1. U.S. Trends in Refractive Surgery: 2011 ISRS Survey - Partner of AAO - Richard J. Duffey, MD David Leaming, MD Refractive Subspecialty Day Orlando: October 22, 2011

2. The authors have no financial interests in this survey study. DUFFEY 2011

3. 2011 Survey ä ä Third year of ONLINE*** survey opened by 374 ISRS members of the 1145 total emailed. ä ä 128 responses analyzed by October 6, 2011 for 34% of the U.S. ISRS membership who opened the emailed survey and 11% of the membership. ä ä Fifteenth year of refractive data collection. ä ä Alphabet soup of refractive surgery including corneal and lens-based surgeries.

4. DUFFEY 2011 I Am Currently Doing This Surgery

5. DUFFEY 2011 > 5 Cases / Month

6. DUFFEY 2011 > 25 Cases / Month

7. DUFFEY 2011 > 75 Cases / Month * Peaked in 2001

8. DUFFEY 2011 Preferred Surgery For 30 yo -10.00 Diopter Myope * * 48% LVC

9. DUFFEY 2011 Preferred Surgery For 45 yo +3.00 D Hyperope *70%

10. DUFFEY 2011 Preferred Surgery For 45 yo +5.00 D Hyperope * *

11. DUFFEY 2011 Surgery Done Bilateral At Same O.R. Visit * *

12. DUFFEY 2011 Had Refractive Surgery Performed on Yourself **40%

13. DUFFEY 2011 Family LVC Index: (LASIK or PRK Performed on Our Own Family Member)

14. DUFFEY 2011 Excimer Laser Most Commonly Used *

15. DUFFEY 2011 “Microkeratome” Most Commonly Used * * * 57% femtolaser

16. DUFFEY 2011 Topography Unit Most Commonly Used *

17. DUFFEY 2011 Epi-Keratome Use

18. DUFFEY 2011 Preferred Surgery for “Pre-Cataract” Presbyopia * *

19. DUFFEY 2011 Wavefront-Guided Custom Ablations in Your Practice

20. DUFFEY 2011 Wavefront Analyzer

21. DUFFEY 2011 Comanagement *

22. DUFFEY 2011 When Comanaged, Who Does Day 1 Postop Exam?

23. DUFFEY 2011 Do You Routinely Measure Flap Thickness Intra-operatively ?

24. DUFFEY 2011 Preferred Flap Thickness (when no other constraints) *

25. DUFFEY 2011 Minimum Residual Stromal Bed Thickness Requirement for LASIK * * 64% at 275 microns or greater

26. DUFFEY 2011 Total Cases of Post LASIK Ectasia as the Primary Surgeon in Career * Not growing

27. DUFFEY 2011 Minimum Cent. Corneal Pachymetry for LASIK (all other parameters normal) * 56% OK with 480 or less

28. DUFFEY 2011 Mitomycin-C Use (MMC)

29. DUFFEY 2011 Will You Perform Refractive Surgery on One-Eyed Patients

30. DUFFEY 2011 Post-Op Antibiotic

31. DUFFEY 2011 Post-Op Steroid

32. DUFFEY 2011 Post-Op Nonsteroidals

33. DUFFEY 2011 Location of Phakic-IOL Surgery

34. DUFFEY 2011 Total LVC Volume w/i ISRS (1000s) * 6% increase in Total LVC from 2010. Ratio of PRK / Total LVC increased from 24% to 29% over past year.

35. DUFFEY 2011 2011 ISRS SUMMARY ä ä Third ONLINE ISRS SURVEY was a success with 11% / 34% response rate. ä ä VisX 2:1 (58%) over Wavelight (29%) which is slightly down this year. ä ä About 40% penetration of modern refractive surgery amongst refractive surgeons…. 4 times the general population. Family Index rates also continue to be high despite mixed press re: LVC in the general public media.

36. DUFFEY 2011 2011 ISRS SUMMARY ä ä 27% of respondents are OK with bilateral P- IOL and 9% with bilateral RLE at the same surgical setting (increased). ä ä Multifocal IOL (15%) over accommodative IOL (3%) as a preferred lens-based presbyopia option when used for RLE. ä ä Femtosecond laser use on the rise (57%).

37. DUFFEY 2011 2011 ISRS SUMMARY ä ä Thinner flaps on the rise: 100 micron or less flaps are favored by 53% of surgeons (up from 12% in ‘04). ä ä RSB Thickness on the rise: 32% still think 250 microns is adequate, but 64% recommend 275 microns or more. ä ä New post-LASIK ectasia cases continue to be on the decline.

38. 2011 ISRS SUMMARY ä ä Pentacam (46%) outpaced Z-H (41%) and Orbscan II (39%) for the first time. ä ä LVC Volume up 6% within ISRS membership in 2011 relative to 2010. ä ä Ratio of Surface Ablation / Total LVC increased from 24% to 29% over past year. DUFFEY 2011

39. www.duffeylaser.com Additional Data at www.duffeylaser.com ä ä Types and volumes of refractive surgeries currently being performed ä ä Preferred Epikeratomes ä ä Mitomycin-C use ä ä Post-operative use of antibiotics, steroids and nonsteroidals ä ä Surgical venues for various procedures ä ä …AND MORE DUFFEY 2011

40. Thanks to the ISRS leadership for their support and for your participation in the 2011 Survey We look forward to your response to our fourth ONLINE survey next fall ***Complete 15 years of survey results found at www.duffeylaser.com