roof for most of those living in western society. Education is becoming more and more expensive. Both of these things incur debt which is getting greater and greater. Wages have not increased in comparison to prices. This is a recipe for impending doom. Well, that’s perhaps a bit overstated, but we’re already seeing significant political upheaval as a result of broad populations essentially at least ideologically defecting from the economic conditions under which we’re all now beginning to suffer.

Food for thought.

NOTE: The best way to answer that nagging question about practice growth or marketing or patient volume in the back of your mind is to book a free 15-minute compatibility call. Get some options and go away with a clear idea of what’s possible.

Presbyopes are growing

Regarding the laser eye surgery market size, we are seeing Presbyopes grow. I mean we have a whole bunch of new people coming into the Presbyopic boat every single year.

The median age of Europeans right now is 42. So this is the onset typically of Presbyopic symptoms, and soon 50% of Europeans will be Presbyopic. I mean you’ve all heard of the ageing population. That is certainly the case in the developed world, and so we have to be conscious of the fact that we need to, you know, really invest not only in the technology to serve these folks but also in communicating to these folks about the technology that is available to them.


Demographic change

Speaking about the ageing population, let’s have a quick look at these perhaps familiar demographic charts which show what I learnt a while ago was termed the ‘pig and the python’. So the way you can imagine this is if you turn it on its side, this is like a snake, and you’ve got a pig rolling through that snake. Of course, it would have to be a python to swallow a pig whole.

So what we see here is this pig going up the snake, and eventually, I suppose out the other end. I don’t know. So you’ve got… Probably a bad analogy.

We’ve got the Traditionalists here, and then we’ve got the Baby Boomers there. So as you can see, there’s quite a big range of Traditionalists there, because all those folks were born before 1945.

And then we’ve got the wider group of Generation X-ers there and Generation Y there. And so what are we going to look like in 2050?

First of all, let’s draw that Presbyopic line there regarding who becomes Presbyopic. We have Baby Boomers at the very top of that snake, Generation X then and Generation Y. So pretty much every Generation Y, well at least two-thirds of them are going to be Presbyopic by 2050. Sorry guys, it’s coming. Generation Z which follows is then going to become the new laser eye surgery market for conventional LASIK.


Presbyopes are motivated

Presbyopes are motivated. We all know about these symptoms. These symptoms are not new. They’re not going to be news to you by any means, but I just want to remind you of the slight psychological difference that takes place among Presbyopes when compared to myopes and hyperopes and those with astigmatism.

Eye strain and headaches after reading or doing close work, yes we know that happens.

Difficulty reading small print especially labels. My goodness, if I have a look at a… I mean even with my slight +1s, +2s, sorry + 1 1/2, it’s hard to read pill bottles. I mean, you look at the back of a pill bottle, and the type is so small that I think I would need a magnifying glass.

Typically what I do is I either go under a lamp, or I take out my cell phone, my mobile phone lantern and click it onto the pill bottle, and that’s when I can see those letters. It’s very, very difficult and I’m reminded of it every single day.

We also have fatigue from doing close up work.

We need brighter lighting when reading or doing close up work.

We need to hold reading material at arm’s length.

That is, you know, I can read as far as this and this and this and at which point I get to this point then all of a sudden I can’t read anymore.

Overall problems seeing and focussing on close objects, yes, and squinting.

And this is an interesting one; they want to stop the clock on ageing.

So I want you to think of this from a patient’s perspective for a moment. That is what we do all day long is think about things from patients’ perspectives, because that’s what we do, we’re marketers.

So I want you to think about what the difference in one’s experience with glasses is when you compare a five-year-old who is prescribed glasses and then has to wear them pretty much for their entire lives. They have years and years and years of getting used to these glasses. These glasses become a part of their identity. They see themselves in glasses whenever they see themselves in pictures. Their habit is essentially putting their glasses on in the morning and taking their glasses off at night and keeping them on all day long.

These people have had a lot of time – decades – to become accustomed to wearing glasses. Those that graduated to contact lenses because they didn’t like the way glasses looked (typically, that’s the main reason for convenience as well), they have had years, decades even, to get accustomed to sticking a piece of plastic in their eye and removing it at night.


So the big difference here is that we are much more malleable; we’re much more open to change when we’re younger and much less so when we’re older.

When I say older, I mean older than being younger like a 20-year-old. When we’re 40, we are considerably more set in our ways. Some people liken it to… well, you know, you stick a human in an oven, and you’re baking them the whole time they’re growing up, and eventually, they come out fully baked, right? If you take them out a little earlier, they’re a bit half-baked. But when they’re fully baked, they’re solid. That’s it. It’s difficult to change them.

New problems

And that’s one of the reasons why Presbyopes are so motivated because these are new problems. These are new problems that we’re dealing with, and new problems tend to want to get solved, whereas problems that we’ve lived with for years and years and years, decades in some cases, our whole lives in other cases, are problems to which we have become accustomed. They’re problems that we have now begun to develop coping mechanisms that have now made these problems smaller problems.

In fact, in many cases, when we talk to laser refractive patients and prospective patients we say “can you tell me a little bit about your problem?” And they say “oh, I don’t have a problem. I just wear glasses, and I want to get rid of them.” I mean, it’s amazing, but yet they’re happy to spend thousands of pounds or Euros and put their most precious biological possessions under the hands – and in the past, knives, and certainly in every case, lasers – of surgeons and happily pay for that privilege.

Yes, these are problems, but still, psychologically humans are exceedingly adaptable, and they find many, many ways to deal with the problems they have.

However again I’ll restate because it bears restating when we have brand new problems we are keen, keen, keen, keen to get rid of them because they are new and we haven’t yet developed the coping mechanisms. We haven’t yet acclimatised to these new problems.


The “On/Off Syndrome”

And one of the biggest problems is this one, and this is exactly what we feel like we’re doing all the time. We’re taking them off; we’re putting them on, we’re taking them off, we’re putting them on, we’re taking them off.

That’s another unique difference between what we experience wearing reading glasses versus what those who have worn glasses for their entire lives experience.

We are always taking them off and putting them on because our visual needs are changing all the time from distance to near, distance to near and everything in between.

And the worst thing is that these guys have an amazing ability to find their way into lost places. There’s a reason I have four pairs. It’s not because I’m luxurious, it’s because I typically don’t know where two of those pairs are at any given time. So, I consistently have to rebuy them. Fortunately, they’re cheap, but it’s a pain.

So yes, this is one of the biggest problems. We call it the on/off syndrome, and it’s what most prospective laser eye surgery patients who are interested in Presbyopic laser complain about, as well those who are interested in refractive lens exchange, they’re the same.


So let's summarise the opportunity before we get into some tactical approaches about how to grasp it.

So, Baby Boomers and Generation X-ers are a huge part of the population, when taken together much bigger than Millennials, in fact, closer to double the size.

Presbyopes are a growing laser eye surgery market. We keep getting a new boat load of Presbyopes into the bucket on a constant basis and many, much more than are dying off.

Baby Boomers are highly motivated when they notice anything wrong. Baby Boomers are the generation that invented cosmetic surgery. I mean, talk about motivated! The moment these people see something that suggests that they're getting older than they feel the moment they want to fix it. That motivation has generated an enormous market in non-invasive, non-surgical cosmetics and creams and the health and fitness boom which helps many, many people in my generation and the generation that came before me to stay looking as young and healthy as they possibly can. Cosmetic surgery involves everything from lifting one's jaws to brows and Blepharoplasty (eyelids) and nose jobs, and that's just the face. Baby Boomers and Generation X-ers are keen, keen, keen to look our best despite our advancing years.

For example, I'm 46 years old, but I don't feel 46 years old. I feel closer to 36 years old. People keep saying, the 40s are the new 30s. Well, yes, that's exactly what it feels like. And it's not just because I feel fit and healthy but also because the kinds of activities that I get involved in are not the kinds of things that my parents did when they were 46. I mean not even close.

The kinds of activities I engage in are the kinds of things that I've been doing right throughout my 30s and all through my 20s. So yes, we're a motivated bunch, and Baby Boomers are very similar, and we want things to be as good as they possibly can be for as long as they possibly can be. So yes, we'll spend the money that we have to make that happen.


Baby Boomers have more spending power than Millennials, and that is where it all comes down to. If there's one objection to laser refractive surgery that I can't overcome and find great difficulty in teaching anyone else to overcome - it is the price.

Now you can justify why you're more valuable than the lower priced option, you can show comparisons, you can demonstrate how much better your results are, how much greater your safety is, how much better customer service you offer, etc. etc. But there's one thing that you can't do - you can't create out of thin air the money for people who don't have it.

You can't squeeze blood from a stone, and this is what the situation that we're all now beginning to embrace is.

Many look at Millennials as the new generation that will save refractive surgery and bring it back to its glory days when the Boomers elevated it to such great heights. It's not going to happen. It just simply won't until huge macro-economic changes take place that is the essential the design of our politics.

So these types of changes take time. They take time to change. We hope they change. I am very much a believer in equality and intergenerational equality is a hugely important issue for me as well, but I know I can't make it happen on my own. And, you know, for now, we need to adapt. We also need to give Millennials a bit of a break. What I mean by that means offering them services and products that they too can afford. Why should we have all the fun?

So, we have to be conscious of that.


Should I abandon regular LASIK?

Some people when they hear this talk they think oh my goodness, what are you saying "Rod, are you saying that I need to abandon the Millennial laser eye surgery market, I need to abandon regular LASIK in favour of these new Presbyopic laser options or perhaps refractive lens exchange?"

Absolutely not.

Nothing could be further from what my message is intended to be. What I'm saying to you is that no, you don't have to abandon what you're doing. Instead, do both.

Abandon LASIK?

Offer both laser eye surgery markets something they can adopt. Grow your business by expanding your offerings to offer something that Millennials tremendously can benefit from and also something that Presbyopes, Generation X-ers and Baby Boomers, can also benefit from.

Laser eye surgery is one of the most successful elective surgical procedures in history, and I'm very happy to be a part of that, and I would be the last person to say to anyone that they need to abandon LASIK as an option for people. It is an excellent product with tremendous patient satisfaction and exceedingly low complication rates. In fact, the myths and misconceptions far, far outpace the concerns that we should have when it comes to looking at the statistics of what can go wrong.


So absolutely not. I am not saying to abandon LASIK. I'm saying embrace it, embrace that Millennial population, treat them the way they ought to be treated, the way they need to be treated, the way they want to be treated but also look at expanding your offerings by offering both conventional LASIK and also Presbyopic LASIK when that becomes available for you.

Guess what; the technology has been around for over a decade; it's working exceedingly well. Here in the UK, it is a success story. In the rest of Europe, it's just beginning to take off. I'm sure it's going to be huge in the US when the FDA approves it. The US, by the way, most people who are listening to this presentation know this, but the US is traditionally the slowest group to adopt new technologies, and there are lots of reasons for that. It has very little to do with the experimental nature of the technology but more about the politics of keeping the status quo. Yes, offer both when you can.

Evidence suggests that presbyopic treatment does not cannibalise LASIK treatment. So we've seen practices that increase their laser eye surgery market, increase their patient base, and increase their patient volume by offering these two different options as opposed to the thought that I get communicated to me by some surgeons which is "oh well if I now offer Presbyond all of a sudden nobody will want Smile."

No, no, no, that's not even remotely the case. I mean, does somebody come in and go "oh, you have beer and wine. I'm a beer lover, but now I'm just going to have wine instead, so therefore I'll never buy beer again."? It doesn't work that way. There are different products for different occasions. There's different services or different needs. There are different medical procedures for different medical needs. So this is what we're talking about here about expanding the laser eye surgery market, not contracting it and certainly not cannibalising it from one to the other.


We need different marketing approaches for Millennials, we need different marketing approaches for Generation X-ers, and we need different marketing approaches for Baby Boomers.

And fortunately for you, we have studied these groups at great length and in great depth to understand what appeals to them the most. I mean right now we're getting loads and loads of books and talks and thinking around Millennials, and that's great. That is super important and super valuable, but we need to also think about how not to just think about who we're talking to but also how we integrate all of that into practice.

How can you serve all of these groups with the same approach? It's not going to be as effective as having a different approach for every group.

NOTE: The best way to answer that nagging question about practice growth or marketing or patient volume in the back of your mind is to book a free 15-minute compatibility call. Get some options and go away with a clear idea of what’s possible.


So, by adding Presbyopic LASIK, it more than doubles your laser eye surgery market. We have, of course, the Millennials on this age range for whom LASIK is ideal. We then have the Generation X in this range, and then we have the Baby Boomers in this range, of whom Presbyopic LASIK is very useful, and Generation X is right now sitting in about the middle. We also have the Traditionalists in that range of whom are a smaller population that are the bread and butter of those Ophthalmologists who are working on age-related conditions.

Now, these circles that I put up here are in fact sized to represent the relative sizes of the populations of these generations in Europe. So they're not just, you know, haphazardly sized that way. They, in fact, represent the different populations.


Now, what do we have to do? We have to move to segmentation. We have to go from homogenous broadcast-oriented marketing to heterogeneous narrowcast-oriented marketing. And what does that mean?

Well, we have to change the way we communicate regarding the marketing channels we use. We have to change the messages that we use to appeal to people. We have to change the communication styles for these different generations. We have to change the way that we interact with these patients and respond to what they expect for the different generations. We have to change the way we price for the different generations as well to respect the fact that there's a tremendous amount of economic inequality among the generations and between the generations.

So, yes, we need to go from the homogenous, monolithic way of thinking regarding "I got one product, and I've got one approach to the market that product" to a more segmented approach where we're talking about different laser eye surgery markets and speaking to them in different ways for multiple products. So it's a change for many laser refractive surgeons to get used to.


Let's first talk about marketing channels. So we're going from analogue outbound and interrupt which was the flavour of marketing in the past to digital inbound and interactive.

So, the notion of going from interruptive marketing, meaning interrupting one during dinner, for example, from a telemarketer to going to interactive marketing, taking the lead from people who are interested in the marketing and then engaging with them.

We're talking about going from analogue, which is the opposite of digital, so going from more print-based and radio-based and television-based advertising to more on-demand digital advertising that is in the form of many websites, an SMS, an email and newsletters and videos and all that.

We're going from outbound to inbound meaning going out and trying to penetrate markets with our messages as opposed to inbound where we have our laser eye surgery markets come to us because they love our content and therefore want to engage with our marketing.

So I'm just going to talk a little bit about Traditionalists. They're on the analogue and outbound and interrupt side. Now what I mean by that is that's the kind of marketing they're used to. These folks are the ones who were first exposed to advertising from the very beginning.

Advertising hasn't been around for as long as agriculture has been around. We're talking about just a very short period of time relative to how long we've been around and Traditionalists were the first to experience advertising on a mass scale.

There were no real mass media in the 1900s. Yes sure, there were newspapers and things like that, but many people couldn't even read way back then compared to the near ubiquitous reading levels that we have now.


And then we have Baby Boomers who are a little bit more on the side of getting away from the analogue, getting away from the outbound. Of course, they grew up here because marketing hadn't changed for a very long time and in fact, it didn't change until the great man of advertising, David Ogilvy, first started promoting the idea that "hey, we need to kind of look at advertising slightly differently, things are changing."

And this is where we get the "Madmen" era where we have a different approach to advertising. We start looking at it as a proper profession as opposed to just something that businesses do to sell products.

And the Baby Boomers have been slowly moving along the side here towards the digital, towards the inbound, towards the interactive. Almost every baby boomer now has an email address. Many of them are holding their mobile phones just as much as Generation X-ers and Millennials are. They interact with their families using texts / SMS. They use their own WhatsApp. They've got Facebook profiles. One of the main reasons why Millennials have left Facebook in droves is because their parents are on there. So yes, Baby Boomers are certainly adopting this and taking hold of the new media much, much more than Traditionalists ever will.


And then we have Generation X, who grew up in the shadow of the Baby Boomers and then also has drifted in the direction of digital inbound and interactive. So these folks are starting the companies, which are in fact the new media companies that have been most successful over the last ten to 15 years.

And then we have Millennials and Millennials are pushing the edge of the envelope now on the digital inbound and interactive scale. They're the ones who are getting into social media platforms that most of us haven't even heard of because they're so niche.

We're going from a quite unified approach regarding media. Like for example, how many channels did Traditionalists enjoy on their television sets? None before 1945. However, they did have a radio, and they had, typically, state radio. Baby Boomers they enjoyed a couple, three/four/five in some cases, very few radio channels that they had an option to listen to.

Generation X. This is when we first got recordable media, the first start of the tapes like audio tapes and VCRs and VHS and Betamax, and then eventually we got into more of the digital components where we started now getting into cable and satellite and then further, moving forward now we have digital TV, internet TV and now it's YouTube.

So, this is an example of how it used to be one channel, and this has diversified now and fragmented into literally millions of channels that people can get on board and watch. I mean, I have my own YouTube channel. This is how fragmented these things are. You're watching this, and this video is actually on our YouTube channel. Yes, media is everywhere, and media belongs to everyone. It's an interactive approach. No longer are we just sitting here like an audience. We are participants in the media.


This chart can be a little bit overwhelming, but it's one of the most interesting charts that people respond to in my speaking. They look at this, and they go "oh wow, okay finally somebody has plotted the marketing tactics concerning how the generations adopt them."

I'm not going to go through each one of these, there's way too much to get through, but as you can see if you're doing the kinds of things that are on the side of the Traditionalists and if your market is not Traditionalists you've got to stop doing those things.

Maybe not immediately, maybe you've got to wean yourself off and replace those lead sources with other lead sources that are more productive, but these things are dying.

Newspapers, TV, radio, people don't care about these things anymore. These things are going away. The average cable news viewer is somewhere around 72 years old. Talk about Traditionalists, right? We see these folks hang onto that media and they'll be the last folks who watch television of that nature. So all the stuff that you see today, all the big news channels they're all losing popularity, they're all losing ground. ESPN is losing ground. We're seeing an amazing reduction in their popularity and the views and the viewers, unique viewers, among all of these old world channels and so is the advertising going to go away on that. Maybe there'll be some deals to be had. There should be. I mean the advertising that's being offered in that media is way overpriced in my opinion, and hopefully, it'll get cheaper and cheaper to reflect its true value.


On the other hand, if you're looking at Baby Boomers then you've got to be doing more of the things that we have of the Baby Boomers group. Things like SEO, SEM, social media marketing, SMS marketing, podcasts. These are not the types of media - those new and shiny things that people talk about that you want to be doing if you're mainly focussing on Baby Boomers.

This is a good way of understanding where do the laser eye surgery market that I have an interest in intersecting with the types of marketing tactics that I think drive lead volume?

So we have to decide "okay, am I using the right channels that appeal to the right target laser eye surgery market?" and, you have to get rid of the ones that don't appeal. Either don't adopt the ones that are too new and get rid of the ones that are too old, again, depending on your target market mix.

If you're only working on Millennials, why are you doing anything on the Traditionalist side? It's amazing to me. See the thing is that many of the owners and managers of laser refractive clinics are Baby Boomers and Traditionalists yet they're marketing to a group they know nothing about. And, they don't know the types of things that Millennials enjoy, so they're missing out on major opportunities to attract them.


Of course, there's a lot of conversation going on about this very subject in trying to get these Traditionalist and baby boomer owners and managers to start looking at Millennials as a marketplace and start changing the approaches that they take with them.

But we've also got to think about the other ways too is that Baby Boomers and Generation X-ers are changing too. These folks aren't just staying where they are. They're moving with the times, and they're starting to adopt a lot of the same things that Millennials are.

Nowhere near the same pace, nowhere near as fragmented, but certainly they are following in the footsteps of the younger in this case.

Marketing messages, let's talk about how those differ. So with Traditionalists, we're talking about a message that says: "it's all about me", and the "me" in this case is the company or the provider of the service.

So the kinds of advertisements that you would see in the past are the kinds of advertisements that are focussed entirely on the company. It's like "look at our brand of soap, it's the best, you know, it's the cleanest, it's the cheapest", whatever. It's used by, you know, the Presidents.

This is the approach that has been communicated to Traditionalists for decades now. "It's all about me. It's all about me."

But things changed when David Ogilvy started looking at it. And this again was in the 60s when all we had was print and radio and TV, David Ogilvy looked at what was being offered in the advertising space and thought, "wait a minute, these headlines can't be all about us. They've got to be about our customers. They've got to be about the benefits that we're offering people." So, we have to answer the question with them; what's in it for me.

And, yes, that's where advertising became all about you, and that's why 'you' is one of the most favourite words in ad copy because the more we're talking to individuals about what's important to them, the better off we'll have a chance of resonating with them.


Now, one would imagine; well, if it goes from "all about me" and then it all goes to "all about you" then that's the extent of that continuum. However, you would be wrong, because now we're going to "it's all about us".

Now it's interesting because Millennials have had a pretty bad rap. Many people consider them lazy because they don't have jobs. Oh yes, it's not exactly easy to get employment as a Millennial these days. Young people always have the highest unemployment rates across all the generations, but not only that; it's getting harder and harder to get anything of substance regarding a long-term job, a long-term career job, the kinds Baby Boomers are used to. No longer are folks spending 20 to 30 years in the same job. It just isn't possible anymore. Things are changing way too fast. Information is changing constantly. Knowledge is changing constantly, and pretty soon we're all going to be replaced by robots. I mean just think about what we'll do then.

So, with Millennials it's all about us and what they want is they want to know about your company. Yes, that's important, they want to know that you'll help them achieve what they want to achieve with regards to benefits of your product.

They believe that's important, too. But additionally, not necessarily more important, but additionally, they want to know that you care about the world. They want to know that you are willing to stick your neck out and take - for example - some of your profits and donate them to causes they care about.

They care about things like the environment. They care about things like economic inequality. They care about things like education. They care about helping those in need abroad - foreign aid. They care about human rights for everybody, expanding that circle of equality and liberty for all. They care about women's rights and the rights of minorities.

These are the kinds of things they care about, and they want you to care about those things too because it's more personal now than it was before. The relationships have gone from transactional to transformational and what we're talking about here are Millennials who care about seeing you as a good corporate citizen.

They don't want to put money into you if you aren't putting some of that money elsewhere and showing that you are... That it's not "all about you". They're not interested in making you rich. That's not something they care about too much.


So what we had before is feature-focused advertising just in summary. We had benefit-focussed advertising then after that that especially appeals to Baby Boomers and Generation X-ers and now we have socially-conscious communication. And again it's not just advertising; now it's two-way. Now, these are conversations. It's not all about you and you talking to me. It's about us talking to each other, and that's the Millennial mindset.


Communication styles, well let's talk a little bit about how that differs, and it does. In the past we had a lot more formality in our communication, both written and orally. We wouldn't have a video, for example, of the type that I'm preparing now unless it was studio produced. Unless you know it cost them lots and lots of money and loads of money on editing. I'm going to edit this myself. On top of that, I'd be dressed in a suit; I'd be speaking from a prepared speech.

It's a completely different approach to how we talk today. Now it's very much off the cuff. It's very much what's on our minds. It's very much of the moment, and it's very much given in an informal tone.

And this is how Millennials want to be spoken to, too. Baby Boomers and Generation X-ers not so much. They're still on the cusp. However, there's a big difference between Traditionalists and Millennials. It's massive regarding how they like to be spoken to.

So the language differences are clear. In the past especially doctors used to use the first and third person, I and he and it was often a he because there weren't very many women doctors at all. Then we moved to the second person, and you might still be surprised that ophthalmology just hasn't moved on as quickly as other professions and I don't mean in medicine, medicine, in general, is quite slow to move forward regarding communication styles. I'd say ophthalmology is one of the more advanced ones in medicine, but medicine as a whole is quite slow. Some would say glacial; I would say slow.

For example, even now only months ago I spoke to one of our clients who said to us, I think I wrote about this in a blog post recently, the client said "thank you very much for my website but why is my picture not on the front cover? Why is my name and everything I offer not on the front page?"

And I said to them "well, because it's not all about you. These folks want to know what can be done for them and the person they most care about is not you, unfortunately. The person they most care about is themselves."


And so what they're most interested in is "do they understand my problem, do they have an easy and quick way of helping me fix it or at least getting into the process of helping me fix it and do I have a general feeling that I can afford it." And then, lastly, it's "do I want you to do it and do I want to do it now?"

So it's changed. We're not just looking at a doctor and saying, you know, is this the right person de facto because his name begins with the initials DR, he's the best person for the job.

Now what we're talking about is "this is a competitive marketplace, do you get me? Do you understand me?"

And Millennials again are "do you understand us? Do you understand how we can all work together, Millennial and you, to solve my problems together?"

So here we're using the 'we'. Again this is not hard and fast. Not every single sentence is going to have a 'we' instead of a 'you'. But I want you to consider taking that tone of voice, that sort of like "we're in this together, we're on the same side of the table." You know, in the second person phase, the Generation X we didn't have a table at all because we wanted openness. A familiarity between us. With the Traditionalists we had a table dividing us, you see what I mean? So it's a real difference in terms of how we communicate and the style that we take.


The Traditionalists are very much more in long-form copy and what I mean by that is long written pages. So for example when we design a website for Traditionalists we won't have them hopping from link to link to link and lots and lots of pages. What we'll do is instead is we'll write everything they need to know in one document. Yes, about, for example, a particular condition or a particular treatment - one long document on the web. Because what are they going to do? Well, they're probably going to print it out and read it offline. So how are they going to be able to do that if they're jumping from link to link getting lost? And again it's not because they're stupid, absolutely not. It's more about the fact that they're just not used to seeing information in a three-dimensional space in the same way that Millennials are. Millennials are happy to go from link to link to link seeing a PDF, watching a video, looking at your Twitter profile then going back over to YouTube to see one of your videos that you show on Twitter, then checking out your Facebook and then going back to your website. Getting an email, communicating with you by SMS, they're hopping around, right? It's a completely different story.

Generation X and Baby Boomers, they're used to getting their messaging in 30 to 60-second spots in standard advertising sizes. So that's in fact what you get a lot of websites and videos on YouTube, and we're slowly getting away from that. Does it make any senses for me to provide you with an hour video? Those of you who would be interested are very much going to be interested.

This is my version of long-form copy. But as well when I blend it into a video then I get the advantage of communicating with Generation X-ers and Baby Boomers in the way they like.

If I were speaking to Millennials I would probably be wanting to break down what I'm talking about in Tweetable parts, bullet points. I'd use a lot more evidence-based information. I'd cite my sources. I would also display what I do in multimedia as well. Not just video, not just text but also in diagrams and infographics and quizzes and things like that, learning and participate with interactive tools. That is how I'd communicate to Millennials.


Patient interactions are also changing, and when I talk about this, I mean on the phone and also in person.

With Traditionalists, what we have here are single channel, didactic, clinically-focussed patient interactions.

So it's all coming from the doctor, it's all very much I tell you what you're going to do, "patient". It's clinically focussed. We don't talk about emotions, we talk about the data, we talk about the information, and we talk about the condition, mainly the condition and mainly the treatment.

And then we're moving towards multi-channel. As I said, coming in all sort of different approaches. So we might have a conversation on the phone, then we'll also have a conversation by Skype, we'll also have a conversation in person. We'll also text each other.

Autodidactic and interactive, so we're coming in with a lot of patients who have a lot more information. The conversation is much more question and answers between us. They will probably ask us questions as opposed to us asking them all the questions and the tone of the conversation is much more emotionally focussed.


So what we're talking about here is talking about emotions and talking about why they want to have this done and how this feels and what kind of impact this is going to have on their lives.

Now, these aren't just Millennials. These are Generation X-ers and Baby Boomers. Remember the green and the yellow, the Baby Boomers and the Generation X are all moving down these continuums as well. It's only the Traditionalists who tend to remain in the same place, again because they've lived their entire lives in that place and many of them, in fact, resist change as opposed to Baby Boomers and Generation X by varying degrees adopt change more easily. Millennials know nothing but change, so that's their lives. I mean it would be no doubt hopelessly boring if things stopped changing.

Where we had house calls before we have phone calls now predominantly and we're going to have Skype calls in the future.

We had the doctor doing all the talking in the didactic single channel approach, and over time the doctor did 80% of the talking. I still pretty much before I speak to the people that I train with (because I train a lot of doctors in how to handle first appointments and that's the critical sales component of the process for elective surgery), they're doing 80% of the talking, and that doesn't work. It doesn't work for Millennials, absolutely not, and it also doesn't work for Generation X and Baby Boomers.

So now where we're going to is getting to a point where we have the patient doing 80% of the talking and this is hard because when they talk they also ask questions and then we have to answer those questions, and it lengthens these conversations into much perhaps longer interactions than we're used to. And what do we do with all that time? What about all the other time that we need to actually do work? It can be challenging.


We're talking about a low information patient in the past. Again it doesn't mean they were ignorant, they just simply didn't have the means to educate themselves.

Medicine was an area that - like all information - was fenced around the elite. So only those with the right credentials, and the right experience and the right training would know anything about these particular subject areas.

And slowly these fences have expanded, and they've filtered and over time what we're seeing is - sometimes not for great effect - we're seeing people become more responsible for their education and walking into doctors' practices armed with loads and reams of information about their condition and about their options.

So what we're dealing with here is the high information patient and I bear a view that Millennials are no doubt the highest information patients you're ever going to face. They're the most educated patient. They no doubt have had a longer education than anyone else. Their education has been of the highest quality, a higher quality than anyone else, and more specific and niche than anyone else. And not only that but they also have something that's very, very useful for autodidacts which is the internet and pretty much anything that's worth knowing and many things that are not are available on the internet for free for anyone who can search for it, of which Millennials are pros.

So, yes, we're talking about a very high information patient, but also Generation X-ers are not far behind at all. Generation X-ers are very, very good at research. They grew up, especially in their senior years, educationally with internet research, so they know it well, and they're going to walk in doing what they have to do.

And Baby Boomers are also becoming very, very good at research as well on the internet. They grew up with libraries, you know? They grew up with consuming information just as much as everyone else, perhaps not as much and not as differentiated but certainly high volume where Traditionalists didn't do that so much.


In the past, we had the husband deciding how things were going to go, whether or not somebody was going to have treatment for anything. And then we had the wife decide. So as things changed. The decision making authority went more to the wife because - well I'm not even going to say why because - perhaps I can only speculate - that women tend to have more patience for health information and more interest and men tend to have a little less interest in their health. That's changing, but the kind of change we see that is in more Millennial-focussed Generation X-ers and also certainly Millennials, of whom the genders as well are now becoming less rigid and more fluid. Male Millennials are becoming more in touch with their feminine side than ever before while female Millennials are becoming more in touch with their masculine sides than ever before.

Now for the Millennials, the family decides. They bring in whoever is going to be part of the conversation: mom, dad, brothers, sisters, they'll bring them all into the conversation. So we have many Millennials who will bring in people to the consultations, to first appointments, and make these decisions together. So we have many decision makers, many influencers. It's much more complex.

Pricing approaches - what does this look like?

Well, we used to have a fair and a more cash-based society when it came to the people who could afford things, especially in the Western world. Strange, isn't it?

Considering we're supposed to have made progress.

And then we moved towards a premium and financed society, so things were being sold at much, much higher luxury prices and when we couldn't afford them with cash we simply put them on credit.

And now we've gone to a budget and debit society with Millennials. So, it's "what can I do on a slim budget because remember my discretionary income is tiny in comparison to Generation X and Baby Boomers." And they also don't have a lot of credit available, so they have to go on debit.


So what does this look like? Well, the Traditionalists are anti-credit. They're the folks who won't take a loan, who won't take up any financing. If they have the cash, they'll buy it. If they don't, they won't. What's interesting is that many of these folks do have the cash. They have liquid, therefore they're considerably more able to make these decisions when they need to.

Generation X and Baby Boomers are pro-credit. They're all about "bring on the credit cards and bring on the debt, and I'll pay it off later." They're the most credit-oriented generation in history. Millennials, unfortunately, have very little access to credit in comparison to the generations that preceded them.

They not only have less income, which is a factor in getting credit, but they also have more current debt load which is also a factor - a negative factor - in getting credit as well. And, yes, they also have many, many other things that they might otherwise already have payments going towards. They also have fewer assets and assets are typically a factor when getting credit. Yes, you have to have considerably more of an asset base to get any collateral-based credit.


So yes, these are the challenges that are facing Millennials, and so we're going to have to think about how this works. Traditionally speaking, only about 25%, of patients used financing whether it was interest-bearing or it's just the credit to finance a procedure anyway, but we're also looking at Millennials perhaps not having access to that kind of financing.

The other thing too about Millennials too is that they move around a lot more. So you might have people coming to the UK who have only been here for six months, whereas Generation X-ers might've been a bit more established. The challenge is is that somebody with only six months of longevity in a country has much lower access to credit than somebody with many more years.

So again there's a lot of movement, there's a lot of migration, and that's coupled with all these other challenges in getting credit. So we're going to see this tough credit environment is not going to get easier for Millennials. It's in fact probably only going to get harder.


In the past, the husband pays, so they were the primary breadwinner. In fact, they were the only breadwinner for many Traditionalists and then as double income households became the norm the couple paid. So we could draw money from the husband's income, and we could draw money from the wife's income, even if only one of them needed an elective treatment.

And now the patient pays. So what do I mean by that? Well, now often Millennials are not coupled. They, in fact, have the lowest rates of marriage than any generation that preceded it and they're often living with their parents because they just simply can't afford to live alone. So yes, now it's the patient pays and, yes, I will grant that in some cases - especially if Millennials have wealthy baby boomer parents - they will get Baby Boomers to help them either finance their elective procedures like laser eye surgery or simply pay for them outright.

However, I will suggest to you that when we're hoping that someone else pays for our patient's treatment, remember only 25% of folks elect for financing so I would suggest that the number that can get the financing from their parents or just get it paid for by their parents might even be less. So it's not exactly a good solid foundation on which to base your pricing practices.

Take-home messages

Yes, so that's it. There's quite a lot there. I just want to complete this presentation with some take-home messages, essentially a summary of what I've said.

The Presbyopic laser eye surgery market is much, much, much too large and too wealthy for laser refractive surgeons to ignore.

The key thing here is we've been waiting a long time for the technology to be available. We now have it. Some of us in the US especially are still waiting for that technology to become approved. That is imminent.

Now is the time to understand how to change your practice to adopt this segmented approach, to recognise that, number two, laser eye surgery markets differ from each other, and we need to take a segmented marketing approach to attract these very different patients.

So yes, that's the essence of what I'm trying to communicate, and I hope that has been useful. I'm sure it's been informative.

Thank you!

I want to thank you for your attention over the last hour plus, in what I hope has been a very enriching talk. I encourage you as well to ask me any questions you like at the bottom, in the comments, or in social media and please keep in touch.

Again, thank you very much for listening.


NOTE: The best way to answer that nagging question about practice growth or marketing or patient volume in the back of your mind is to book a free 15-minute compatibility call. Get some options and go away with a clear idea of what’s possible.

About the author

Rod Solar
Founder & Scalable Business Advisor / fCMO

Rod Solar is a co-founder of LiveseySolar and a Scalable Business Advisor for its customers. Rod mentors and coaches eye surgery business CEOs/Founders and their leadership teams to triple their sales, double their profit, and achieve their “ideal exit”.

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Meet our Founders

We’re passionate about helping leaders of high-quality, growth-minded practice owners double their practice revenue

Rod Solar

Founder & Scalable Business Advisor

Rod Solar is a co-founder of LiveseySolar and a Scalable Business Advisor / fCMO for our customers. Rod mentors and coaches CEOs/Founders and their leadership teams to triple their sales, double their profit, and achieve their “ideal exit”.

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LiveseySolar completely transformed the way we were approaching this… We’ve gone from having just the dream of having a practice to having a practice up and running with people making inquiries and booking for procedures… It’s extremely pleasing. We feel lucky we connected with LiveseySolar.

— Dr Matthew Russell, MBChB, FRANZCO, specialist ophthalmic surgeon and founder of VSON and OKKO

Laura Livesey

Founder & CEO

Laura Livesey is the co-founder & CEO of LiveseySolar. She has developed powerful refractive surgery marketing systems that increase patient volumes and profits for doctors, clinics, and hospitals, since 1997.

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Rod and Laura know as much about marketing surgery to patients as I know about performing it. They are an expert in the field of laser eye surgery marketing. They know this industry inside out. I believe that they could help many companies in a variety of areas including marketing materials, sales training and marketing support for doctors.

— Prof. Dan Reinstein, MD MA FRSC DABO, founder of the London Vision Clinic, UK