FORCES INFLUENCING MARKETING

There are several main influences on the current state of marketing for presbyopia, each of which has made it more challenging for the practice to successfully attract and treat patients. Let’s look at them one at a time.

History of Presbyopic Solutions

Treatment of presbyopia has been a work in progress for more than 200 years, ever since Ben Franklin came up with the first solution in the form of a bifocal lens. From Revolutionary War times to present day, researchers, scientists, and eye doctors have failed to come up with a comprehensive solution in the form of a treatment or procedure that directly cures presbyopia. To date, the profession lacks consensus as to the root cause of presbyopia and we are left with several competing theories. In marketing terms, we do not yet have any single product that works in the form of a surgical solution. What is available today is a portfolio of solutions ranging from appliances (spectacles and contacts) to indirect alternatives (monovision) to implants (intraocular lenses and inlays). None of these, however, directly cure or treat the condition. While numerous start-up companies attempt to find a cure through a surgical solution, none have yet emerged to achieve clinical as well as commercial validation.

Low Consumer Awareness of Surgical Solutions for Presbyopia

It is indeed rare that a medical condition would have 100% incidence in the target population; presbyopia meets that definition. Ironically, most presbyopic patients have no idea that surgical solutions exist. This is largely due to their being invisible to the eye care system as currently structured. A patient who has functioned as an emmetrope all his or her life does not need to visit a doctor once his or her lens fails to achieve full accommodation. The person simply goes to the drugstore or online and orders a pair of reading glasses. The cost is low enough that he or she can afford to experiment and find what works for him or her. A visit to a doctor is not required. Therefore, there is no ability to inform and educate the patient to available alternatives. Reaching this invisible audience will be covered later in this chapter.

The Success of LASIK

LASIK has become the most widely performed elective surgical procedure on the planet for one simple reason: it works. The effectiveness of the procedure and its outstanding safety profile have made it a viable alternative to spectacle or contact lens dependent patients. Satisfaction surveys put LASIK in the mid-90s (on a 100-point scale), and patients anecdotally refer to LASIK as an investment in self that has changed their lives for the better. The results are immediate, the downtime is low, and the ability to enhance an outcome is typically part of the consumer package.

One unintended consequence is that other eye procedures have trouble competing in the patient’s mind with the outstanding results achieved with LASIK. As pioneering cataract surgeon Sam Masket, MD, once told me, “My cataract patients may not be willing to pay extra, but they all expect LASIK-like results” (personal communication, 2008). This same sentiment may have doomed conductive keratoplasty, whose results were less predictable, less stable, and shorter lasting when compared to LASIK. Interestingly, conductive keratoplasty patients did not compare their outcomes to like alternatives, such as elimination of reading glasses for some activities. Instead, LASIK became a catchall benchmark for consumers and remains so today.

The Unique Challenge of Marketing Presbyopia Surgery to Presbyopes

Unlike LASIK and cataract patients, presbyopes are not within the sphere of influence of eye care professionals (ophthalmologists and optometrists), because they do not typically seek treatment for that specific vision issue. As a result, traditional approaches to marketing a new surgical treatment to these current or potential patients have been largely ineffective.

Clearly, innovative ideas are needed to market new surgical treatments for presbyopia successfully. In order to create new approaches, we must first identify the environment and media that influence presbyopes. Once these factors are determined, we can devise novel ways to motivate these patients.

PLANO PRESBYOPES: WHERE ARE THEY?

Although many presbyopes do not tend to visit eye care professionals, they regularly shop for over-the-counter reading glasses. As they get older, the power of the readers must also be continually upgraded, and most presbyopes own several pairs of readers. If a patient has significant myopic or hyperopic refractive error, they must wear glasses or contact lenses all the time and are used to having glasses on their faces. In contrast, plano presbyopes do not normally wear any type of glasses, so they often struggle with having a pair of readers handy when they need them. As a result, they tend to have a large quantity of reading glasses throughout the house (eg, one of our patients had 19 pairs). Not only is this a significant inconvenience for them, but it is also tremendously frustrating, since they are constantly searching for their readers, and cannot seem to find them when they need them the most.

Therefore, since the result is a frequent need to visit stores and websites that sell over-the-counter readers, such venues represent new opportunities to market the latest presbyopia surgical treatments for these patients. For example, print advertisements, educational kiosks, or keywords can all be used to create awareness that options for treatment exist, providing a call to action to come in for evaluation by a specialist. These can be placed at strategic locations in stores and on website search results where presbyopic patients typically shop for reading glasses. The content does not need to be overly complex: videos can convey the happiness that presbyopia surgery patients similar to themselves are experiencing, depicting them as free of their dependence on readers, having eliminated an irritating nuisance, and reinforcing the self-perception of feeling and looking younger.

While it is true that marketing new treatments to presbyopes presents an unprecedented challenge to us as ophthalmologists and optometrists, since these patients have not traditionally been under our sphere of influence, the unblazed trail of marketing to such a significant patient population also presents a tremendous and exciting opportunity for innovators who are willing to invest in educating presbyopes where they live.

THE GOAL OF PRESBYOPIC MARKETING

As a condition, presbyopia needs to be viewed 180 degrees opposite from how every other condition of the eye is discussed in an ophthalmic practice. At the core of the typical doctor-patient interaction, the process goes something like this. Patient will present with a complaint, receive a diagnosis, and be provided a solution, typically in the form of a procedure or a prescription. Patient returns to the practice at some future date for further evaluation. This process can be described as procedure-centric or procedure-focused. Although it does begin with understanding of a patient’s condition, the entire ophthalmic profession has been geared around the solutions to those conditions, beginning with how we categorize and delineate subspecialties. We have cataract surgeons, LASIK practices, and dry eye clinics. The ophthalmic profession has evolved around diagnosis and treatment of specific conditions. Like it or not, the practice is organized around one or more procedures.

Presbyopia is sufficiently different in that it requires a unique approach, which we describe as “start with patient.” (Note: We considered using “patient first,” but that phrase does not create a sufficient distinction as it closely resembles the main intent of the Hippocratic Oath.) By starting with the patient, you organize your presbyopic marketing efforts around the patient instead of around the procedure. The goal of presbyopic marketing cannot use the same metrics as cataract or LASIK, such as number of cases performed, percentage of patients who move forward with a procedure, or ability to upgrade the instrumentation used during the procedure.

Presbyopic marketing needs to stay focused on the issue itself and the pain points it creates in the lives of just about everyone over the age of 50 years. Given the fact that one-half of your local adult population has likely never been to an eye doctor, there is a huge opportunity to stake out a position as a presbyopic specialist. In this context, your training, skill, and experience in dealing with medical conditions of the eye allows you to make that claim, if you choose to start with patient and resist the temptation to market a specific procedure. Your competition in this context is the rack of readers at the drugstore. That is typically the first go-to option for most patients when they become sufficiently frustrated at their ability to read up close. Your goal in marketing is to create awareness that a specialist exists who can help a person deal with this newfound frustration.

THE THREE KEY QUESTIONS

Recognizing that developing a presbyopic practice within your practice requires a different type of communication skill that begins with developing your own set of answers to the following 3 questions:

1. Who are they?
   
2. What do they need?
   
3. How can they be influenced?

One of the key observations over the years has been that doctors are very good at talking “tech” yet struggle to communicate in ways that patients understand and feel heard. This is most evident in self-pay procedures including LASIK and refractive cataract surgery but extends to all parts of the patient-doctor interaction. A serious look at these 3 questions forces the doctor to examine what is truly important to the patient (start with patient). We recommend thinking about these questions on 2 levels. First, apply them to the presbyopic population as a whole. Working with your staff, develop a shared understanding of what life is like for the presbyope. Your team will be able to look at this from their perspective as a medical practice and as someone who either is presbyopic or has family and friends who are. Here are some additional questions to guide the discussion:

► What do we hear from patients who are suffering from near vision issues?

► What would happen if we invested time to listen to their concerns?

► How can we utilize their frustration to gain greater understanding and cooperation with their eye care overall?