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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
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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…
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DUFFEY 2004 > 5 Cases / Month
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DUFFEY 2004 > 25 Cases / Month
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DUFFEY 2004 > 75 Cases / Month
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DUFFEY 2004 Preferred Surgery For 30 y.o. -3.00 Diopter Myope
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DUFFEY 2004 Preferred Surgery For 30 yo -7.00 Diopter Myope
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DUFFEY 2004 Preferred Surgery For 30 yo -12.00 Diopter Myope
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DUFFEY 2004 Preferred Surgery For 45 yo +1.00 D Hyperope
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DUFFEY 2004 Preferred Surgery For 45 yo +3.00 D Hyperope
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DUFFEY 2004 Preferred Surgery For 45 yo +5.00 D Hyperope
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DUFFEY 2004 Surgery Done Bilateral At Same O.R. Visit
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DUFFEY 2004 Procedure Future Index (Doing Now and/or Plan in Future)
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DUFFEY 2004 Interested In or Taken a Course
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DUFFEY 2004 Had Refractve Surgery Performed on Yourself
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DUFFEY 2004 Excimner Laser Most Commonly Used
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DUFFEY 2004 Microkeratome Most Commonly Used
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DUFFEY 2004 Topography Unit Most Commonly Used
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DUFFEY 2004 Pupil Gauge Instrument Use
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DUFFEY 2004 Most Common Refractive Goal with LVC in Presbyopic Patients
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DUFFEY 2004 Preferred Surgery for Presbyopia
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DUFFEY 2004 Value of Custom Ablation
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DUFFEY 2004 Wavefront Analyzer
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DUFFEY 2004 Wavefront-Guided Custom Ablations in Your Practice
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DUFFEY 2004 Increase in Charge for Custom
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DUFFEY 2004 Comanagement
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DUFFEY 2004 Comanage with Whom
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DUFFEY 2004 Recheck Topography before LVC Enhancements
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DUFFEY 2004 Recheck Pachymetry before LVC Enhancements
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DUFFEY 2004 Do You Intra-operatively Measure Flap Thickness?
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DUFFEY 2004 When Did You Start Measuring?
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DUFFEY 2004 Preferred Flap Thickness (when no other constraints)
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DUFFEY 2004 Minimum Residual Stromal Thickness Requirement
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DUFFEY 2004 Total Cases of Post LASIK Ectasia as the Primary Surgeon in Career
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DUFFEY 2004 Minimum Cent. Corneal Pachymetry for LASIK (all other parameters normal) ä Invalid data due to typo in question.
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DUFFEY 2004 Mitomycin-C Use (MMC)
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DUFFEY 2004 Will You Perform Refractive Surgery on One-Eyed Patients
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DUFFEY 2004 Pre-operative Eye Exam Included in Refractive Surgery Pricing
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DUFFEY 2004 Post-Op Antibiotic
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DUFFEY 2004 Post-Op Anti-inflammatory
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DUFFEY 2004 Membership in Other Ophthalmic Professional Organizations
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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.).
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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).
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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
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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 120-160 microns.
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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%).
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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 www.duffeylaser.com
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