- Medically Reviewed by: Mr Mfazo Hove, Consultant Ophthalmic Surgeon
- Author: Mr Mfazo Hove
- Published: August 11, 2026
- Last Updated: August 6, 2026
The Real, The Fake and The Future of Eye Surgery
I am writing this from China, partway through a family journey that has taken us to Shanghai and will carry us on to Beijing, to the pandas of Chengdu and to West Lake in Hangzhou. The trip is not finished, and neither is my thinking, but Shanghai has already rearranged enough of my assumptions that I want to set them down before the rest of the country complicates them further.
The first thing to say about Shanghai is that it could be a Western city. The skyline, the retail, the coffee, the manners of daily life: nothing about it feels foreign in the way visitors are led to expect. Then you pay for something and the illusion collapses. A taxi to the airport, the longest journey we made, cost nine pounds. Most journeys cost four to six. There is no tipping culture, so the fare is the fare. Every car we travelled in was electric; in our entire time in the city I did not sit in a single combustion engine, and the smog I had braced for simply was not there. The city looks like the West and prices like somewhere else entirely, and that gap is the subject of this essay.
AP Plaza
On the way to the Science and Technology Museum we stumbled into a shopping mall called AP Plaza. The name was the first joke. Inside was every counterfeit good you can imagine: watches, bags, trainers, tailoring cut to order, all of it confident, none of it hidden.¹ For a man who collects Audemars Piguet, walking into a building that shares its initials and sells its likeness at five per cent of the price is a peculiar experience. The watches were not crude. Some were close enough that most people, including most people who own the real thing, would need help telling them apart.
The counterfeiting does not stop at luxury.² In one car, the speaker grilles carried the distinctive Sennheiser perforation pattern. The speakers were not Sennheiser. The visual language of quality had been borrowed even where the badge had not. It is easy to be sniffy about this, and Western commentary usually is. But history suggests that Western intellectual property has rarely remained a permanent barrier to Chinese industrial development. Once something can be understood, engineered and manufactured, China has repeatedly shown a remarkable ability not merely to reproduce it, but eventually to improve upon it. Electric vehicles that many consumers would judge to be comparable, and in some respects better, at a fraction of the price. A watch indistinguishable from the Swiss original at a twentieth of the cost. At some point the question stops being whether this is fair and becomes something more uncomfortable: which model of value is correct?
The Equivalents
Because the deeper pattern is not counterfeiting at all. It is substitution. Nothing Western operates in China in its Western form; everything has been translated into a local equivalent at a local price. Didi, not Uber. WeChat, not WhatsApp. Alibaba, not eBay. Electric cars that owe nothing to Detroit or Stuttgart and increasingly surpass both. The counterfeit mall is the crude, visible edge of a much larger machine that studies what the West makes, absorbs it, rebuilds it and reprices it. Twenty years ago I could not have imagined a nation genuinely competing with America. I no longer think the interesting question is whether the pendulum swings. I find myself asking only when.
Yet the substitution model has a frontier, and AP Plaza marks it precisely. In technology, China no longer copies at all: its large language models and its wearable smart glasses are original, market leading and cheaper than ours. In electric vehicles it has moved from imitation to superiority. But in watches, leather goods and fashion it still copies, and the copying is the tell. You counterfeit only what you cannot yet originate. China can manufacture the object to any standard it chooses; what it has not yet manufactured is a brand the world desires for its own sake, because the raw materials of luxury are not components but time, heritage and meaning, and those cannot be compressed the way engineering can. Until a Chinese house makes the watch people queue for, rather than the watch that imitates it, its value proposition in luxury remains bounded. It has been done before: Japanese whisky now outscores Scotch in blind tastings, and Grand Seiko is spoken of with reverence in rooms that once dismissed it. The day a Chinese marque achieves the same, Switzerland will face a competitor rather than a counterfeiter, and that is a far more serious thing.
The Anomaly in My Own Field
Which brings me to the observation that startled me most, because it sits inside my own profession. On an earlier visit to China in April I learned two things. At its own APAC User Meeting, ZEISS announced that it had sold one hundred and twenty VisuMax lasers, the femtosecond platform behind small incision lenticule extraction,³ ⁴ ⁵ in China in a single year, in a country whose myopia epidemic has made it the largest refractive market on earth.⁶ ⁷ And the price of laser eye surgery and lens replacement surgery there is essentially the same as in the West.
Sit with that for a moment. In an economy that has re-priced taxis, phones, cars and watches, the cost of refractive surgery has not moved. German machines at Western prices, in the one country whose entire economic project is the elimination of exactly that arrangement. It works for us. It surely cannot last there. I am not advocating for it, but I would be astonished if a Chinese equivalent of the VisuMax does not eventually appear, priced the way Chinese equivalents are always priced, because everything in China runs on the local solution and there is no obvious reason a femtosecond laser should be the permanent exception. And it would be folly to assume that what arrives will be a copy. China did not copy the electric vehicle; it produced a better one. The first Chinese femtosecond platform may not merely undercut the VisuMax. It may supersede it.⁸ The hardware, in the end, is not just the copyable part. It is the improvable part.
There is, of course, another possibility. The machine may never arrive here at all. Europe and America have become increasingly willing to protect strategic industries, whether through tariffs, regulation or procurement rules, and Chinese electric vehicles have discovered that manufacturing a better product is no longer sufficient for unrestricted access to Western markets. A Chinese femtosecond platform might encounter exactly the same barriers. Protectionism can delay commoditisation. History suggests it rarely prevents it indefinitely. And that is the quiet truth beneath this essay: the markets in question are not really free. Governments decide where commoditisation is allowed to happen.
There is a curious symmetry here. The West and China are compressing the same equation from opposite ends. Here, the machine has stayed expensive while the surgeon’s fee has collapsed. There, the fee holds for now, and the machine will be the thing that collapses. Run either process to its conclusion and the only element left standing, in both systems, is the surgeon.
The ZEISS Question
There is another company that should perhaps be asking itself the same questions I found myself asking in Shanghai. ZEISS has enjoyed extraordinary success in China. Selling one hundred and twenty VisuMax platforms in a single year is an astonishing commercial achievement. It must feel like the goose that lays the golden eggs. Yet history suggests that periods of greatest success are often precisely when companies become least able to imagine disruption.⁹ Kodak continued selling vast quantities of photographic film long after digital photography had ceased to be a scientific curiosity. Success delayed the urgency to reinvent itself.
I wonder whether ZEISS faces a similar dilemma. Every VisuMax sold today strengthens its position. It also demonstrates the size and attractiveness of a market that Chinese engineering will eventually seek to serve. If that future platform is not simply cheaper but genuinely better, the challenge will not be pricing. It will be relevance.
I have seen the shape of this future already. When I visited Aier eye hospitals in China, the diagnostic and surgical machines were Western and Japanese: ZEISS, Nidek. I very much doubt that will still be the case in ten years. And the Japanese names in those theatres are themselves the precedent, because Japan once entered a market the West assumed it owned outright. If Japan could, China surely can.
I raise this as someone whose own practice runs on ZEISS platforms, and who has stood on ZEISS stages in Istanbul and across China this year. The question is not disloyal; it is the opposite. Incumbents that ask it while the golden eggs are still arriving tend to survive. Incumbents that cannot bear to ask it become case studies. Kodak, after all, invented the digital camera in 1975. What it could not do was threaten its own success before someone else did.
Market leadership, in the end, must eventually be earned rather than inherited, and it must be earned again in every generation.
What The Swiss Already Learned
If that sounds alarming, the Swiss watch industry is the reassuring precedent, because it has already died once and chosen its resurrection carefully.¹⁰ Quartz made the mechanical watch functionally obsolete fifty years ago; a thirty pound Casio keeps better time than anything in my collection. The industry survived by leaving the function business altogether and selling scarcity, provenance and meaning instead. Fifty years later, Switzerland exports far fewer watches than it once did at far greater total value.¹¹ The middle of the market, the brands selling function with a Swiss badge, is being hollowed out. The summit, the houses selling meaning, holds. The lesson is precise: you do not survive the cheaper equivalent by matching its price. You survive by knowing exactly which part of what you sell cannot be manufactured.
And I do not need to look to Switzerland, or to Shenzhen, to see this pattern, because it has already reached my own field, as I set out recently in Better, Safer, and Paid Less. Over my career, the insured reimbursement I have seen for cataract surgery has fallen from around eight hundred and fifty pounds per eye to roughly two hundred and fifty-five to three hundred pounds today, a fall of approximately two thirds, over exactly the period in which the operation became safer, more precise and more expensive to deliver, a pattern documented on both sides of the Atlantic.¹² ¹³ ¹⁴ The middle of ophthalmology is being hollowed out right now, in Britain, by payers rather than factories. A Chinese femtosecond laser would not start that process. It would merely accelerate one the West began itself.
The Clinic Thought Experiment
Back at AP Plaza, I found myself running a thought experiment. Suppose everyone in my clinic wore a very good fake AP, and mine was the only real one. Is mine still worth what I paid? If worth means what the watch says to the room, honestly, no. The signal dies the moment it becomes illegible; when every wrist carries a convincing copy, the genuine article communicates nothing. Anyone who bought a watch for the audience was always holding a fragile asset, because that value lived in other people’s heads.
But that was never why I bought them. I buy one watch a year, when my annual bonus arrives, and spend the following eleven months deciding on the next. Each one is a record of a specific year of my life, chosen slowly and bought with money earned restoring people’s sight. The copy can replicate the dial. It cannot have been the reward. In a world of perfect fakes, value migrates to the two places a factory cannot reach: the provenance that stands behind an object, and the private meaning it carries for its owner. It is worth noticing that this is my China question answered in miniature. When the artefact becomes copyable, value relocates to whoever is accountable for it, and to whatever it privately means.
Two Surveillance Propositions
There is one more asymmetry, and I felt it on my own wrist. In London I think carefully before wearing a good watch, because the threat is organised and patient: they see the watch in the restaurant and follow you out. So my rule is binary and decided at the front door. If the evening is genuinely door to door, taxi there and taxi home, I wear what I like. If there is any outside time at all, the watch never leaves the house. People in London have been killed for fake watches, which tells you the street does not authenticate; it prices the appearance of wealth.
In China I felt none of this. Street robbery in Chinese cities is genuinely rare: near-total surveillance, a cashless economy in which stolen goods are difficult to move, and severe consequences. I was safer wearing a real watch in the counterfeit capital of the world than in Mayfair, partly because the saturation of fakes provides camouflage; robbery becomes bad business when the odds favour the copy. But the safety has a price, and it belongs in the same ledger as the nine pound taxi. You are unmuggable in Shanghai because you are unhideable. London sells you disorder with privacy. China sells you order with surveillance. Two propositions, two prices, and I am genuinely unsure which model is correct.
Where Value Survives
So, will the world keep paying Western prices for goods China can produce at a fraction of them? Sector by sector, the answer is already in: only where the price was never really about the goods. Western pricing survives where the moat is trust, scarcity or accountability. It collapses wherever the moat was merely manufacturing, and every industry is currently being sorted into one pile or the other. And when the price of the routine collapses, the honest response, the one the great Swiss houses chose and the one we chose at Blue Fin Vision®, is to move upmarket rather than down, and to compete on what can be demonstrated rather than on what can be discounted. The upgrade ends where clinical care begins.
My own field will not be exempt, and I do not fear it. If a Chinese femtosecond platform eventually arrives at a Chinese price, the machine will have been commoditised, or superseded, as machines always are. What cannot come off a production line is the judgement of the surgeon holding it,¹⁵ the accountability of the person who answers for the outcome, and the outcomes themselves. At Blue Fin Vision® we publish ours: six consecutive years of National Ophthalmology Database data, with a posterior capsule rupture rate of approximately 0.2 per cent against the current national benchmark of 0.69 per cent.¹⁶ No factory in Shenzhen can copy that number. It has to be earned, one operation at a time, and stood behind, one patient at a time.
That, in the end, is what AP Plaza taught me, standing in a building named after my own watches, surrounded by their doubles. The fake tells the time. The Chinese laser, when it comes, may be better than anything we make. Which is precisely why the real and the fake were never distinguished by appearance, or even by performance. They are distinguished by accountability. The real survives wherever someone is prepared to stand behind it. Everything else eventually becomes a commodity.
Epilogue
Watching thousands of counterfeit Swiss watches being sold in Shanghai also made me wonder about another assumption. Apple persuaded the world that an Apple Watch assembled in China remained entirely an Apple Watch; the value resided in the design, the software and the ecosystem, not the geography of manufacture. Swiss watchmaking has taken the opposite view. “Swiss Made” has become part of the product itself. I wonder how long that distinction will survive. If value ultimately lies in design, engineering, provenance and accountability rather than assembly, perhaps one day the Swiss industry will face the same question Apple answered years ago: can a watch designed in Switzerland, engineered in Switzerland and manufactured in China still be considered Swiss?
References
- Organisation for Economic Co-operation and Development, European Union Intellectual Property Office. Trends in Trade in Counterfeit and Pirated Goods. Paris: OECD Publishing; 2019.
- World Health Organization. A Study on the Public Health and Socioeconomic Impact of Substandard and Falsified Medical Products. Geneva: World Health Organization; 2017.
- Sekundo W, Kunert KS, Blum M. Small incision corneal refractive surgery using the small incision lenticule extraction (SMILE) procedure for the correction of myopia and myopic astigmatism: results of a 6 month prospective study. British Journal of Ophthalmology. 2011;95(3):335-339.
- Shah R, Shah S, Sengupta S. Results of small incision lenticule extraction: all-in-one femtosecond laser refractive surgery. Journal of Cataract and Refractive Surgery. 2011;37(1):127-137.
- Blum M, Täubig K, Gruhn C, Sekundo W, Kunert KS. Five-year results of small incision lenticule extraction (ReLEx SMILE). British Journal of Ophthalmology. 2016;100(9):1192-1195.
- Morgan IG, Ohno-Matsui K, Saw SM. Myopia. Lancet. 2012;379(9827):1739-1748.
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- Christensen CM. The Innovator’s Dilemma: When New Technologies Cause Great Firms to Fail. Boston: Harvard Business School Press; 1997.
- Donzé PY. History of the Swiss Watch Industry: From Jacques David to Nicolas Hayek. Bern: Peter Lang; 2011.
- Federation of the Swiss Watch Industry FH. Swiss Watch Exports in 2025. Biel: Federation of the Swiss Watch Industry; 2026.
- Portney DS, Berkowitz ST, Garner DC, Qalieh A, Tiwari V, Friedman S, Patel S, Parikh R, Mian SI. Comparison of incremental costs and Medicare reimbursement for simple versus complex cataract surgery using time-driven activity-based costing. JAMA Ophthalmology. 2023;141(4):358-364.
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- Malcolm J, Donachie PHJ, Hernandez R, Buchan JC. The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: report 20, the hidden cost of intraocular lens choices for National Health Service funded cataract surgery in England. Eye. 2025;39(17):3142-3147.
- Day AC, Gore DM, Bunce C, Evans JR. Laser-assisted cataract surgery versus standard ultrasound phacoemulsification cataract surgery. Cochrane Database of Systematic Reviews. 2016;(7):CD010735.
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ABOUT THE AUTHOR
Mr Mfazo Hove
Consultant Ophthalmic Surgeon
MBChB MD FRCOphth CertLRS
Mr Mfazo Hove is a Consultant Ophthalmic Surgeon with experience spanning more than 57,000 procedures. He completed 6.5 years of specialist training at Moorfields Eye Hospital and served for five years as a consultant at the Western Eye Hospital, Imperial College Healthcare NHS Trust. He is the founder of Blue Fin Vision®, a consultant-led private ophthalmology practice operating across London, Essex, and Hertfordshire. His clinical expertise encompasses advanced cataract surgery, refractive lens replacement, laser vision correction, and implantable Collamer lenses (ICL).
A ZEISS Key Opinion Leader, Mr Hove is a respected international speaker with five invited engagements across seven cities in 2026:
- ZEISS China tour (Changsha, Shanghai, and Hangzhou, April – ZEISS APAC User Meeting)
- RCOphth Annual Congress – May – Manchester
- ZEISS EMEA User Meeting (Istanbul)
- ZEISS Lausanne User Meeting (Lausanne)
- European Society of Cataract and Refractive Surgeons Annual Congress (ESCRS, London)
Schedule Your Consultation Today
If you would like to discuss cataract or lens replacement surgery with a consultant who publishes his outcomes, book a consultation with the Blue Fin Vision® team at Harley Street or at one of our centres across London, Hertfordshire and Essex.
