US Trends in Refractive Surgery: The 2004 ISRS/AAO Survey Richard J. Duffey, MD David Leaming, MD ISRS / AAO Meeting New Orleans- October 22, 2004

2004 Survey ä August mailing to 1500 U.S. members of the recently combined ISRS/AAO. ä 184 responses analyzed by October 1st for 12.3% of the U.S. ISRS/AAO membership. ä Eighth year of refractive data collection. ä Alphabet soup of refractive surgery. ä Many new questions on flap thickness preference and measurements, MMC use, enhancement tests, one-eyed patients, ectasia, co-management,…etc…etc…

DUFFEY 2004 > 5 Cases / Month

DUFFEY 2004 > 25 Cases / Month

DUFFEY 2004 > 75 Cases / Month

DUFFEY 2004 Preferred Surgery For 30 y.o Diopter Myope

DUFFEY 2004 Preferred Surgery For 30 yo Diopter Myope

DUFFEY 2004 Preferred Surgery For 30 yo Diopter Myope

DUFFEY 2004 Preferred Surgery For 45 yo D Hyperope

DUFFEY 2004 Preferred Surgery For 45 yo D Hyperope

DUFFEY 2004 Preferred Surgery For 45 yo D Hyperope

DUFFEY 2004 Surgery Done Bilateral At Same O.R. Visit

DUFFEY 2004 Procedure Future Index (Doing Now and/or Plan in Future)

DUFFEY 2004 Interested In or Taken a Course

DUFFEY 2004 Had Refractve Surgery Performed on Yourself

DUFFEY 2004 Excimner Laser Most Commonly Used

DUFFEY 2004 Microkeratome Most Commonly Used

DUFFEY 2004 Topography Unit Most Commonly Used

DUFFEY 2004 Pupil Gauge Instrument Use

DUFFEY 2004 Most Common Refractive Goal with LVC in Presbyopic Patients

DUFFEY 2004 Preferred Surgery for Presbyopia

DUFFEY 2004 Value of Custom Ablation

DUFFEY 2004 Wavefront Analyzer

DUFFEY 2004 Wavefront-Guided Custom Ablations in Your Practice

DUFFEY 2004 Increase in Charge for Custom

DUFFEY 2004 Comanagement

DUFFEY 2004 Comanage with Whom

DUFFEY 2004 Recheck Topography before LVC Enhancements

DUFFEY 2004 Recheck Pachymetry before LVC Enhancements

DUFFEY 2004 Do You Intra-operatively Measure Flap Thickness?

DUFFEY 2004 When Did You Start Measuring?

DUFFEY 2004 Preferred Flap Thickness (when no other constraints)

DUFFEY 2004 Minimum Residual Stromal Thickness Requirement

DUFFEY 2004 Total Cases of Post LASIK Ectasia as the Primary Surgeon in Career

DUFFEY 2004 Minimum Cent. Corneal Pachymetry for LASIK (all other parameters normal) ä Invalid data due to typo in question.

DUFFEY 2004 Mitomycin-C Use (MMC)

DUFFEY 2004 Will You Perform Refractive Surgery on One-Eyed Patients

DUFFEY 2004 Pre-operative Eye Exam Included in Refractive Surgery Pricing

DUFFEY 2004 Post-Op Antibiotic

DUFFEY 2004 Post-Op Anti-inflammatory

DUFFEY 2004 Membership in Other Ophthalmic Professional Organizations

DUFFEY 2004 ’04 ISRS/AAO Survey Conclusions ä LASIK dominates between -8D and +3D. ä Bilateral LASIK same O.R. visit is SOC. ä P-IOL for high myopes (40%). ä RLE for high hyperopes (43%). ä LASIK, LASEK, RLE, P-IOL, PRK, CK, and LRI all with apparent bright futures. ä RK, LTK, and SE fading…fad…f…. ä ICR making a limited comeback (? niche proced.).

DUFFEY 2004 Conclusions continued... ä VisX at > 2:1 over all other lasers. ä Orbscan leveled off after 6 years of growth (23%). ä Intralase is increasing market share (12%). ä Pupillometry 2:1 IR instrument over card. ä Wavefront custom ablations further growth: ä 90% use wavefront analyzers. ä 90% perform custom ablations…and at increasing frequencies (38% whenever possible).

DUFFEY 2004 Conclusions continued... ä Surgeons are charging approximately $400 more per eye for custom ablations. ä Fourth generation fluoroquinolones have over- taken the post-refractive surg. market (Z>V). ä PF and FML lead post-op steroids/anti- inflammatories. ä Co-management significantly decreasing in surgeons participating and percentage of patients being comanaged over last 2 years (down half). ä 29% penetration of refrac sx amongst ref surgeons

DUFFEY 2004 Conclusions continued... ä Mono-LASIK is the most sought goal for presbyopic patients seeking refract surgery (44%). ä Less than one-third of refractive surgeons (31%) measure true flap thickness in the OR. ä Over half of surgeons (56%) have had at least one documented case of post-LASIK ectasia in his/her surgical patients over a career. ä 80% think 250 microns is adequate for RST. ä Most desired flap thickness is microns.

DUFFEY 2004 Conclusions continued... ä 64% use MMC for prophylaxis and/or haze. ä 51% OK with refractive surgery on one-eyed pt. ä Preop exam usually (82%) included in refractive surgery price. ä 8% of respondents OK with bilateral P-IOL at the same surgical setting. ä Crystalens accommodative IOL on radar screen for preferred presbyopia option (14%).

Thanks to the ISRS/AAO leadership for their support and for your participation in the 2004 Survey We look forward to your response to the 2005 survey next fall Complete results at