Group Members and Laser Eye Surgery Market Research

GROUP MEMBERS

Serial Name of Group Class Roll
No. Members Nos.

1 SHILPA KHUNT TY I 154
2 DRASHTI MEHTA TY I 162
3 JINAL NAYAK TY I 175
4 PRIYANKA RAI TY II 211
5 RESHMA RANGWANI TY II 213
6 PUJA RANPARIYA TY II 214
7 RINI GEORGE TY II 217
(Group Co-ordinator)
8 DRASHTI SHAH TY II 226
9 KINAL SHAH TY II 231
10 NARESH PATEL TY II 275

Acknowledgement

Through this acknowledgement, we express our sincere gratitude towards all those people
who have helped us in the preparation of this research report, which has ben a very good
learning experience for all of us.

We would like to thank the Director H.D. Trivedi, the faculty, the Computer Lab
Instructor, the Libararian & the Administration staff of B.K. Majumdar Institute of
Business Administration-HLBBA for the support.

Finally we express our sincere thanks to Prof. Neha Poddar who guided us throughout the
project & gave us valuable suggestions & encouragement to complete the research
project successfully. We express our sincere gratitude to her that she gave her valuable
time to support us.

Rini George
(Group Co-ordinator)

Preface

As a part of the course curriculum the third Year BBA students are required to work in
groups & prepare a research based project report. The objective behind preparing this
project report is to relate the management theories though in the classroom to their
practical application.

The preparation of this project report is based on the facts & findings noted during the
survey & the information collected from various secondary sources such as internet,
written documents & published documents. Inspite of our best efforts there may be errors
of omission & commissions which may please be excused.

Our survey is restricted to the city of Ahmedabad. Ophthalmologist & the opticians
situated in Ahmedabad have been interviewed for the same. It includes the information
collected through survey of local public & information collected from eye specialists.

CONTENTS

SR. NO. PARTICULARS PAGE NOS.

1. EXECUTIVE SUMMARY 2

2. OBJECTIVES AND SCOPE 3

3. MARKET RESEARCH 4-6

4. INTRODUCTION 7-27

5. INTERVIEWS-PILOT SURVEY 28-33

6. PRIMARY DATA ANALYSIS 34-61

7. CONCLUSIONS 62-63

8. RECOMMENDATIONS 64

9. BIBLIOGRAPHY 65

10. ANNEXURES 66-71

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EXECUTIVE SUMMARY

This project is an endeavour on the part of our entire group to understand the regional market
in the city Ahmedabad for a service known as ‘Laser vision correction surgery’ by
segregating the consumers into sets of existing users as well as the potential users of the
above said service.
This project sought to obtain answers to 2 set of questions-
a) With respect to the potential users –
1. Are they aware regarding such a ‘Vision Correction’ service being offered?
2. Do they find it to be a better solution for the purpose of vision improvement?
3. What according to them are the reasons for lower acceptability of this treatment as
compared to other alternatives like spectacles and contact lenses?
b) With respect to the existing users –
1 Are the tall claims made by the ‘laser eye surgery’ providers true and is it actually
a better vision correction solution?

First of all, the market research methodology i.e. ‘descriptive research’ process used has
been explained i.e. we have used survey as a tool to understand the market.
Secondly, the eye care industry background and secondary data available about laser vision
treatment on the internet and in booklets has been presented.
Thirdly, eye experts have been interviewed to understand whether this service is safe and
reliable and all the ophthalmologists have approved of this service with the exception of just
one doctor who advised against opting for this surgery
Fourthly, the primary data findings with relation to the potential market has been analysed-
which shows the availability of a large untapped market consisting of willing customers in
Ahmedabad who could be convinced to use the said service by employing certain strategies
to remove their misconceptions and by raising their awareness regarding this treatment’s
long term benefits as compared to other available alternatives which are perceived to be
cheaper as of now.
Fifthly, the data has been collected from existing users of the service and presented to
validate claims made by the laser eye surgery providers against the touchstone of
experience. It has been found that the claims made are true and it is indeed a safe, better and
one time solution if administered under expert’s supervision.

We can conclude that, people in Ahmedabad perceive the city as a viable location in terms
of expert services, state of art facilities and technology and really affordable prices for
getting laser surgery done. But, to make Ahmedabad a more preferred and attractive
destination for getting laser eye surgery done by a larger number of consumers in the future,
some recommendations (like advertisements should provide specific rather than general
information, convince the dear ones of the target consumer rather than just the target
consumer of the benefits of the service etc.) have been made by our group towards the end
of the project

This has been an humble effort on our part and we hope the project findings may prove
useful to everyone.

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Laser vision correction (Refractive Surgery) –
A Market Research

Objective :
To understand the market sentiments regarding laser surgery as a treatment to cure
vision defects.
( A Detailed explanation of the market sentiments to be studied are stated as under -)

Primary objective -
a) Awareness regarding the treatment
b) To understand consumer’s perception regarding this treatment i.e. whether
they find it superior as compared to spectacles and contact lenses.
c) Willingness to accept this treatment and factors hindering adoption

Secondary objective –
a) The reasons because of which one should opt for laser vision correction surgery
b) To find if there are any side effects after undergoing this surgery and if it is indeed safe
and better option for vision improvement.

Scope

a) Respondents (people with vision defects) for the purpose of conducting a survey
to be selected from the city of Ahmedabad only.
b) We are going to research only about the laser treatment wherein its being used
for vision improvement purpose

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MARKET RESEARCH
Marketing Research is the systematic and objective identification, collection, analysis, dissemination
and use of information for the purpose of improving decision making related to the identification and
solution to problems in marketing.
Marketing research attempts to provide accurate information that reflects a true state of affairs. It is
objective and meant to be conducted impartially. Thus, the motto of every researcher should be –
‘Find it and tell it like it is.’
Consumer marketing research is a form of applied sociology that concentrates on understanding the
preferences, attitudes, and behaviors of consumers in a market-based economy, and it aims to
understand the effects and comparative success of marketing campaigns

We as a group seek to explore in depth on our project topic i.e. the study of the penetration of the
treatment ‘laser vision correction (refractive surgery) ’ in Ahmedabad city and obtain useful
findings by using the tools of marketing research.

Classification of Market Research

Market Research

Problem Problem
Identification Solving
Research Research

This project is a Problem Identification Research, because our interest solely lies in just
identifying or finding out various variables forming a part of the market environment for laser
vision surgery.

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The role of marketing research in managerial decision making is explained further using the
framework of the DECIDE model:

D — Define the marketing problem

E — Enumerate the controllable and uncontrollable decision factors

C — Collect relevant information

I — Identify the best alternative

D — Develop and implement a marketing plan

E — Evaluate the decision and the decision process

With respect to this project, we have performed just the first 4 steps i.e. till identification of
the best alternative – i.e. we have given a list of recommendations to enable greater
penetration of this service ‘laser vision correction surgery’ in Ahmedabad city. It has been
done so, because the last 2 steps are to be performed by the policy makers and executors.

Market Research Process

The market research process consists of 6 major steps –

1) Define the problem and research objectives
The problem to be addressed through this project is to find out the reasons underlying the low
acceptance of ‘laser surgery’ as a vision correction option inspite of being a permanent and
hassle free solution
The content of the project would comprise of information regarding various costs and
techniques of laser vision correction; expert opinion regarding about success ratio, side effects
and permanency of better vision post – surgery & know consumers’ opinions regarding this
treatment as to their awareness, apprehensions and beliefs regarding this treatment.
This problem is to be researched in order to generate useful findings for people with vision
defects and help them understand ‘laser surgery’ treatment better.

2) Develop the research plan

a) Data source – Internet and books(secondary data) and primary data is also used

b) Research approach – Survey/ Descriptive research
Descriptive research design is a scientific method which involves observing and
describing the behavior of a subject without influencing it in any way. Many scientific
disciplines, especially social science and psychology, use this method to obtain a general
overview of the subject

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c) Research instruments – Questionnaire (for consumers) and Interviews(for eye
experts)
d) Sampling plan
i) Sampling unit – People with vision defects
ii )Sampling size – 460 units
iii) Sampling procedure –Convenience sampling

3) Collect information – Interviews of ophthalmologists and opticians have been conducted and
the questionnaires have been filled by the people having vision related problem.

4) Analyze information – Information collected from ophthalmologists and opticians as well as
respondents with vision defect has been tabulated and analyzed by means of graphs.

5) Present findings- It has been presented in the ‘Conclusions’ section of this project.

6) Make decisions –We leave the decision making part (as to whether they have to opt for laser
vision correction surgery or not) to the discretion of the user of the information given in this
project.

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INTRODUCTION TO LASER VISION CORRECTION
Traditionally, spectacles and nowadays even contact lenses is being used for the purpose of
vision improvement. But, as some of us know its been over a decade now, that a new
technology known as ‘laser vision correction surgery ‘(Refractive Surgery) has come into the
market to serve our needs better. So, below stated are some facts that will enable better
understanding regarding this treatment.

Laser Eye Surgery improves vision. The purpose of laser eye surgery is to correct refractive
errors and reduce a person's dependency on glasses or contact lenses. The procedure uses a
laser to reshape the cornea, the clear outer layer of the eye, in order to change the eye's
focusing power and improve vision. There are many types of laser eye surgery, but the most
common and well-known type of laser eye surgery is LASIK. LASIK is used to treat myopia
(nearsightedness), hyperopia (farsightedness), and astigmatism (distorted vision).

Over the past few years, laser eye treatment has been seen to make an enormous difference to
people with near-sight, far-sight and astigmatism. It's a difference that has changed their
quality of life as well as their quality of vision. For many people, laser treatment can mean
new freedom.

Advantages of laser vision correction are -

• Freedom to change the way the world sees you
• Freedom from the time-consuming, day-to-day hassle of glasses or contact
lenses
• Freedom to play sports without the inconvenience of glasses or contact lenses
• Freedom to go on holiday and to work without worrying about your eyesight
• Freedom to wake up during the night and see clearly

The result is that more and more people, including many celebrities, are choosing to undergo
this highly sophisticated and very successful procedure. Also, there are an increasing number
of clinics offering a variety of methods to correct your vision.

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The various kinds of laser surgery techniques available are as follows –

i) Lasik

LASIK is a surgical eye procedure that is performed to correct one’s eyesight, reducing the
need for glasses or contact lenses. LASIK is a procedure that permanently changes the shape
of the cornea, the clear covering of the front of the eye, using an excimer laser. By reshaping
the cornea, the refractive error is corrected and vision is improved.

The Development of LASIK
LASIK is an acronym for Laser Assisted In-Situ Keratomileusis. "Keratomileusis" is derived
from two Greek words that literally mean "to shape the cornea." "In-Situ" means "in place."
Thus, the term LASIK means "to reshape the cornea in place using laser." In simple terms, a
flap is cut in the top layer of the eye and folded back so a laser can reshape the surface of the
eye and then the flap is put back and the eye heals. LASIK is one of the many eye surgery
options, but it is the most commonly performed laser vision correction procedure.

The LASIK procedure is the combination of two sophisticated techniques of surgery with the
purpose of correcting refractive errors.
1. The first technique uses a knife, called a microkeratome, to cut a thin layer in the cornea,
leaving a hinge at one end of the flap. The flap is folded back to reveal the middle section
of the cornea, called the stroma, the area to be sculpted by the laser. Cutting a flap allows
for a rapid recovery of vision and reduces discomfort after surgery.
2. The second technique uses pulses from a computer controlled Excimer laser (a cold,
invisible, ultraviolet laser) to sculpt the underlying cornea by vaporizing a portion of the
stroma and correcting the refractive error. Then the flap is replaced.

The LASIK procedure was developed in 1990 by Dr. Lucio Buratto (Italy) and Dr. Ionnis
Pallikaris (Greece), combining two known surgical procedures, Keratomileusis [Radial
Keratotomy (RK)] and Photorefractive Keratectomy (PRK). They were the first to use a
microkeratome to cut a thin flap of cornea and then apply the Excimer laser to remove tissue
from the cornea. The microkeratome had been used successfully in South America for about
30 years, but had not been used in combination with the laser. It was Dr. Pallikaris that
suggested the name Laser In-Situ Keratomileusis (LASIK) for this procedure. The evolution
of LASIK occurred in the search for a better form of refractive surgery to eliminate some of
the limitations, risks, and complications of these earlier techniques.

LASIK evolved from PRK and both surgeries use an Excimer laser in a similar manner. The
major difference between the two surgeries is the way that the stroma, the middle layer of the
cornea, is exposed before it is vaporized with the laser. In LASIK, a flap is cut in the stroma
layer, which is folded back for the surgery, then replaced after the use of the laser. Since
LASIK does not disturb the sensitive top layer of the cornea there is less discomfort and a
faster recovery than with PRK, and the visual benefits are the same.

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In 1991, Dr. Stephen Slade performed the first LASIK procedure in the United States.
LASIK is now the most commonly performed refractive surgery procedure.

LASIK or Lasik (laser-assisted in situ keratomileusis) is a type of refractive surgery for
correcting myopia, hyperopia, and astigmatism. LASIK is performed by ophthalmologists
using a laser. The procedure is generally preferred to photorefractive keratectomy, PRK, (also
called ASA, Advanced Surface Ablation) because it requires less time for the patient's
recovery, and the patient feels less pain overall. However, there are instances where a
PRK/ASA procedure is medically justified as being a better alternative to LASIK. Many
patients choose LASIK as an alternative to wearing corrective eyeglasses or contact lenses.

a) Wavefront-guided LASIK
Wavefront-guided LASIK is a variation of LASIK surgery in which, rather than applying a
simple correction of focusing power to the cornea (as in traditional LASIK), an
ophthalmologist applies a spatially varying correction, guiding the computer-controlled
Excimer laser with measurements from a wavefront sensor. The goal is to achieve a more
optically perfect eye, though the final result still depends on the physician's success at
predicting changes which occur during healing. In older patients though, scattering from
microscopic particles plays a major role and may outweigh any benefit from wavefront
correction. Therefore, patients expecting so-called "super vision" from such procedures may
be disappointed. Still, surgeons claim patients are generally more satisfied with this technique
than with previous methods, particularly regarding lowered incidence of "halos," the visual
artifact caused by spherical aberration induced in the eye by earlier methods. Currently, there
is no research in support of the surgeons' claims.

LASIK Benefits

Source: Eye Surgery Education Council

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ii) Radial Keratotomy (RK)
The first practical application of Radial Keratotomy (RK) resulted from the occurrence of an
eye accident. In the 1970's, Dr. Fyodorov of Russia was treating a boy whose glasses had
broken and cut his cornea. When the boy's eyes had recovered, his refraction was significantly
less myopic than it was before the injury. Dr. Fyodorov researched past efforts in refractive
surgery and eventually worked out a more predictable formula for refractive surgery.
The Radial Keratotomy (RK) procedure involves using a series of peripheral cuts (incisions)
radiating from the central cornea, with the result of flattening the central cornea. RK can only
correct low degrees of myopia and astigmatism. In 1978, American ophthalmologists became
interested in Dry. Fyodorov's findings. After visiting Dry. Fyodorov in Russia, Dr. Leo Bores
brought the technology back to the United States.

iii) Excimer Laser
The Excimer laser is a device that generates high-energy, cold, ultraviolet pulses. It is a
unique type of light that does not cut bodily tissue, but rather weakens the molecular bond of
tissue cells until the surface tissue disintegrates. When applied to laser eye surgery, the pulses
are delivered to the surface of the eye's cornea, literally vaporizing away eye tissue in order to
reshape the cornea, one microscopic layer at a time.
During laser eye surgery, the Excimer laser is computer controlled and programmed to
custom treat each individual eye with a high degree of precision. The Excimer laser is noted
worldwide for it’s safety and effectiveness.
Although the Excimer laser is now used for laser eye surgery, it was originally used for
etching silicone computer chips in the 1970's. While working in the IBM research laboratories
during 1980 to 1983, Dr.'s Rangaswamy Srinivasin, James Wynne, and Samuel Blum,
discovered the potential of the Excimer laser in relation to biological tissue interactions. They
realized the laser could remove targeted tissue without causing any heat damage to the
surrounding material.
Dr. Steven Trokel, a New York City ophthalmologist, made the connection for reshaping the
corneal tissue and patented the Excimer laser for vision correction. He performed the first
laser surgery on a patient's eyes in 1987. Over the next ten years, the techniques and
equipment for laser eye surgery were perfected. In 1996, the first Excimer laser for refractive
surgery was approved for use in the United States.

iv) Photorefractive Keratectomy (PRK)

Photorefractive Keratectomy (PRK) was the first surgical procedure developed to reshape the
cornea using a laser. In PRK, the top layer of the cornea, called the epithelium, is scraped
away to expose the stroma layer underneath. Because there are nerve fibers in the epithelium,
there may be some initial discomfort equivalent to a badly scratched eye. This can further
cause pain, irritation, watering of the eye, blurry vision, or the feeling of a particle in the eye.
An eye bandage is worn to reduce the irritation and encourage healing of the tissue. Following
PRK, vision is blurry for a few days, but improves as the corneal epithelium heals. Vision is
often reasonably good at one week and stabilized by six months.

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v) Zyoptix

Zyoptix is a new and advanced laser eye treatment from Bausch and Lomb, which experts
hope will help people with vision defects with a better choice.

Zyoptix: Changing perspective of life

Sophisticated technology has made LASIK a fast, virtually painless and very popular
procedure. By 2001, over 2 million people world-wide had chosen LASIK for vision
correction.

It's hard to imagine that Zyoptix can take LASIK to a new dimension in terms of vision
correction. The additional diagnostic screening benefits of wavefront technology has allowed
patient improved selection and personalised treatment to a level never imagined before.
Zyoptix provides surgeons with so much more detailed information on which to base
decisions about your treatment.

Zyoptix was the first system in Europe and Asia that applied Wavefront technology in laser
eye treatment to provide Personalised Vision treatments (sometimes known as Wavefront or
custom LASIK). By September 2003 over 100,000 Zyoptix treatments had been performed.

In October 2003, Zyoptix received FDA approval for use in the USA.

Latest Technology: Zyoptix

Building on its success Bausch & Lomb, launched the very latest technology for Zyoptix
treatments in September 2003.

New features and benefits include:

An enhanced safety feature that ensures the
Iris Recognition
correct eye is treated

A personal file that stores your unique
Zy-ID™ digital ‘map’ of each iris & treatment
information

Compensates and corrects for eye
A faster and Multi-
movements during surgery in x, y and z
Dimensional Eyetracker
dimensions

Treatment times can now be more than twice
100 Hz laser head source
as fast

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Improved Illumination & new
Better visibility during treatment
microscope

More people could eligible for Zyoptix
treatment for example those with long/far
New treatment options
sight, complicated (mixed) astigmatism,
large pupils or thin corneas.

Technology and the Equipment

The advanced Zyoptix treatment depends on highly sophisticated, computer-controlled
equipment, which is integrated by specialised software. In a Zyoptix treatment,
the following equipment is used:

• The Orbscan® topographer
• The Zywave™ aberrometer
• Iris Recognition / Zy-ID™
• Zyoptix Treatment Cards
• The excimer laser
• The eyetracker
• The microkeratome

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Things to be considered before selecting ‘LASIK’ –
Although laser eye surgery is considered a relatively safe procedure, it is still major medical
surgery. As an elective procedure, prospective patients should become informed about the
LASIK procedure and learn about the options, benefits, risks and complications, so that they
can make an informed decision. It is important for patients to get an explanation of the
procedure from the doctor in order to know what to expect before, during, and after LASIK
surgery. Overall, the decision to undergo laser eye surgery involves choosing the best
procedure, finding a qualified doctor, and determining if you are a good candidate for laser
eye surgery.

1. Procedure
There are several necessary preparations in the preoperative period. The operation itself
involves creating a thin flap on the eye, folding it to enable remodeling of the tissue beneath
with a laser. The flap is repositioned and the eye is left to heal in the postoperative period.

Factors affecting surgery
Typically, the cornea is avascular because it must be transparent to function normally, and its
cells absorb oxygen from the tear film. Thus, low-oxygen-permeable contact lenses reduce the
cornea's oxygen absorption, sometimes resulting in corneal neovascularization—the growth of
blood vessels into the cornea. This causes a slight lengthening of inflammation duration and
healing time and some pain during surgery, because of greater bleeding.
Although some contact lenses (notably modern RGP and soft silicone hydrogel lenses) are
made of materials with greater oxygen permeability that help reduce the risk of corneal
neovascularization, patients considering LASIK are warned to avoid over-wearing their
contact lenses. Usually, it is recommended that they discontinue wearing contact lenses days
or weeks before the LASIK eye surgery.
A 2004 Wake Forest University study established that heat and humidity affect LASIK
surgery results, both during the procedure and in the two weeks before the surgery.

a)Preoperative
Patients wearing soft contact lenses are usually instructed to stop wearing them 5 to 21 days
before surgery. One industry body recommends that patients wearing hard contact lenses
should stop wearing them for a minimum of six weeks plus another six weeks for every three
years the hard contacts have been worn. Before the surgery, the patient's corneas are
examined with a pachymeter to determine their thickness, and with a topographer to measure
their surface contour. Using low-power lasers, a topographer creates a topographic map of the
cornea. This process also detects astigmatism and other irregularities in the shape of the
cornea. Using this information, the surgeon calculates the amount and the locations of corneal
tissue to be removed during the operation. The patient typically is prescribed and self-
administers an antibiotic beforehand to minimize the risk of infection after the procedure.

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b)Operation
The operation is performed with the patient awake and mobile; however, the patient is
sometimes given a mild sedative (such as Valium) and anesthetic eye drops.
LASIK is performed in three steps. The first step is to create a flap of corneal tissue. The
second step is remodeling of the cornea underneath the flap with the laser. Finally, the flap is
repositioned.

1) Flap creation
A corneal suction ring is applied to the eye, holding the eye in place. This step in the
procedure can sometimes cause small blood vessels to burst, resulting in bleeding or
subconjunctival hemorrhage into the white (sclera) of the eye, a harmless side effect that
resolves within several weeks. Increased suction typically causes a transient dimming of
vision in the treated eye. Once the eye is immobilized, the flap is created. This process is
achieved with a mechanical microkeratome using a metal blade, or a femtosecond laser
microkeratome (procedure known as IntraLASIK) that creates a series of tiny closely
arranged bubbles within the cornea. A hinge is left at one end of this flap. The flap is folded
back, revealing the stroma, the middle section of the cornea. The process of lifting and folding
back the flap can sometimes be uncomfortable.

2) Laser remodeling
The second step of the procedure is to use an Excimer laser (193 nm) to remodel the corneal
stroma. The laser vaporizes tissue in a finely controlled manner without damaging the
adjacent stroma. No burning with heat or actual cutting is required to ablate the tissue. The
layers of tissue removed are tens of micrometres thick. Performing the laser ablation in the
deeper corneal stroma typically provides for more rapid visual recovery and less pain than the
earlier technique, photorefractive keratectomy (PRK).
During the second step, the patient's vision will become very blurry once the flap is lifted.
They will be able to see only white light surrounding the orange light of the laser, which can
lead to mild disorientation.
Currently, manufactured Excimer lasers use an eye tracking system that follows the patient's
eye position up to 4,000 times per second, redirecting laser pulses for precise placement
within the treatment zone. Typical pulses are around 1 millijoule (mJ) of pulse energy in 10 to
20 nanoseconds.

3) Repositioning of flap
After the laser has reshaped the stromal layer, the LASIK flap is carefully repositioned over
the treatment area by the surgeon and checked for the presence of air bubbles, debris, and
proper fit on the eye. The flap remains in position by natural adhesion until healing is
completed.

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c) Postoperative care
Patients are usually given a course of antibiotic and anti-inflammatory eye drops. These are
continued in the weeks following surgery. Patients are usually told to sleep much more and
are also given a darkened pair of shields to protect their eyes from bright lights and protective
goggles to prevent rubbing of the eyes when asleep and to reduce dry eyes. They also are
required to moisturize the eyes with preservative-free tears and follow directions for
prescription drops. Patients should be adequately informed by their surgeons of the
importance of proper post-operative care to minimize the risk of complications.
Over time, most attention has shifted from other aberrations and centered on spherical
aberration. LASIK and PRK tend to induce spherical aberration, because of the tendency of
the laser to undercorrect as it moves outward from the center of the treatment zone. This is
primarily an issue for major corrections. There are theories that posit that if the lasers were
simply programmed to adjust for this tendency, no significant spherical aberration would
occur. In eyes with few higher order aberrations, wavefront-optimized LASIK (rather than
wavefront-guided LASIK) may well be the future.

2. Selecting a good doctor
One of the most important decisions is choosing the eye surgeon that will perform the
surgery. An experienced and reputable doctor will increase the likelihood of a positive
outcome. To find a qualified doctor, one should try to get a recommendation from your
primary eye doctor and talk to other people who have had eye surgery. Also, be wary of
discount eye centers that offer rates much lower than other doctors - you usually get what you
pay for - and you will most likely be sacrificing quality of care and treatment.

One’s eyes are as unique as your fingerprints. The best LASIK results are achieved when
treatment is customized to one’s individual eyes using wavefront technology.

Any individual’s eyes are as unique as his/ her fingerprints - no two eyes are the same. Even
two eyes of the same person are different from each other. The recommended eye surgery for
a person with visual defect will be based on a visual eye exam by the doctor. After the doctor
examines the patient’s eyes, he will be able to tell whether the patient is a good candidate for
either conventional or custom LASIK eye surgery. If a person does not meet patient criteria
for LASIK, it is likely that he/she may qualify for other laser eye surgery options.

Before your laser eye surgery, as is required before most medical procedures, you will be
asked to sign a consent form. At this time, if you still have any questions or concerns, make
sure you discuss them with your doctor.

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Patient Screening Affects Outcome
Many of the possible complications associated with laser eye surgery can be avoided with
proper screening to ensure that you are an appropriate candidate for laser eye surgery, and if
you are, what the best treatment is for your prescription. Your doctor should test and examine
your vision and explain the results with you. Most complications happen to patients that were
not good candidates for laser eye surgery in the first place, including people with large pupils,
thin corneas, severe astigmatism, high or complex prescriptions, or other eye health problems.
As with any important medical decision, it may be beneficial to get a second opinion. Doctors
have a financial incentive to accept you as a patient, and you want to find an experienced
refractive surgeon that will carefully examine your eyes and make sure you are a good
candidate for laser eye surgery. If you are not a good candidate or have a borderline case,
hopefully one of them will let you know. A reputable laser eye surgeon should turn away
patients that are unlikely to benefit from the procedure.

3. Conditions necessary to be qualified as a LASIK canditate
LASIK eye surgery has successfully treated many individuals with refractive errors, but there
are some people who are not good candidates for the procedure. Before LASIK surgery is
performed, a doctor should conduct pre-op tests and exams to make sure a patient meets the
criteria for LASIK eye surgery. Determining if someone is a good candidate for LASIK
surgery is important in determining the outcome of surgery. Many problems can be avoided
by properly screening patients.

If one wears contact lenses, he/she will want to stop wearing them before their initial LASIK
exam. Contact lenses change the shape of the cornea and it takes some time for the eyes to
settle into their natural curvature. It is important to allow enough time for one’s eyes to
stabilize before proceeding with LASIK otherwise the measurements will not be accurate and
the results could be disastrous. Refer to the chart below for average time needed depending on
the type of contact lenses one wears.

Timetable for Not Wearing Contact Lenses Before LASIK Exam

Source: US FDA

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4. Age
An individual’s vision should be stable for at least a year before laser eye surgery is
performed. Many children and teens who have refractive errors want to have LASIK surgery,
but because eyes continue to change until growth is complete, it isn’t until the early twenties
that most doctors will consider LASIK an option.

New advances in eyesight corrective surgery are providing consumers greater choices.
Patients in their 40s or 50s who are considering LASIK surgery to improve their vision might
want to consider to be evaluated for implantable lenses as well. "Early signs of a cataract
might argue for surgery and implantation of multifocal lenses instead."
The FDA has approved LASIK for age 18 and over. More importantly the person's eye needs
to be stable for two years prior to surgery

5. Health Condition Requirements
• Pregnancy and Breastfeeding - Women who are pregnant or nursing will need to wait
until hormone levels return to normal and the eyes stabilize before having laser eye
surgery.

• Eye Conditions - It is also important that the eyes are healthy and that the patient
doesn’t have any conditions that would make them unsuitable for LASIK, such as
severe dry eyes and corneas that are too thin or steep. However, for people who are
not good candidates for LASIK because of severe dry eye or thin corneas, there are
other laser eye surgery options that may be appropriate.

• Autoimmune Disease - Another health issue that may make a person unsuitable for
LASIK is the presence of an autoimmune disease. The concern with autoimmune
conditions is the unexpected and undesirable responses to eye surgery. The FDA has
listed autoimmune conditions as a contraindication for laser eye surgery, meaning it is
not approved or advised. Although performing LASIK on a person with an
autoimmune condition is an off-label use of a medical device, a doctor may legally
perform the surgery if they feel it is medically appropriate. Many individuals with
autoimmune conditions have undergone LASIK surgery and had successful results. If
you have an autoimmune condition and want to consider laser eye surgery, make sure
you discuss this with your eye surgeon, your primary care doctor, and a neurologist.

17

6. Cost of the surgery -

There is not one "right" price for laser eye surgery. The amount one pays will be based on
many factors, including the surgeon one chooses, the equipment and quality of the laser
system used, the time given to each patient and procedure, one’s vision prescription, and
the type of procedures being performed.

Comparing LASIK Prices
When comparing advertised prices, one should also be comparing what is included in that
amount and what is not. There can be a wide variation in what the advertised price includes.
About the only thing that is the same no matter where one goes, is that the price is quoted "per
eye."
The best value is not going to be in finding the cheapest price per eye but in the total quality
of service you'll be receiving for the total amount you'll be paying.
When the cost of LASIK surgery can vary from less than $1,000 to over $3,000 per eye,
obviously wide differences exist.

Consider the following criteria:
1. SURGEON - The fee for a surgeon will be based on training and experience. A skilled
surgeon with proper training and extensive operative experience will cost more than a
surgeon with minimal training or a low amount of experience. Rather than trying to
find the cheapest doctor, find out about the surgeon's credentials and record of
procedures.

2. EQUIPMENT - Technology matters and state-of-the-art equipment costs more. Ask
what laser system the doctor is using and make sure that it is FDA approved for the
procedure one'll be receiving. As differences exist in the technology from machine to
machine, one needs that machine that is best suited to correct their vision prescription.
It is also important that the equipment be properly maintained. The equipment is
expensive to purchase (about $500,000) and costly to maintain properly (about
$90,000 annually), costs that are reflected in the price of surgery. A discount price
may indicate that substandard equipment is used or that maintenance is not what it
should be.

3. TIME- Fees can vary based on the level of preoperative testing and postoperative
check -ups. Many problems can be avoided with proper screening and testing, so it's
important to find a doctor that will take the time to test and screen, answer questions
and talk about expectations, explain procedures, risks and complications, follows up
with postoperative check -ups, and performs enhancements if necessary. Ask if these
tests and appointments are all included in the fee. A discount center may skimp on
appointments or not provide adequate time with each patient. Also, while many
reputable doctors quote prices that includes all visits and procedures, a discount center
may lure one with a low surgery price, but it bills one separately for tests, visits and
enhancements.

18

4. PRESCRIPTION - The type of correction one needs will be determined by their vision
prescription. The more correction that needs to be done, the higher the cost. Most
people are not eligible for the low price stated in ads that advertise "LASIK from $500
per eye" as their eyes require more extensive correction or more follow-up after
surgery.

5. PROCEDURE - The surgery price will be based on what LASIK procedures one is
getting done. Custom LASIK uses wavefront technology to measure and map the eye,
and costs more than traditional LASIK. LASIK with IntraLase which uses a laser to
cut the flap in the eye rather than using a microkeratome, also costs more.

Average Cost of Conventional LASIK in 2008

Average Cost of Wavefront LASIK with Intralaser in 2008

‘LASIK Price – should not be an issue’
With something as important as one’s eyesight, it is important to consider more than price.
One should look for a qualified doctor who uses up-to-date and well-maintained equipment,
who will spend time to properly evaluate the eyes of people with vision defect and makes the
best recommendations for you, and who will provide thorough follow-up care. When given
the cost for one’s eye surgery, ask what is included in the fee and what is not included.

19

7. Lasik complications
Although the majority of LASIK patients are happy with the outcome of their eye surgery, as
with any elective medical procedure, the possible complications should be considered prior to
treatment. One may receive inputs from friends who have had the procedure and doctors who
perform the surgery, but ultimately the decision should be of the individual who is
considering to undergo the surgery.

• Factors for Favorable Outcomes
Many complications can be avoided with proper testing and screening to ensure that you are a
good candidate for LASIK eye surgery. Selecting an experienced surgeon who has performed
hundreds or thousands of procedures also increases your chances of a successful surgery.
There is never a guarantee in any medical procedure, even if you're the best candidate and
you're operated on by the best surgeon who uses the best equipment, but it greatly reduces the
chance of an unfavorable outcome.

• Rate of LASIK complications -
According to studies done in the late 1990's, about five percent of LASIK patients
experienced some type of problem.
Currently, experienced LASIK surgeons report that only about 1% of their LASIK eye
surgery patients experience complications if the doctors carefully select only those people that
are good candidates for the procedure.
Even if complications do occur, most of them can be corrected with further treatments and
enhancements. It is very rare to experience permanent and significant vision loss with LASIK
eye surgery. Many of the possible concerns associated with LASIK eye surgery can be
corrected and treated with timely and accurate medical care.

• Intraoperative complications

The incidence of flap complications has been estimated to be 0.244%.Flap complications
(such as displaced flaps or folds in the flaps that necessitate repositioning, diffuse lamellar
keratitis, and epithelial ingrowth) are common in lamellar corneal surgeries but rarely lead to
permanent visual acuity loss; the incidence of these microkeratome-related complications
decreases with increased physician experience.
According to proponents of such techniques, this risk is further reduced by the use of
IntraLasik and other non-microkeratome related approaches, although this is not proven and
carries its own set of risks of complications from the IntraLasik procedure.
A slipped flap (a corneal flap that detaches from the rest of the cornea) is one of the most
common complications. The chances of this are greatest immediately after surgery, so patients
typically are advised to go home and sleep to let the flap heal. Patients are usually given sleep
goggles or eye shields to wear for several nights to prevent them from dislodging the flap in
their sleep. A faster operation may decrease the chance of this complication, as there is less
time for the flap to dry.

20

• Flap interface particles are another finding whose clinical significance is
undetermined. A Finnish study found that particles of various sizes and reflectivity
were clinically visible in 38.7% of eyes examined via slit lamp biomicroscopy, but
apparent in 100% of eyes using confocal microscopy.

• Early postoperative complications
The incidence of diffuse lamellar keratitis (DLK), also known as the Sands of Sahara
syndrome, has been estimated at 2.3%. When diagnosed and appropriately treated, DLK
resolves with no lasting vision limitation.
The incidence of infection responsive to treatment has been estimated at 0.4%. Infection
under the corneal flap is possible. It is also possible that a patient has the genetic condition
keratoconus that causes the cornea to thin after surgery. Although this condition is screened in
the preoperative exam, it is possible in rare cases (about 1 in 5,000)[citation needed] for the
condition to remain dormant until later in life (the mid-40s). If this occurs, the patient may
need rigid gas permeable contact lenses, Intrastromal Corneal Ring Segments (Intacs),
Corneal Collagen Crosslinking with Riboflavin or a corneal transplant.
The incidence of persistent dry eye has been estimated to be as high as 28% in Asian eyes and
5% in Caucasian eyes. Nerve fibers in the cornea are important for stimulating tear
production. A year after LASIK, subbasal nerve fiber bundles remain reduced by more than
half. Some patients experience reactive tearing, in part to compensate for chronic decreased
basal wetting tear production.
The incidence of subconjunctival hemorrhage has been estimated at 10.5% (according to a
study undertaken in China; thus results may not be generally applicable due to racial and
geographic factors).

Late postoperative complications
The incidence of epithelial ingrowth has been estimated at 0.1%.Glare is another commonly
reported complication of those who have had LASIK. Halos or starbursts around bright lights
at night are caused by the irregularity between the lasered part and the untouched part. It is
not practical to perform the surgery so that it covers the width of the pupil at full dilation at
night, and the pupil may expand so that light passes through the edge of the flap into the
pupil. In daytime, the pupil is smaller than the edge. Modern equipment is better suited to
treat those with large pupils, and responsible physicians will check for them during
examination.
Late traumatic flap dislocations have been reported 1–7 years post-LASIK.

Other Complications
Lasik and other forms of laser refractive surgery (i.e. PRK, LASEK and Epi-LASEK) change
the dynamics of the cornea. These changes make it difficult for your optometrist and
ophthalmologist to accurately measure your intraocular pressure, essential in glaucoma
screening and treatment. The changes also affect the calculations used to select the correct
intraocular lens implant when you have cataract surgery. This is known to ophthalmologists
as "refractive surprise." The correct intraocular pressure and intraocular lens power can be
calculated if you can provide your eye care professional with your preoperative, operative and
postoperative eye measurements.

21

Although there have been improvements in LASIK technology, a large body of conclusive
evidence on the chances of long-term complications is not yet established. Also, there is a
small chance of complications, such as haziness, halo, or glare, some of which may be
irreversible because the LASIK eye surgery procedure is irreversible.
The incidence of macular hole has been estimated at 0.2 percent to 0.3 percent. The incidence
of retinal detachment has been estimated at 0.36 percent. The incidence of choroidal
neovascularization has been estimated at 0.33 percent. The incidence of uveitis has been
estimated at 0.18 percent.
Although the cornea usually is thinner after LASIK, because of the removal of part of the
stroma, refractive surgeons strive to maintain the maximum thickness to avoid structurally
weakening the cornea. Decreased atmospheric pressure at higher altitudes has not been
demonstrated as extremely dangerous to the eyes of LASIK patients. However, some
mountain climbers have experienced a myopic shift at extreme altitudes.
In situ keratomileusis effected at a later age increases the incidence of corneal higher-order
wavefront aberrations. Conventional eyeglasses do not correct higher order aberrations.
Microfolding has been reported as "an almost unavoidable complication of LASIK" whose
"clinical significance appears negligible."
Blepharitis, or inflammation of the eyelids with crusting of the eyelashes, may increase the
risk of infection or inflammation of the cornea after LASIK.[citation needed]
Myopic (nearsighted) people who are close to the age (mid- to late-forties) when they will
require either reading glasses or bifocal eyeglasses may find that they still require reading
glasses despite having undergone refractive LASIK surgery. Myopic people generally require
reading glasses or bifocal eyeglasses at a later age than people who are emmetropic (those
who see without eyeglasses), but this benefit is lost if they undergo LASIK. This is not a
complication but an expected result of the physical laws of optics. Although there is currently
no method to completely eradicate the need for reading glasses in this group, it may be
minimized by performing a variation of the LASIK procedure called "slight monovision." In
this procedure, which is performed exactly like distance-vision-correction LASIK, the
dominant eye is set for distance vision, while the non-dominant eye is set to the prescription
of the patient's reading glasses. This allows the patient to achieve a similar effect as wearing
bifocals. The majority of patients tolerate this procedure very well and do not notice any shift
between near and distance viewing, although a small portion of the population has trouble
adjusting to the monovision effect. This can be tested for several days prior to surgery by
wearing contact lenses that mimic the monovision effect.There are reports of decrease in the
number of corneal keratocytes (fibroblasts) after LASIK.

• LASIK Eye Surgery Complications Include:

1) Visual Aberrations Symptoms
2) Dry Eye Symptoms
3) Infection. Symptoms
4) Incomplete Correction (undercorrection, overcorrection, or regression). Symptoms
5) Irregular Astigmatism. Symptoms
6) Flap Folds or Wrinkles.

22

7) Keratectasia..
8) Diffuse Lamellar Keratitis (DLK).
9) Epithelial Ingrowth.
10) Higher order aberrations
11) Spherical aberration

8. LASIK SURGERY RECOVERY
Although each laser eye surgery patient responds and heals differently to the LASIK
procedure, most patients have a quick recovery with little discomfort and wake-up the next
morning with great vision. Always follow your doctor's instructions for post-surgery care as
what happens after laser eye surgery can affect the outcome as much as the laser eye surgery
itself.

1) Short Term Recovery
Immediately after LASIK surgery the doctor will have you rest for a short time in the office,
then let you go home with instructions to rest for several hours (letting someone else drive
you home). The doctor may cover your eyes with an eye shield to protect them for the first
day. Most people experience 4-6 hours of mild irritation, and your doctor will probably
suggest taking a mild pain reliever. Your eyes may tear or water and your vision may be hazy
or blurry. Your eyes may itch or feel like there is something in them, and you will want to rub
your eyes, but don't! There is a slim chance that rubbing your eyes could dislodge the corneal
flap and necessitate further treatment. You may also experience sensitivity to light, but this
usually improves considerably after the first few days.

• Rest
Although many LASIK patients can return to work the next day, you should try to schedule a
few days of rest. Most doctors will advise you to avoid any exercise workouts or strenuous
activities for the first week that might traumatize the eye and affect healing. Strenuous contact
sports are usually not recommended for at least a month after surgery, in order to protect the
eyes from anything that might get in them and keep them from being bumped or hit.

• Eye Products
In order to prevent eye infection from surgery, your doctor may advise you to avoid the use of
lotions, creams or make-up around the eye for a short time, from a couple of days to a couple
of weeks depending on how your eyes are healing. It is also advised to avoid swimming and
using hot tubs for one to two months.

• First Check-Up
You should see your laser eye doctor for the first check-up within 24-48 hours after surgery.
Your doctor will remove the eye shield, test your vision, and examine your eyes. He may give
you eye drops to use to help prevent infection and inflammation and advise you to use
artificial tears to help lubricate the eye. Do not wear your contacts even if your vision is
blurry.

23

LASIK Recovery Timetable

Source: US FDA

2) Long Term Recovery

During the first six months after laser eye surgery (the normal healing time), one should
expect to visit your doctor for periodic check-ups. If at any time one’s vision or other
symptoms get worse instead of better, one should contact the doctor immediately and not wait
for their next scheduled visit. If there is a problem, it is best to treat it as soon as possible.
After LASIK eye surgery, ones vision takes time to stabilize and may fluctuate for up to three
to six months.

If further correction or enhancement is necessary, the doctor will usually wait until the eyes
have stabilized and the eye measurements are consistent for two consecutive visits at least 3
months apart.

LASIK eye surgery is permanent, however one’s eyes may change naturally with time.
LASIK does not prevent presbyopia and the eventual need for reading glasses.

24

• LASIK EYE SURGERY STATISTICS
Millions of people have had laser eye surgery and the majority are satisfied with the outcome
(93% according to the ASCRS - American Society of Cataract and Refractive Surgery).
Ninety-five percent of patients reported improved vision, and eighty-five percent said their
quality of life improved.

Laser Eye Surgery Results

Source: Eye Surgery Education Council

• LASIK Expectations
Two LASIK patients with the same outcome may have a difference of opinion on the outcome
of the surgery, based on their expectations. Your doctor should discuss what to expect before,
during and after your surgery, including any questions you might have. It is important to be
fully informed before the surgery.

• LASIK enhancement
Following LASIK surgery, the healing period is approximately six months. It is estimated that
an average of 5-10% or surgeries need an enhancement. A LASIK enhancement is just a fine-
tuning of the original surgery should it be necessary.

9. Comparing Test Results

When comparing statistics on lasers and procedures, it is important to keep in mind the
perspective and limits of the tests as reported. When viewing laser statistics, keep in mind the
following points:
Today's results are probably better than FDA date due to technical improvements and surgeon
experience
FDA data in one study cannot always be fairly compared to FDA data in another study due to
differences in study designs and patient criteria - there has never been a head to head study
that has shown that one laser is consistently better than another laser
Studies cannot cover every possibility

25

Once the FDA approves the laser, the surgeon can use the laser any way they believe is
appropriate, commonly referred to as "off-label" use.
In addition to reported laser results, the quality of the laser will also be dependent on whether
or not the laser equipment is being properly maintained.
While it is true that certain patients may be better off with one type of laser over another, for
most people the choice of laser does not make a significant difference. The final vision
outcome is more importantly influenced by the skill and experience of the surgeon and the
quality of care before and after the eye surgery.

One of the most important factors in achieving a positive outcome with laser eye surgery is
determining whether one is a good LASIK candidate.

• LASIK surgery results
The surveys determining patient satisfaction with LASIK have found most patients satisfied,
with satisfaction range being 92–98 percent. A meta-analysis dated March 2008 performed by
the American Society of Cataract and Refractive Surgery over 3,000 peer-reviewed articles
published over the past 10 years in clinical journals from around the world, including 19
studies comprising 2,200 patients that looked directly at satisfaction, revealed a 95.4 percent
patient satisfaction rate among LASIK patients worldwide.

Safety and efficacy
The reported figures for safety and efficacy are open to interpretation. In 2003, the Medical
Defence Union (MDU), the largest insurer for doctors in the United Kingdom, reported a 166
percent increase in claims involving laser eye surgery; however, the MDU averred that these
claims resulted primarily from patients' unrealistic expectations of LASIK rather than faulty
surgery. A 2003 study, reported in the medical journal Ophthalmology, found that nearly 18
percent of treated patients and 12 percent of treated eyes needed retreatment. The authors
concluded that higher initial corrections, astigmatism, and older age are risk factors for LASIK
retreatment.
In 2004, the British National Health Service's National Institute for Health and Clinical
Excellence (NICE) considered a systematic review of four randomized controlled
trials[18][19] before issuing guidance for the use of LASIK within the NHS.[20] Regarding
the procedure's efficacy, NICE reported, "Current evidence on LASIK for the treatment of
refractive errors suggests that it is effective in selected patients with mild or moderate short-
sightedness," but that "evidence is weaker for its effectiveness in severe short-sightedness and
long-sightedness." Regarding the procedure's safety, NICE reported that "there are concerns
about the procedure's safety in the long term and current evidence does not appear adequate to
support its use within the NHS without special arrangements for consent and for audit or
research."
Leading refractive surgeons in the United Kingdom and United States, including at least one
author of a study cited in the report, believe NICE relied on information that is severely dated
and weakly researched.
On October 10, 2006, WebMD reported that statistical analysis revealed that contact lens
wear infection risk is greater than the infection risk from LASIK. Daily contact lens wearers

26

The researchers calculated the risk of significant vision loss consequence of LASIK surgery
to be closer to 1-in-10,000 cases.

Patient dissatisfaction
Some patients with poor outcomes from LASIK surgical procedures report a significantly
reduced quality of life because of vision problems. Patients who have suffered LASIK
complications have created websites and discussion forums to educate the public about the
risks, where prospective and past patients can discuss the surgery. In 1999, Surgical Eyes was
founded in New York City by RK patient Ron Link as a resource for patients with
complications of LASIK and other refractive surgeries. Other patient-founded websites to
assist those with complications are LaserMyEye founded in 2004 and Vision Surgery Rehab
in 2005. Most experienced and reputable clinics will do a full-dilation medical eye exam prior
to surgery and give adequate post-operative patient education care to minimize the risk of a
negative outcome.
For best results, Steven C. Schallhorn, an ophthalmologist who oversaw the US Navy's
refractive surgery program and whose research partly influenced the Navy's decision to allow
its aviators to get LASIK, recommends patients seek out what's called "all-laser Lasik"
combined with "wavefront-guided" software.
The FDA website on LASIK clearly states: "Before undergoing a refractive procedure, you
should carefully weigh the risks and benefits based on your own personal value system, and
try to avoid being influenced by friends that have had the procedure or doctors encouraging
you to do so." As such, prospective patients still need to fully understand all the potential
issues and complications, as satisfaction is directly related to expectation.
The FDA received 140 "negative reports relating to LASIK" for the time period 1998–2006.

P.N. : This is presentation of secondary data – source of information being the internet – In order
to facilitate greater understanding of the service being researched and also to provide statistics of
global trends in this laser vision correction industry market that is spread worldwide.

27

ANALYSIS OF THE INTERVIEWS CONDUCTED

• Interviews with Ophthalmologists ( eye doctors) -

No. Name of Locality for Qualifications Experience No. of laser
the doctor medical practice – surgeries
in Ahmedabad done
1 Yogesh Kapoor C.G.Road Refractive Surgeon- 18 years 1700
MS(ophthalmology)
2 Mitesh Ramany Maninagar MS(ophthalmology) 14 years Over 500

3 Diyank Bhrambhatt Navrangpura MS(ophthalmology) 15 years Over 500

4 Brijesh .C.Patel Stadium Road MS(ophthalmology) 5 years 500
5 Tejas D. Shah & Panjrapole M.S. D.O. 18 years Over 1000
Preksha V. Shah Crossroads

(P.N. : Interview’s question format is attached in the annexures section)

( Other than the 5 doctors mentioned above , we had gone to meet a 6th doctor –Dr.Ashish Dave in
Maninagar but he refused to discuss anything about laser vision correction because as an eye doctor
he didn’t believe it to be a safe or better solution for vision related problems so he had not prescribed
or performed even a single laser surgery till now for any of his patients.)

Presentation of information collected-

1) Types of treatment techniques available –
a) Simple / Standard Laser
b) P.R.K.
c) Lasik
d) Wavefront
e) Tempto sound
f) Lapto Lasik
g) Zyoptix (advanced technology developed & provided by Bausch and Lomb clinic)

2) Cost range for treatment- Between Rs. 15000 to Rs.40000
( Range found by taking the least among starting costs and highest among the maximum costs
from the information given by the above mentioned 5 ophthalmologists)

28

3) Laser surgery is recommended by-

Laser surgery ACCORDING TO BELOW MENTIONED DOCTORS’ OPINION
is recommend
Dr.Yogesh Dr.Mitesh Dr.Diyank Dr.Brijesh C. Dr. Tejas D.
-ed by : Kapoor Ramany Bhrambhatt Patel Shah

50% - - 10% to 15% -
Optician
50% 100% 100% 70% 100%
Ophthalmologist
4) Various kinds of vision defects requiring such kind of a surgery are-
a) Myopia
b) Hypermetropia
c) Astigmatism
d) Far sightedness
e) Near sightedness

5) ‘Laser surgery- as a permanent solution to all vision defects’- Doctors’ opinion
was :
a) Four doctors agreed that laser surgery was a permanent solution for vision defects
b) Dr. Yogesh Kapoor (Chief surgeon at Bausch and Lomb clinic) believed that in some
cases, patient may get vision defects again especially patients who before surgery also
used spectacles with ‘more than 14’ power lenses.

6) The success ratio of such laser surgeries is-

ACCORDING TO BELOW MENTIONED DOCTORS’ OPINION
Dr.Yogesh Dr.Mitesh Dr.Diyank Dr.Brijesh .C. Dr. Tejas D.
Kapoor Ramany Bhrambhatt Patel Shah

Success ratio of
Laser surgery is : 96.75% 99.99% 99.90% 100% 100%

29

7) Age limit for such a surgery –


Age limit for Above 18 18-50 years Above 18 Less than 40 No
Laser surgery is : years years years
(person
between
18- 21 years
only, if their
vision
prescription
has
stabilized)

8) Side effects if any –then they are as follows:

Side Effects ACCORDING TO BELOW MENTIONED DOCTORS’ OPINION

Yes / No Some cases No Sometimes No No
only due to
negligence of
doctors
a) Dry eyes - a) Night glare - -
Types of side effects b) Blurred b) Under
night vision correction or
over correction

9) Recuperating period
All doctors felt that 1 day of rest after surgery is enough for patient to recover and feel better.

30

10) Inspite of being a superior alternative to combat vision defects –reasons
for lesser acceptability among people –


a) fear a)fear of damage a) surgery phobia a) ignorance a) ignorance
Reasons for lesser b) ignorance to eyes b) surgery b) high cost
popularity of c) high cost b) high cost phobia
Laser surgery
among people is
because of these
reasons :

11) Popularity of laser surgery from ‘Gender’ perspective –

Popularity among ACCORDING TO BELOW MENTIONED DOCTORS’ OPINION
Both genders
Less Less Less
Males 50% favoured 60% favoured favoured
More More More
Females 50% favoured 40% favoured favoured

31

12) Popularity of laser surgery with regard to economic stature of customers is –


Socio economic
status of patients All income a) Mostly - rich All income All income All income
opting for laser groups b) 20% - needy groups groups groups
surgery

Spectacles cost between Rs.250 to Rs.1500 and contact lenses cost between Rs. 1500 to Rs. 5000-
whereas laser surgeries cost around Rs 15000 to Rs 40000.
Still, doctors said that cost was not a hindrance when something as important as eyes and its
vision quality was concerned and in some cases when vision gets very weak getting laser surgery
done becomes necessary- i.e. why people across all income groups opt for such an operation.

32

Presentation of information collected from opticians –

(P.N. : Interview’s question format is attached in the annexures section)

Opticians 1 2 3 4 5
Ratio of
Spectacles and
Contact lenses 60% & 40% 80% & 20% 90% & 10% 80% & 20% 65% & 35%
usage respectively

Whether customers
enquire regarding 7% to 8% Yes Yes 5% Yes
Laser Vision
Surgery

Gender - which
brings more of Female Female Female Female Female
such queries

Income group –
which All Rich Rich Rich Rich
brings more of
such queries

Opticians –whether
offer laser surgery Yes Yes No No Yes
related information
on own initiative

Tie- ups with any
Laser centre Yes No No No No

Laser Vision
Surgery– whether Mostly No No No No
superior to
Spectacles and
Contact lenses

33

COMPOSITION OF THE RESPONDENTS OF THE SURVEY
The sampling method used is convenience sampling - still care has been taken to ensure that
respondents selected come from varied localities of Ahmedabad, are of different age groups and
income classes, have opted for different vision correction solutions, have been experiencing vision
defects for different time spans and that the data is not gender biased. This has been done to enable us
to get a more clear and accurate picture of the market sentiments of people all across Ahmedabad.

So, before presenting the survey results – the respondents composition is being presented.

(P.N. : Survey’s questionnaire format is attached in the annexures section)

Total respondents = 460

( A ) GENDER

Female respondents = 244
( Including 15 laser surgery patients, other 229 respondents are those who use conventional solutions
like spectacles or contact lenses)

Male respondents = 216
( Including 9 laser surgery patients, other 229 respondents are those who use conventional solutions
like spectacles or contact lenses)

GENDER COMPOSITION

MALE
43% MALE
FEMALE FEMALE
57%

34

( B ) Area of residence of respondents
The purpose behind selection of this criteria is to understand the attitude of people residing in
different localities towards the treatment ‘ Laser Vision Correction Surgery’. Though all the
respondents reside within Ahmedabad city , but still staying at different locations within the city
affects their attitudes to great extent because each locality is more like a social group which has its
own values, lifestyle, spending capacities and cultural barriers and all of us very well understand the
impact of all of these on consumer buying behaviour - here we are primarily concerned with
understanding the consumer’s (actual and potential) attitude regarding a service (laser surgery) being
offered to them.
Here, we have surveyed a total of 66 localities – the aim being a diversified set of respondents.


Area No. of Respondents Area No. of Respondents
Maninagar 73 Naroda 8
Amraivadi 6 Rakhial 3
Khokra 40 Meghaninagar 6
Satellite 31 Kalapinagar 2
C.G.Road 13 Gurukul 4
Navrangpura 70 Ghirdharnagar 2
Naranpura 30 Akbarnagar 1
Bapunagar 11 Odhav 1
Sardarnagar 1 Jawahar chowk 1
Bavla 1 Nehrunagar 1
Ashram road 3 Sardar patel park 1
Vasna 10 Vatva 1
Vadaj 3 Kalupur 3
Vejalpur 4 Ranip 1
Raipur 1 Science City 1
Khedia 1 CTM 3
Isanpur 18 Stadium Crossroads 6
Sabarmati 9 Bopal 2
Motera 3 Shastrinagar 1
Ghodasar 6 Bodakdev 3
Ambavadi 4 Thakkarbapanagar 2
Hatkeshwar 1 Prahladnagar 1
Vastrapur 3 Bhimjipura 1
Chandkheda 7 Subhashbridge 1
Shahpur 3 Sarkhej 2
Shahibaug 14 Thaltej 1
Nikol 2 Paldi 3
Swastik 1 Ghatlodia 2
Panchvati 2 Chandlodia 1
New C.G. Road 13 Ellisbridge 1
Hansol 4 Ankur 1
Law garden 2 Indira bridge 1
Jivraj Park 1 Judges Bungalow Road 1

35

A map of Ahmedabad city has been presented in order to understand better that how dispersed is
our respondent set and this has been done in order to ensure an unbiased response which would
not have been the case if we would have opted for people concentrated in just a few specific
locations.

36

( C ) AGE OF RESPONDENTS


AGE OF RESPONDENTS FEMALE MALE TOTAL
0 - 10 2 0 2
10 - 20 150 81 231
20 - 30 38 61 99
30 - 40 19 20 39
40 - 50 28 37 65
50 - 60 5 16 21
60 - 70 2 1 3
TOTAL 244 216 460

160
AGE OF RESPONDENTS

140
NO. OF RESPONDENTS

120

100
FEMALE
80
MALE
60

40

20

0

0-10 10-20 20-30 30-40 40-50 50-60 60-70

AGE GROUP

37

( D ) PERIOD OF VISION DEFECT EXPERIENCE
By including question regarding this criteria in the questionnaire used for the survey , we sought to
understand whether the period of vision defect experience was an important underlying factor used
by people to select laser vision correction surgery or not.
But, surprisingly period of vision defect experience did not influence respondents much. As most of
them with similar periods of eyesight problems experience had varying opinions regarding laser
vision correction surgery.

Period of vision defect 0-6 6-12 12-18 18-24 24-30 30-36 TOTAL
Gender
Female 156 69 13 1 4 1 244
Male 114 66 17 10 9 0 216
TOTAL 270 135 30 11 13 1 460

PERIOD OF VISION DEFECT EXPERIENCE

180
160
NO. OF RESPONDENTS

140
120
100 Female
80 Male
60
40
20
0
0-6 6-12 12-18 18-24 24-30 30-36
PERIOD OF VISION DEFECT EXPERIENCE

38

( E ) INCOME OF RESPONDENTS

This criteria was added to check if a person’s income had bearing on his decision to opt for laser
surgery , as it was offered at a comparatively higher rate than spectacles or contact lenses. But, no
specifically biased response was seen owing to the income factor.


INCOME GROUP FEMALE MALE TOTAL
Upto 20000 117 77 194
20000 – 40000 68 78 146
40000 – 60000 27 27 54
Above 60000 32 34 66
TOTAL 244 216 460

INCOME OF REPONDENTS
140
NO.OF RESPONDENTS

120

100

80
FEMALE
60 MALE
40

20

0
Upto 20000 20000 – 40000 40000 – 60000 Above 60000
INCOME OF REPONDENTS

39

( F ) MEASURE SELECTED FOR VISION CORRECTION
As mentioned earlier also, the respondent set included just the people with vision defects, we have
tried to select respondents who use varied means to combat vision problems, again it was an attempt
to avoid skewed data.


VISION CORRECTION SOLUTION USED FEMALE MALE TOTAL
Spectacles 184 178 362
Contact Lenses 28 18 46
Both ( Spectacles and Contact Lenses) 17 11 28
Laser Surgery 15 9 24
TOTAL 244 216 460

MALE

5% 4%
Spectacles
8%

Contact Lenses

Both ( Spectacles and
Contact Lenses)
Laser Surgery
83%

6%
FEMALE
7%
Spectacles

11%
Contact Lenses

Both ( Spectacles
and Contact Lenses)
Laser Surgery
76%

40

After, looking at the composition of the respondents set – it can be clearly understood that utmost
care has been taken to collect the relevant data from a varied set of people to get unbiased responses
in order to maintain a level of accuracy inspite of the limited sample size that we had chosen.

We were also able to make out that the respondents’ belonging to any particular locality, age group,
income group, gender etc. did not have a bearing on their responses i.e. to emphasize on the fact that
we received varied responses from people belonging to same groups (groups as in age group, income
group etc.)

This above stated finding in a sense contradicts the beliefs of the eye experts ( Opticians and
Ophthalmologists ) . The experts beliefs were –
1. Females were in more favour of this treatment than the males
( Respondents of both genders showed great confidence in this treatment )
2. Only the affluent class were keen on getting this treatment done
( Respondents of middle and lower middle class also were willing to get this treatment done )

Thus, even those people whom the experts considered as not being a segment of the potential market
were actually keen to know more about this service and take its benefit in the near future.

P.N. – Henceforth, from the next page onwards - all the data i.e. being presented is just about
those 436 ( 460 – 24 = 436 ) respondents who use spectacles or contact lenses only. These
436 respondents are the potential consumers for laser vision correction surgery
treatment. Their opinions will reflect the sentiments of the potential or available market.
This data will be of utmost importance to the entities providing this service as they will
be better informed and equipped to reach out to a greater number of these type of
respondents who have not yet used their service but in future may decide to do so – if
their certain problems with regard to acceptance of the said service are well addressed.

The analysis for the remaining 24 (460 – 436 ) respondents i.e. people who have already
undergone laser surgery i.e. the actual consumers of this service is given separately after
the analysis of these 436 respondents.

41

( A ) AWARENESS REGARDING THE EXISTENCE OF A ‘ LASER VISION
CORRECTION SURGERY ’ TREATMENT

A question was asked to determine whether people were aware of such a treatment being offered to
combat their eyesight related problems. Assessing the awareness level among people in Ahmedabad
being the primary objective of our project, because then only we could list reasons for non acceptance
of laser vision correction surgery among these potential customers (people using spectacles and
contact lenses). The reason being that ‘awareness’ is the precondition for acceptance or non
acceptance of any product or service- in this case for the ‘ laser surgery’ service being offered .

Listed below are the responses generated for the question – ‘Awareness regarding the existence
of a treatment like ‘ Laser Vision Correction Surgery ’ ?

Gender
Female Male TOTAL
Response
Yes 207 184 391
No 22 23 45
TOTAL 229 207 436

AWARENESS REGARDING LASER VISION CORRECTION
TREATMENT

250

200
NO.OF RESPONDENT

150
FEMALE
MALE
100

50

0
Yes No
RESPONSES

42

(B) EXPOSURE TO ADVERTISEMENT ABOUT ‘ LASER VISION
CORRECTION SURGERY ’

Responses generated with regard to the question asked –‘ Have you come across any
advertisements for ‘laser vision correction surgery’? ’

Gender Female Male TOTAL
Response
Yes 182 168 350
No 47 39 86
TOTAL 229 207 436

EXPOSURE TO ADVERTISEMENT

200
180
NO.OF RESPONDENT

160
140
120
Fem ale
100
Male
80
60
40
20
0
Yes No
RESPONSES

43

( C ) MEDIUM OF ADVERTISEMENT – BY WHICH CONSUMERS ARE
EXPOSED TO INFORMATION ON LASER VISION CORRECTION
SURGERY

There were 5 options of advertisement mediums given to the respondents to select from – they were
as follows –
a) Hoardings
b) Television
c) Newspaper
d) Radio
e) Other print media

Respondents of the survey questionnaire had selected one or more options of mediums where they
had come across advertisements about ‘laser vision correction surgery’. Here, we have not listed the
frequency of respondents who had selected any particular option or set of options, but we have rather
listed the frequency of their exposure to a number of type of mediums of advertisements – because
‘which medium’ was not our area of interest (with relation to the objective of our project ) but rather
we chose to study ‘how many different mediums’ were the potential customers exposed to – because,
it would have a more direct impact on the level of awareness and probable acceptance of this
treatment as it is a known fact that - more the number of sources that provide information regarding a
product/service – more is the product/service recall – because repeatedly given information tends to
get stored in consumer minds – this in turn may translate into more acceptance by the potential
customers n the future.

Gender Female Male TOTAL
No. of advertisement mediums
No medium 45 36 81
1 medium 90 66 156
2 mediums 73 69 142
3 mediums 15 31 46
4 mediums 5 4 9
5 mediums 1 1 2
TOTAL 229 207 436

No. of advertisement mediums

100
90
N o re p d nts

80
70
o. f s on e

60
Female
50
Male
40
30
20
10
0
No 1 2 3 4 5
m e dium m e dium m e dium s m e dium s m e dium s m e dium s
No. of adve rtis e m e nt m e dium s

44

The same question has been analysed, in order to understand which mediumhas been more effective
in order to analyse which medium has been successful to inform a greater mass of people

We, can see that hoardings and newspaper have been major mediums for educating people regarding
this treatment

MEDIUM OF ADVERTISEMENT MALE FEMALE TOTAL
Hoardings 146 93 239
Television 45 16 61
Newspaper 90 138 228
Radio 5 5 10
Other Print Media 20 66 86
TOTAL 306 318 624

MEDIUM OF ADVERTISEMENT
14%
2% Hoardings
37% Television
Newspaper
Radio
37% Other Print Media

10%

45

( D) SUPERIORITY OF ‘LASER VISION CORRECTION SURGERY’ AS
COMPARED TO OTHER VISION CORRECTION SOLUTIONS LIKE
SPECTACLES AND CONTACT LENSES

This information was sought by means of the questionnaire used in the survey in order to determine
whether the people considered laser vision correction surgery to be better as compared to other
conventional vision solutions in the first place – because their perception with regard to its superiority
will determine acceptance of laser vision correction solution in the near future by the respondents
(potential customers).

Gender Female Male Total
Response
Yes 169 161 330
No 58 45 103
Not sure 2 1 3
Total 229 207 436

Superiority of laser surgery as compared to other vision correction
solutions
180
160
No. of respondents

140
120
100 Female
80 Male
60
40
20
0
Yes No Not sure

Responses

46

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