Why laser eye surgeons should embrace presbyopic laser eye surgery

Transcript

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.

00:01:39

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.

00:04:10

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.

00:06:39

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.

00:08:01

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.

00:10:02

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.

00:13:18

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.

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.

00:14:29

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.

00:15:41

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.

00:17:18

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.

00:19:53

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.

00:21:17

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.

00:24:30

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.

00:26:16

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.

00:27:28

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.

00:29:55

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.

00:31:43

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.

00:33:35

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.

00:35:11

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.

00:37:13

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.

00:38:23

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.

00:40:19

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.

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.

00:42:20

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.

00:43:59

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.

00:46:45

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.

00:49:08

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.

00:54:42

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.

00:56:24

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.

00:58:22

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.

ADDING PRESBYOPIC LASIK  MORE THAN DOUBLES YOUR  laser eye surgery market

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.

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.

Bye-bye.