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

US TRENDS IN REFRACTIVE SURGERY: 2003 ASCRS

SURVEY

Richard J. Duffey, MDRichard J. Duffey, MD

David Leaming, MDDavid Leaming, MD

San Diego: May 3, 2004San Diego: May 3, 2004

DUFFEY 2004

2003 ASCRS SURVEY Sept. mailing to 5000 U.S. members of ASCRSSept. mailing to 5000 U.S. members of ASCRS 509 responses representing 11% of the U.S. 509 responses representing 11% of the U.S.

ASCRS membershipASCRS membership Seventh year of refractive data collection allowing Seventh year of refractive data collection allowing

analysis and comparison of trends amongst analysis and comparison of trends amongst ASCRS U.S. surgeons ASCRS U.S. surgeons

RK, AK, Cat/LRI, PRK, LASIK, LASEK, ICR, RK, AK, Cat/LRI, PRK, LASIK, LASEK, ICR, LTK, CK, P-IOL, CLE, SE, excimers, microkert., LTK, CK, P-IOL, CLE, SE, excimers, microkert., topogr., pupillometry, wavefronttopogr., pupillometry, wavefront

2003 ISRS SURVEY Sept. mailing to 1098 U.S. members of the newly Sept. mailing to 1098 U.S. members of the newly

combined ISRS/AAOcombined ISRS/AAO 135 responses analyzed by Oct 15 for 12.5% of the 135 responses analyzed by Oct 15 for 12.5% of the

U.S. ISRS/AAO membershipU.S. ISRS/AAO membership Seventh year of refractive data collection allowing an Seventh year of refractive data collection allowing an

analysis of trends in USanalysis of trends in US RK, AK/LRI, PRK, LASIK, LASEK, ICR, LTK, CK, RK, AK/LRI, PRK, LASIK, LASEK, ICR, LTK, CK,

CLE, P-IOL, SE, excimer lasers, microker., topo., CLE, P-IOL, SE, excimer lasers, microker., topo., coman., postop meds, charges, pupillometry, custom coman., postop meds, charges, pupillometry, custom abl., etc.abl., etc.

DUFFEY 2004

> 5 CASES / MONTH

1

23

27

51

40 0

5 2 2 00

10

20

30

40

50

60

LR

I a

lone

PT

K

LA

SIK

ICR

CK

CL

E

'97'98'99'00'01'02'03

DUFFEY 2004

> 25 CASES / MONTH

31

25

1 10

5

10

15

20

25

LRI c Cat PRK LASIK LASEK P-IOL

'97'98'99'00'01'02'03

DUFFEY 2004

> 75 CASES / MONTH

1

0

8

1

0

1

2

3

4

5

6

7

8

LRI c Cat PRK LASIK P-IOL

'97'98'99'00'01'02'03

DUFFEY 2004

PREFERRED SURGERY FOR 30 yo -3.00 DIOPTER MYOPE

05

86

51 3

0

10

20

30

40

50

60

70

80

90

RK PRK LASIK LASEK P-IOL WAIT

'97'98'99'00'01'02'03

DUFFEY 2004

PREFERRED SURGERY FOR 30 yo -7.00 DIOPTER MYOPE

2

87

5 2 40

10

2030

4050

6070

8090

100

PRK LASIK LASEK P-IOL WAIT

'97'98'99'00'01'02'03

DUFFEY 2004

PREFERRED SURGERY FOR 30 yo -12.00 DIOPTER MYOPE

2

13

3

33

8

40

0

10

20

30

40

50

60

PRK LASIK LASEK P-IOL CLE WAIT

'97'98'99'00'01'02'03

DUFFEY 2004

PREFERRED SURGERY FOR 45 yo +1.00 D HYPEROPE

4

60

3 2

17

2

12

0

10

20

30

40

50

60

PR

K

LA

SIK

LA

SEK

LT

K

CK

CL

E

WA

IT

'99'00'01'02'03

DUFFEY 2004

PREFERRED SURGERY FOR 45 yo +3.00 D HYPEROPE

1

69

3 0 2 39 12

0

10

20

30

40

50

60

70

PR

K

LA

SIK

LA

SEK

LT

K

CK

P-I

OL

CL

E

WA

IT

'99'00'01'02'03

DUFFEY 2004

PREFERRED SURGERY FOR 45 yo +5.00 D HYPEROPE

1

14

0

8

44

34

0

10

20

30

40

50

60

70

PRK LASIK LASEK P-IOL CLE WAIT

'99'00'01'02'03

DUFFEY 2004

HAD REFRACTIVE SURGERY PERFORMED ON YOURSELF

5

1

3

14

10

2

4

6

8

10

12

14

RK AK/LRI PRK LASIK LTK

'98'99'00'01'02'03

DUFFEY 2004

SURGEON WILLING TO DO BILATERAL AT SAME VISIT

73

98

82

67

81

70

38

0102030405060708090

100

PR

K

LA

SIK

LA

SEK

ICR

CK

P-I

OL

CL

E SE

'97'98'99'00'01'02'03

DUFFEY 2004

PRESENT and FUTURE PRACTICE PLANS

12

76 7784

53

19

7

43

7985

14

0102030405060708090

RK

LR

I c

Cat

PR

K

LA

SIK

LA

SEK

ICR

LT

K

CK

P-I

OL

CL

E SE

'01'02'03

DUFFEY 2004

TOPOGRAPHY UNIT OWNED

91

22

11

40

1611

0102030405060708090

100

YES EyeSys Tomey Zeiss-Hum

Orbscan Other

'98'99'00'01'02'03

DUFFEY 2004

MICROKERATOME USED MOST

53

412

5 4 16

13

30

10

20

30

40

50

60

70

Han

sato

me

Mor

ia C

B

Mor

ia M

2

Nid

ek

Intr

alas

e

'98'99'00'01'02'03

DUFFEY 2004

EXCIMER USED MOST

21

73

17

4 4 101020

3040506070

80

YE

S

Vis

X

Alc

on

Nid

ek

B a

nd L

Las

erSi

gh

'97'98'99'00'01'02'03

DUFFEY 2004

Pupil Gauge Instrument Use

47

38

6 8

0

10

20

30

40

50

60

Card Colvard Procyon Other

'02'03

DUFFEY 2004

Wavefront Analyzer

55

75

17

4 2 20

10

20

30

40

50

60

70

80

YES VisX Alcon B and L Tracey Other

'02'03

DUFFEY 2004

Wavefront-Guided Custom Ablations in Your Practice

48

1412 13

84

05

10

1520

2530

3540

4550

Zero 1-10% 11-25% 26-50% 51-75% 76-100%

'03

DUFFEY 2004

Anticipated Value of Custom Laser Ablations

18

51

27

40

10

20

30

40

50

60

Extreme Moderate Little None

'02'03

DUFFEY 2004

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

20

1

11 13

23

33

0

10

20

30

40

50

60

70

Zero $100 $200 $300 $400 $500+

'02'03

DUFFEY 2004

Preferred Surgery for Presbyopia

55

31

13

10

10

20

30

40

50

60

Mon

ovis

Mic

rom

ono

Mul

tifo

calI

OL

SE

'02'03

DUFFEY 2004

Post-Op Antibiotic

33 32

1511

5 300

5101520253035404550

Zym

ar

Vig

amox

Ocu

flox

Qui

xin

Cil

oxan

Tob

ram

ycin

Gen

tam

icin

'02'03

DUFFEY 2004

Post-Op Anti-inflammatory

53

25

103 1 3 3

0

10

20

30

40

50

60

PF

FM

L

Lot

emax

Dex

amet

Vex

ol

Acu

lar

Vol

tare

n

'03

DUFFEY 2004

’03 ASCRS SURVEY CONCLUSIONS LASIK dominates between -8D and +3D.LASIK dominates between -8D and +3D. Bilateral LASIK same O.R. visit is SOC.Bilateral LASIK same O.R. visit is SOC. P-IOL or Wait for high myopes. P-IOL or Wait for high myopes. CLE for high hyperopes.CLE for high hyperopes. LASIK, LASEK, CLE, P-IOL, PRK, CK all LASIK, LASEK, CLE, P-IOL, PRK, CK all

with apparent bright futures. with apparent bright futures. RK, ICR, LTK, and SE dead or dying.RK, ICR, LTK, and SE dead or dying.

DUFFEY 2004

Conclusions continued...

VisX at 2:1 over all other lasers.VisX at 2:1 over all other lasers. Pupillometry 55:45 IR instrument over cardPupillometry 55:45 IR instrument over card Wavefront custom ablations have gained Wavefront custom ablations have gained

rapid acceptance into practice with 69% rapid acceptance into practice with 69% stating moderate to extreme value added.stating moderate to extreme value added.

55% use wavefront analyzers.55% use wavefront analyzers. 52% perform custom ablations.52% perform custom ablations.

DUFFEY 2004

Conclusions continued...

Surgeons are charging $300-$500 more per Surgeons are charging $300-$500 more per eye for custom ablationseye for custom ablations

Orbscan is not S.O.C. require. for refrac. sxOrbscan is not S.O.C. require. for refrac. sx Monovision is still “choice” for presbyopiaMonovision is still “choice” for presbyopia Fourth generation fluoroquinolones have Fourth generation fluoroquinolones have

overtaken the post-refractive surg. market.overtaken the post-refractive surg. market. PF and FML lead post-op steroids/anti-PF and FML lead post-op steroids/anti-

inflammatories.inflammatories.

Thanks to ASCRS leadership for their support and for your

participation in the 2003 Survey

We look forward to your responses in We look forward to your responses in the 2004 survey this autumn.the 2004 survey this autumn.

Complete results at www.ascrs.org Complete results at www.ascrs.org and at www.duffeylaser.comand at www.duffeylaser.com