US TRENDS IN REFRACTIVE SURGERY: 2003 ASCRS SURVEY Richard J. Duffey, MD David Leaming, MD San Diego: May 3, 2004

DUFFEY ASCRS SURVEY n Sept. mailing to 5000 U.S. members of ASCRS n 509 responses representing 11% of the U.S. ASCRS membership n Seventh year of refractive data collection allowing analysis and comparison of trends amongst ASCRS U.S. surgeons n RK, AK, Cat/LRI, PRK, LASIK, LASEK, ICR, LTK, CK, P-IOL, CLE, SE, excimers, microkert., topogr., pupillometry, wavefront

2003 ISRS SURVEY n Sept. mailing to 1098 U.S. members of the newly combined ISRS/AAO n 135 responses analyzed by Oct 15 for 12.5% of the U.S. ISRS/AAO membership n Seventh year of refractive data collection allowing an analysis of trends in US n 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.

DUFFEY 2004 > 5 CASES / MONTH

DUFFEY 2004 > 25 CASES / MONTH

DUFFEY 2004 > 75 CASES / MONTH

DUFFEY 2004 PREFERRED SURGERY FOR 30 yo 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 HAD REFRACTIVE SURGERY PERFORMED ON YOURSELF

DUFFEY 2004 SURGEON WILLING TO DO BILATERAL AT SAME VISIT

DUFFEY 2004 PRESENT and FUTURE PRACTICE PLANS

DUFFEY 2004 TOPOGRAPHY UNIT OWNED

DUFFEY 2004 MICROKERATOME USED MOST

DUFFEY 2004 EXCIMER USED MOST

DUFFEY 2004 Pupil Gauge Instrument Use

DUFFEY 2004 Wavefront Analyzer

DUFFEY 2004 Wavefront-Guided Custom Ablations in Your Practice

DUFFEY 2004 Anticipated Value of Custom Laser Ablations

DUFFEY 2004 Anticipated/Real Increase in Charge to Patient for Custom Wavefront Laser Treatment

DUFFEY 2004 Preferred Surgery for Presbyopia

DUFFEY 2004 Post-Op Antibiotic

DUFFEY 2004 Post-Op Anti-inflammatory

DUFFEY 2004 ’03 ASCRS SURVEY CONCLUSIONS n LASIK dominates between -8D and +3D. n Bilateral LASIK same O.R. visit is SOC. n P-IOL or Wait for high myopes. n CLE for high hyperopes. n LASIK, LASEK, CLE, P-IOL, PRK, CK all with apparent bright futures. n RK, ICR, LTK, and SE dead or dying.

DUFFEY 2004 Conclusions continued... n VisX at 2:1 over all other lasers. n Pupillometry 55:45 IR instrument over card n Wavefront custom ablations have gained rapid acceptance into practice with 69% stating moderate to extreme value added. n 55% use wavefront analyzers. n 52% perform custom ablations.

DUFFEY 2004 Conclusions continued... n Surgeons are charging $300-$500 more per eye for custom ablations n Orbscan is not S.O.C. require. for refrac. sx n Monovision is still “choice” for presbyopia n Fourth generation fluoroquinolones have overtaken the post-refractive surg. market. n PF and FML lead post-op steroids/anti- inflammatories.

Thanks to ASCRS leadership for their support and for your participation in the 2003 Survey We look forward to your responses in the 2004 survey this autumn. Complete results at and at