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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
