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US Trends in Refractive Surgery:
2009 ASCRS Survey
Richard J. Duffey, MDDavid Leaming, MD
Boston: April 13, 2010
Duffey 2010
Disclosures
The authors actually spend some of their own hard-earned dollars to cover the annual costs of this survey.
Duffey 2010
2009 ASCRS Survey Sept. emailing to 4768 U.S. members of ASCRS
First time totally ONLINE Survey
3778 opened emails with 518 responding representing 14% response rate in the U.S. [same average response with snail mail surveys]
Fourteenth year of refractive data collection allowing analysis and comparison of trends amongst ASCRS U.S. surgeons
Alphabet soup of refractive surgery.
Added questions in recent years as the field has incorporated new laser and refractive technologies including premium IOL’s, astigmatism correction, etc.
Duffey 2010
Preferred Surgery for 30 yo -10.00 Diopter Myope
PRK LASIK P-IOL RLE Wait0
5
10
15
20
25
30
35
40
10
22
37
7
23
'05 '07 '09
Duffey 2010
Preferred Surgery for 45 yo +3.00 D Hyperope
PRK LASIK P-IOL RLE WAIT0
10
20
30
40
50
60
70
80
7
54
0
22
17
'99 '03 '07 '09
Duffey 2010
Preferred Surgery for 45 yo +5.00 D Hyperope
PRK LASIK P-IOL RLE Wait0
10
20
30
40
50
60
1
6 5
54
33 '05 '07 '09
Duffey 2010
Microkeratome Used Most
Hansa
/Zy
Mor
ia LSK CB M
2
Mor
ia D
isp B-D
Nidek
Amad
Intra
Lase
Ziem
er
Fem
tech
0
10
20
30
40
50
60
70
17
13
5 42 3
6
54
2 1
'98 '02 '07 '09Series5
Duffey 2010
Excimer Used Most
VISX Alcon Nidek B and L Wavelight0
10
20
30
40
50
60
70
8074
3 2 2
19
'97 '02 '07 '09
Duffey 2010
Wavefront Analyzer
YES VISX Alcon B and L Alleg Tracey Other0
10
20
30
40
50
60
70
80
9083
80
10
3 41 2
'02 '05 '07 '09
Duffey 2010
Wavefront-Guided Custom Ablations in Your Practice
Zero 1--10 11--25 26--50 51--75 76-1000
10
20
30
40
50
60
18
53
6
11
57
'03 '05 '07 '09
Duffey 2010
Preferred Surgery for Presbyopia (Pre-cataract)
Mono Micromono Premium IOL CK0
10
20
30
40
50
60
49
24 23
2
'02 '05 '07 '09
Duffey 2010
Do You Intra-operatively Measure Flap Thickness?
YES NO0
10
20
30
40
50
60
70
80
90
32
68
'04 '07 '09
Duffey 2010
Preferred Flap Thickness (when no other constraints)
80 100 120-130 150-160 180+0
10
20
30
40
50
60
1
35
53
8
3
'04 '07 '09
Duffey 2010
Minimum Residual Stromal Bed Thickness Requirement
225 250 275 300 325+0
10
20
30
40
50
60
70
80
1
39
24
15
'04 '07 '09
Duffey 2010
Total Cases of Post-LASIK Ectasia as the Primary Surgeon in Career
0 1 2 3 4 5 6+0
10
20
30
40
50
60
70
80
64
18
6 62 2 3
'05 '07 '09
Duffey 2010
Minimum Preop Corneal Pachymetry for LASIK (all other parameters normal)
No Limit 460 480 500 52005
101520253035404550
1012
32
44
2
'04 '07 '09
Duffey 2010
Minimum Final Corneal Thickness Allowable Following PRK (including epithelium)
275 300 325 350 375 400 425 450+0
5
10
15
20
25
30
35
2
14
11
21
15
33
23
'05 '07 '09
Duffey 2010
Mitomycin-C Use (MMC)
Never Haze Only Haze/Prophylax0
10
20
30
40
50
60
70
80
90
12
7
81
'04 '07 '09
Duffey 2010
Will Perform Refractive Surgery On One-Eyed Patients
YES NO0
10
20
30
40
50
60
70
47
53
'04 '07 '09
Duffey 2010
Comanagement
YES 1--33 34--66 67--1000
10
20
30
40
50
60
70
80
90
50
79
14
7
'05 '07 '09
Duffey 2010
When Comanaged, who sees Postop LASIK Patient on Day 1 ?
Surgeon Comanager0
10
20
30
40
50
60
70
80
9082
18
'05 '07 '09
Duffey 2010
Minimum “OR” Location for Phakic-IOL Surgery
0
20
40
60
80
1
85
104
'05 '07 '09
Duffey 2010
Refractive Surgery Volumes (extrapolated data in thousands)
LASIK PRK Total LVC0
200
400
600
800
1000
1200
939
127
1066
570
184
754
'97 '99 '01 '03 '05 '07 '08 '09
Duffey 2010
2009 ASCRS SUMMARYU.S. membership volume of LVC in 2009
decreased to 754,000 eyes. Total of 12-13 million since 1996 within ASCRS.
Volume down 30% over past four years.VisX still at > 3:1 (74%) over all other
lasers combined. Wavelight increased to 19%.
Femtosecond lasers for the first time dominate market share at 55%.
Greater than 30% penetration of modern refractive surgery amongst refractive surgeons (no data on surgeon family members this year).
Duffey 2010
2009 ASCRS SUMMARY
P-IOL (37%) and LASIK (22%) in high myopes. RLE (54%) for high hyperopes.
Most desired flap thickness is 120-130 microns (53%). 100 micron flap thickness is favored by 35% of surgeons (up from 11% four years ago).
39% (still dropping) think 250 microns is adequate for RST. 60% say 275-300 microns is better (21% in ’04).
16% of respondents are OK with bilateral P-IOL (11% three years ago) and 6% with RLE at the same surgical setting.
Duffey 2010
2009 ASCRS SUMMARY
46% of surgeons NOT OK with LASIK in corneas <500 um.
Still only about one-third of surgeons surveyed (36%) have had one or more documented cases of post-LASIK ectasia in his/her surgical patients over a career. (Not Growing)
Thanks to ASCRS leadership for their support and for your
participation in the 2009 Survey
We look forward to your responses in the 2010 ONLINE survey this
autumn.
Complete results since 1997 now available at
www.duffeylaser.com
