US TRENDS IN REFRACTIVE SURGERY:2003 ISRS/AAO SURVEY Richard J. Duffey, MD David Leaming, MD ISRS/AAO Meeting Anaheim- November 14, 2003

2003 SURVEY Sept. mailing to 1098 U.S. members of the newly combined ISRS/AAO 135 responses analyzed by Oct 15 for 12.5% of the U.S. ISRS/AAO membership Seventh year of refractive data collection allowing an analysis of trends in US RK, AK/LRI, PRK, LASIK, LASEK, ICR, LTK, CK, CLE, P-IOL, SE, excimer lasers, microker., topo., coman., postop meds, charges, pupillometry, custom abl., etc.

> 5 CASES / MONTH DUFFEY 2003

> 25 CASES / MONTH DUFFEY 2003

> 75 CASES / MONTH DUFFEY 2003

PREFERRED SURGERY FOR 30 yo -3.00 DIOPTER MYOPE DUFFEY 2003

PREFERRED SURGERY FOR 30 yo -7.00 DIOPTER MYOPE DUFFEY 2003

PREFERRED SURGERY FOR 30 yo -12.00 DIOPTER MYOPE DUFFEY 2003

PREFERRED SURGERY FOR 45 yo +1.00 D HYPEROPE DUFFEY 2003

PREFERRED SURGERY FOR 45 yo +3.00 D HYPEROPE DUFFEY 2003

PREFERRED SURGERY FOR 45 yo +5.00 D HYPEROPE DUFFEY 2003

SURGERY DONE BILATERAL AT SAME O.R. VISIT DUFFEY 2003

Procedure Future Index (Doing Now and/or Plan in Future) DUFFEY 2003

HAD REFRACTIVE SURGERY PERFORMED ON YOURSELF DUFFEY 2003

EXCIMER LASER MOST COMMONLY USED DUFFEY 2003

MICROKERATOME MOST COMMONLY USED DUFFEY 2003

TOPOGRAPHY UNIT MOST COMMONLY USED DUFFEY 2003

Pupil Gauge Instrument Use DUFFEY 2003

Value of Custom Ablation DUFFEY 2003

Wavefront Analyzer DUFFEY 2003

Wavefront-Guided Custom Ablations in Your Practice DUFFEY 2003

Increase in Charge for Custom DUFFEY 2003

Post-Op Antibiotic DUFFEY 2003

Post-Op Anti-inflammatory DUFFEY 2003

Comanagement DUFFEY 2003

’03 ISRS/AAO SURVEY CONCLUSIONS LASIK dominates between -8D and +3D. Bilateral LASIK same O.R. visit is SOC. P-IOL for high myopes. CLE for high hyperopes. LASIK, LASEK, CLE, P-IOL, PRK, CK all with apparent bright futures. RK, ICR, LTK, and SE dead or dying. DUFFEY 2003

Conclusions continued... VisX at 2:1 over all other lasers. Orbscan significant growth over last 2 yrs. Intralase is increasing market share. Pupillometry 2:1 IR instrument over card Wavefront custom ablations rapid growth. 67% use wavefront analyzers. 58% perform custom ablations. DUFFEY 2003

Conclusions continued... Surgeons are charging $300-$500 more per eye for custom ablations. Fourth generation fluoroquinolones have overtaken the post-refractive surg. market. PF and FML lead post-op steroids/anti-inflammatories. Co-management apparently decreasing. DUFFEY 2003

Thanks to the new ISRS/AAO leadership for their support and for your participation in the 2003 Survey We look forward to your response to the 2004 survey next fall Complete results at www.aao.org and at www.duffeylaser.com