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

2. DUFFEY 2004 2003 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

3. 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.

4. DUFFEY 2004 > 5 CASES / MONTH

5. DUFFEY 2004 > 25 CASES / MONTH

6. DUFFEY 2004 > 75 CASES / MONTH

7. DUFFEY 2004 PREFERRED SURGERY FOR 30 yo -3.00 DIOPTER MYOPE

8. DUFFEY 2004 PREFERRED SURGERY FOR 30 yo -7.00 DIOPTER MYOPE

9. DUFFEY 2004 PREFERRED SURGERY FOR 30 yo -12.00 DIOPTER MYOPE

10. DUFFEY 2004 PREFERRED SURGERY FOR 45 yo +1.00 D HYPEROPE

11. DUFFEY 2004 PREFERRED SURGERY FOR 45 yo +3.00 D HYPEROPE

12. DUFFEY 2004 PREFERRED SURGERY FOR 45 yo +5.00 D HYPEROPE

13. DUFFEY 2004 HAD REFRACTIVE SURGERY PERFORMED ON YOURSELF

14. DUFFEY 2004 SURGEON WILLING TO DO BILATERAL AT SAME VISIT

15. DUFFEY 2004 PRESENT and FUTURE PRACTICE PLANS

16. DUFFEY 2004 TOPOGRAPHY UNIT OWNED

17. DUFFEY 2004 MICROKERATOME USED MOST

18. DUFFEY 2004 EXCIMER USED MOST

19. DUFFEY 2004 Pupil Gauge Instrument Use

20. DUFFEY 2004 Wavefront Analyzer

21. DUFFEY 2004 Wavefront-Guided Custom Ablations in Your Practice

22. DUFFEY 2004 Anticipated Value of Custom Laser Ablations

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

24. DUFFEY 2004 Preferred Surgery for Presbyopia

25. DUFFEY 2004 Post-Op Antibiotic

26. DUFFEY 2004 Post-Op Anti-inflammatory

27. 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.

28. 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.

29. 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.

30. 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 www.ascrs.org and at www.duffeylaser.com