U.S. Trends in Refractive Surgery: 2012 ISRS Survey

- Partner of AAO -

Richard J. Duffey, MD

David Leaming, MD

Refractive Subspecialty Day

Chicago: November 10, 2012

The authors have no financial interests in this survey study.

DUFFEY 2012

DUFFEY 2012

2012 Survey

Fourth year of ONLINE*** survey opened by 376 ISRS members of the 1150 total emailed…sixteenth year of refractive data collection overall

127 responses analyzed by October 5, 2012 for 34% of the U.S. ISRS membership who opened the emailed survey and 11% of the membership e-mailed.

Alphabet soup of refractive surgery including corneal and lens-based surgeries and premium refractive IOLs.

DUFFEY 2012

I Am Currently Doing This Surgery

86 88

68 6856

39

26

135 6

1

7971

0

10

20

30

40

50

60

70

80

90

100

LASIK SurfaceAblation

LRI/AK-IOL

RLE LRI/AK P-IOL ICR CK K Inlays Multi-LASIK

Multi KInlays

Toric Presby-IOL

'06'07'08'09'11'12

* *

DUFFEY 2012

> 75 Cases / Month

9

21

0

5

10

15

20

25

30

LASIK Surface Ablation AK/IOL

'97'98'99'01'02'03'04'05'06'07'08'10'11'12

* Peaked in 2001

DUFFEY 2012

Preferred Surgery For 30 yo -10.00 Diopter Myope

3

17

28

2

41

9

05

101520253035404550

Never SurfaceAblation

LASIK RLE P-IOL WAIT

'05'06'07'08'09'10'11'12

** 45% LVC

DUFFEY 2012

Preferred Surgery For 45 yo +3.00 D Hyperope

510

60

20

1 4

0102030405060708090

100

Never SurfaceAblation

LASIK RLE P-IOL WAIT

'99'02'05'06'07'08'09'10'11'12

*70% LVC

DUFFEY 2012

Preferred Surgery For 45 yo +5.00 D Hyperope

62

9

62

2

19

0

10

20

30

40

50

60

70

Never SurfaceAblation

LASIK RLE P-IOL WAIT

'99'02'05'06'07'08'09'10'11'12

*

DUFFEY 2012

Willing To Do Bilateral Surgery At Same O.R. Visit

96 97

3119

5

25

0102030405060708090

100

SurfaceAblation

LASIK ICR K Inlay RLE P-IOL

'97'00'04'06'07'08'09'10'11'12

**

DUFFEY 2012

Family LVC Index: (LASIK or PRK Performed on Ourselves and Family Members)

3329

59

14

0

10

20

30

40

50

60

70

Self Spouse Children At least 1 Sibling Parents

'08'09'10'11'12

28

* 3X the general population

DUFFEY 2012

Excimer Laser Most Commonly Used

63

7

26

1 1 2

0

10

20

30

40

50

60

70

VisX Nidek Wavelight B and L Others Schwind

'97'00'03'06'07'08'09'10'11'12

DUFFEY 2012

“Microkeratome” Most Commonly Used

4

1

11

3 2 50

32

52

6 8

0

10

20

30

40

50

60

B-L Moria C-B

MoriaDisp

MoriaM2

MoriaLSK

Amadeus Nidek B-D OtherMK

Intralase Ziemer Other FS

'98

'00

'04

'07

'08

'09

'10

'11

'12

* 66% femtolaser

DUFFEY 2012

Topography Unit Most Commonly Used

43

26

812 14

41

12

05

101520253035404550

Zeiss-Hum

Orbscan EyeSys Tomey Nidek Pentacam Others

'98'00'04'07'08'09'10'11'12

DUFFEY 2012

Preferred Surgery for “Pre-Cataract” Presbyopia

41

30

4

15

71 2

0

10

20

30

40

50

60

Mono ModifiedMonovision

AccommodativeIOL

Multifocal IOL Other Presby-LASIK Blended CK

'02'05'07'08'09'10'11'12

**

DUFFEY 2012

Preferred Flap Thickness (when no other constraints)

0

57

40

3

0

10

20

30

40

50

60

80 100 120-130 150-160

'04'07'08'09'10'11'12

*

DUFFEY 2012

Minimum Residual Stromal Bed Thickness Requirement for LASIK

06

40

24

36

0 00

10

20

30

40

50

60

70

80

200 225 250 275 300 325 350

'04'07'08'09'10'11'12

* 60% at 275 microns or greater

DUFFEY 2012

Total Cases of Post LASIK Ectasia as the Primary Surgeon in Career

50

13 149

5 5 3 2

0

10

20

30

40

50

60

0 1 2 3 4 5 6 to 10 >10

'04'06'08'09'10'11'12

* Not growing

DUFFEY 2012

02

32

43

11 12

0

5

10

15

20

25

30

35

40

45

50

540 microns 520 500 480 460 no limit

'05

'06

'07

'08

'09

'10

'11

'12

Minimum Cent. Corneal Pachymetry for LASIK (all other parameters normal)

* 66% OK with 480 or less

DUFFEY 2012

Will You Perform Refractive Surgery on One-Eyed Patients

5248

0

10

2030

40

50

60

7080

90

100

Yes No

'04'07'08'09'10'11'12

Threshold of Astigmatism Offered Correction at Cataract Sx

DUFFEY 2012

1

17

38

24

8

2 26

2

0

5

10

15

20

25

30

35

40

0.25 0.5 0.75 1 1.25 1.5 1.75 2.0+ DoNot

Offer

'12

* 56% will offer to correct astigmatism when it reaches 0.75 D… 80% if it reaches 1.0 D

Procedure for Low Astigmatism Intervention (0.5 to 1.0 D)

DUFFEY 2012

63

1620

0

10

20

30

40

50

60

70

LRI AK Toric

'12

* 80% LRI/AK

Procedure for Medium Astigmatism Intervention (1.12 to 2.0 D)

DUFFEY 2012

168

76

0

10

20

30

40

50

60

70

80

LRI AK Toric

'12

Procedure for High Astigmatism Intervention (2.0 D plus)

DUFFEY 2012

1 4

95

0

10

20

30

40

5060

70

80

90

100

LRI AK Toric

'12

Do You Currently Perform CXL?

DUFFEY 2012

16

84

0

10

20

30

40

50

60

70

80

90

Yes No

'12

DUFFEY 2012

Total LVC Volume w/i ISRS (1000s)

132

319

451

0

100

200

300

400

500

600

Surface Ablation LASIK Total LVC

'08'09'10'11'12

* 8% decrease in Total LVC from 2010. Ratio of PRK / Total LVC increased from

24% to 29% over past 2 years.

DUFFEY 2012

2012 ISRS/AAO SUMMARY

Fourth ONLINE ISRS/AAO SURVEY was a success with 34% / 11% response rate.

VisX 2:1 (63%) over Wavelight (26%) and other excimers combined…stable.

About 35% penetration of modern refractive surgery amongst refractive surgeons…. 3-4 X the general population. Family Index rates also continue to be high despite mixed press re: LVC in the public media a few years ago.

DUFFEY 2012

2012 ISRS/AAO SUMMARY

25% of respondents are OK with bilateral P-IOL and 5% with bilateral RLE at the same surgical setting (down from last year).

Multifocal IOL (15%) over accommodative IOL (4%) as a preferred lens-based presbyopia option when used for RLE (stable).

Femtosecond laser use still on the rise (66%)

DUFFEY 2012

2012 ISRS/AAO SUMMARY

Thinner flaps still on the rise: 100 micron or less flaps are favored by 57% of surgeons (up from 12% in ‘04).

Preferred RSB thickness stable: 40% think 250 microns is adequate, but 60% recommend 275 microns or more.

New post-LASIK ectasia cases continue to be on the decline with 50% stating no cases of their own patients in their career.

2012 ISRS/AAO SUMMARY

Pentacam (41%) and Z-H (43%) about equal and Orbscan II down (26%) from last year.

LVC Volume down 8% within ISRS/AAO membership in 2012 relative to 2010 and down even greater from last year.

Ratio of Surface Ablation / Total LVC stable at 29% over past two years.

DUFFEY 2012

2012 ISRS/AAO SUMMARY

During cataract surgery 80% of surgeons will offer to correct astigmatism if it measures 1.0 D or more

LRI/AK preferred (80%) if K astigmatism <1.0D Toric IOL preferred (76%) if K astigmatism > 1.12D

CXL offered by 16% of ISRS/AAO members surveyed in the U.S.

DUFFEY 2012

Thanks to the ISRS/AAO leadership for their support

and for your participation in the 2012 Survey

We look forward to your response to our fifth ONLINE survey and the seventeenth survey

overall next fall.

***Complete 16 years of survey results found at www.duffeylaser.com