US Trends in Refractive Surgery: The 2005 ISRS/AAO Survey Richard J. Duffey, MD David Leaming, MD ISRS / AAO Meeting Chicago- October 14, 2005

2005 Survey August mailing to 1500 U.S. members of ISRS/AAO. 246 responses analyzed by October 1st for 16.4% of the U.S. ISRS/AAO membership. Ninth year of refractive data collection. Alphabet soup of refractive surgery. Many new questions on flap thickness preference and measurements, MMC use, enhancement tests, one-eyed patients, ectasia, co-management, SOC, etc., etc. DUFFEY 2005

I Am Currently Doing This Surgery DUFFEY 2005

> 5 Cases / Month DUFFEY 2005

> 25 Cases / Month DUFFEY 2005

> 75 Cases / Month DUFFEY 2005

Preferred Surgery For 30 yo -12.00 Diopter Myope DUFFEY 2005

Preferred Surgery For 30 yo -10.00 Diopter Myope DUFFEY 2005

Preferred Surgery For 45 yo +3.00 D Hyperope DUFFEY 2005

Preferred Surgery For 45 yo +5.00 D Hyperope DUFFEY 2005

Surgery Done Bilateral At Same O.R. Visit DUFFEY 2005

Procedure Future Index (Doing Now and/or Plan in Future) DUFFEY 2005

Had Refractve Surgery Performed on Yourself DUFFEY 2005

Excimer Laser Most Commonly Used DUFFEY 2005

Microkeratome Most Commonly Used DUFFEY 2005

Topography Unit Most Commonly Used DUFFEY 2005

Epi-Keratome Use DUFFEY 2005

Pupil Gauge Instrument Use DUFFEY 2005

Preferred Surgery for Presbyopia DUFFEY 2005

Wavefront Analyzer DUFFEY 2005

Wavefront-Guided Custom Ablations in Your Practice DUFFEY 2005

Comanagement 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 for LASIK DUFFEY 2005

Total Cases of Post LASIK Ectasia as the Primary Surgeon in Career 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

Post-Op Antibiotic DUFFEY 2005

Post-Op Anti-inflammatory DUFFEY 2005

Location of Phakic-IOL Surgery DUFFEY 2005

’05 ISRS/AAO Survey Conclusions LASIK dominates between -10D and +3D. P-IOL for higher than -10D myopes. RLE for high hyperopes (56%). Monovision is the most sought goal for presbyopic patients seeking refract surgery (53%), but 17% are now implanting modern presbyopic IOL’s. DUFFEY 2005

Conclusions continued... VisX still at > 2:1 over all other lasers. Intralase is increasing market share (22%). Epi-Keratome has increased users (18%). 90% use wavefront analyzers. 90% perform custom ablations…and at increasing frequencies (40% whenever possible). DUFFEY 2005

Conclusions continued... Fourth generation fluoroquinolones dominate the post-refractive surgery market (96%). Co-management is on the rebound after several years of decline (increased from 40% to 60% from ’04 to ’05). >25% penetration of refractive surgery on self amongst refractive surgeons. DUFFEY 2005

Conclusions continued... One-third of refractive surgeons now measuring true flap thickness in the OR. Less than half of surgeons surveyed (44%) have had a documented case of post-LASIK ectasia in his/her surgical patients over a career (7% with 3 or more). 66% think 250 microns is adequate for RST after LASIK. 11% recommend 300 microns. Most desired flap thickness is 120-160 microns. DUFFEY 2005

Conclusions continued... 77% use MMC for prophylaxis and/or haze (up from 64% last year). 43% OK with refractive surgery on one-eyed pt. Bilateral extraocular sx at same O.R. visit is SOC. 4% of respondents OK with bilateral P-IOL at the same surgical setting (down from 8% last year). ASC OR is preferred location for P-IOL surgery (78%). 19% OK with “In Office” modified OR. DUFFEY 2005

Thanks to the ISRS/AAO leadership for their support and for your participation in the 2005 Survey We look forward to your response to the 2006 survey next fall Complete results at www.duffeylaser.com