US TRENDS IN REFRACTIVE SURGERY: 2004 ASCRS SURVEY Richard J. Duffey, MD David Leaming, MD Washington, D.C. April 16, 2005

DUFFEY ASCRS SURVEY n Sept. mailing to 6296 U.S. members of ASCRS n 773 responses representing 12% of the U.S. ASCRS membership n Eighth year of refractive data collection allowing analysis and comparison of trends amongst ASCRS U.S. surgeons n Alphabet soup of refractive surgery. n Many new questions on flap thickness preference and measurements, MMC use, enhancement tests, one-eyed patients, ectasia, co-management, etc.

DUFFEY 2005 > 5 CASES / MONTH

DUFFEY 2005 > 25 CASES / MONTH

DUFFEY 2005 > 75 CASES / MONTH

DUFFEY 2005 PREFERRED SURGERY FOR 30 yo DIOPTER MYOPE

DUFFEY 2005 PREFERRED SURGERY FOR 30 yo DIOPTER MYOPE

DUFFEY 2005 PREFERRED SURGERY FOR 30 yo DIOPTER MYOPE

DUFFEY 2005 PREFERRED SURGERY FOR 45 yo D HYPEROPE

DUFFEY 2005 PREFERRED SURGERY FOR 45 yo D HYPEROPE

DUFFEY 2005 PREFERRED SURGERY FOR 45 yo D HYPEROPE

DUFFEY 2005 HAD REFRACTIVE SURGERY PERFORMED ON YOURSELF

DUFFEY 2005 SURGEON WILLING TO DO BILATERAL AT SAME VISIT

DUFFEY 2005 PRESENT or FUTURE PRACTICE PLANS

DUFFEY 2005 TOPOGRAPHY UNIT OWNED

DUFFEY 2005 MICROKERATOME USED MOST

DUFFEY 2005 EXCIMER USED MOST

DUFFEY 2005 Pupil Gauge Instrument Use

DUFFEY 2005 Wavefront Analyzer

DUFFEY 2005 Wavefront-Guided Custom Ablations in Your Practice

DUFFEY 2005 Anticipated Value of Custom Laser Ablations

DUFFEY 2005 Anticipated/Real Increase in Charge to Patient for Custom Wavefront Laser Treatment

DUFFEY 2005 Preferred Surgery for Presbyopia

DUFFEY 2005 Post-Op Antibiotic

DUFFEY 2005 Post-Op Anti-inflammatory

DUFFEY 2005 Recheck Topography before LVC Enhancements

DUFFEY 2005 Recheck Pachymetry before LVC Enhancements

DUFFEY 2005 Do You Intra-operatively Measure Flap Thickness?

DUFFEY 2005 When Did You Start Measuring?

DUFFEY 2005 Preferred Flap Thickness (when no other constraints)

DUFFEY 2005 Minimum Residual Stromal Thickness Requirement

DUFFEY 2005 Total Cases of Post LASIK Ectasia in Career as the Primary Surgeon n Typo in question invalidated data

DUFFEY 2005 Minimum Cent. Corneal Pachymetry for LASIK (all other parameters normal)

DUFFEY 2005 Mitomycin-C Use (MMC)

DUFFEY 2005 Will You Perform Refractive Surgery on One-Eyed Patients

DUFFEY 2005 Pre-operative Eye Exam Included in Refractive Surgery Pricing

DUFFEY 2005 Membership in Other Ophthalmic Professional Organizations

DUFFEY 2005 ’04 ASCRS Survey Conclusions n LASIK dominates between -8D and +3D. n Bilateral LASIK same O.R. visit is SOC. n P-IOL for high myopes (37%). n RLE for high hyperopes (42%). n LASIK, LASEK, RLE, P-IOL, PRK, CK, and LRI all with apparent bright futures. n RK, LTK, and SE fading…fad…f…. n ICR making a limited comeback (? niche proced.).

DUFFEY 2005 Conclusions continued... n VisX at > 2:1 over all other lasers. n Orbscan leveled off after 6 years of growth (18%). n Intralase is increasing market share (9%). n Pupillometry- Card 1:1 vs.IR instrument. n Wavefront custom ablations further growth. n 75% perform custom ablations…and at increasing frequencies (29% whenever possible). n Surgeons are charging approximately $300 more per eye for custom ablations.

DUFFEY 2005 Conclusions continued... n Fourth generation fluoroquinolones (88%) have over-taken the post-refractive surg. market (Z>V). n PF and FML lead post-op steroids/anti- inflammatories. n 20% penetration of refrac sx amongst ref surgeons. n Less than one-quarter of refractive surgeons (23%) measure true flap thickness in the OR. n 77% think 250 microns is adequate for RST. n Most desired flap thickness is microns.

DUFFEY 2005 Conclusions continued... n 59% use MMC for prophylaxis and/or haze. n 35% OK with refractive surgery on one-eyed pt. n Preop exam usually (82%) included in refractive surgery price. n 6% of respondents OK with bilateral P-IOL at the same surgical setting. n Monovision LASIK still preferred surgery for presbyopia patients (40%). n Crystalens accommodative IOL on radar screen for preferred presbyopia option (16%).

Thanks to ASCRS leadership for their support and for your participation in the 2004 Survey We look forward to your responses in the 2005 survey this autumn. Complete results at