US Trends in Refractive Surgery: The 2004 ISRS/AAO Survey

US Trends in Refractive Surgery: The 2004 ISRS/AAO Survey

Richard J. Duffey, MDRichard J. Duffey, MD

David Leaming, MDDavid Leaming, MD

ISRS / AAO MeetingISRS / AAO Meeting

New Orleans- October 22, 2004New Orleans- October 22, 2004

2004 Survey2004 Survey August mailing to 1500 U.S. members of the recently August mailing to 1500 U.S. members of the recently

combined ISRS/AAO.combined ISRS/AAO. 184 responses analyzed by October 1st for 12.3% of 184 responses analyzed by October 1st for 12.3% of

the U.S. ISRS/AAO membership.the U.S. ISRS/AAO membership. Eighth year of refractive data collection.Eighth year of refractive data collection. Alphabet soup of refractive surgery.Alphabet soup of refractive surgery. Many new questions on flap thickness preference and Many new questions on flap thickness preference and

measurements, MMC use, enhancement tests, one-measurements, MMC use, enhancement tests, one-eyed patients, ectasia, co-management,…etc…etc…eyed patients, ectasia, co-management,…etc…etc…

DUFFEY 2004

> 5 Cases / Month> 5 Cases / Month

3

14

69

7

24

3 15

0

12

0

10

20

30

40

50

60

70

80

90

PTK PRK LASIK LASEK LRI-IOL LRI ICR RLE P-IOL CK

'97'98'99'00'01'02'03'04

DUFFEY 2004

Preferred Surgery For 30 yo -12.00 Diopter MyopePreferred Surgery For 30 yo -12.00 Diopter Myope

1 3

17

2 5

40

32

0

10

20

30

40

50

60

70

80

Never PRK LASIK LASEK RLE P-IOL WAIT

'97'98'99'00'01'02'03'04

DUFFEY 2004

Preferred Surgery For 45 yo +5.00 D HyperopePreferred Surgery For 45 yo +5.00 D Hyperope

2 1

13

1

43

10

31

0

10

20

30

40

50

60

Never PRK LASIK LASEK RLE P-IOL WAIT

'99'00'01'02'03'04

DUFFEY 2004

Surgery Done Bilateral At Same O.R. Visit Surgery Done Bilateral At Same O.R. Visit

87

9890 87

40

08

0

10

20

30

40

50

60

70

80

90

100

PRK LASIK LASEK CK SE RLE P-IOL

'97'98'99'00'01'02'03'04

DUFFEY 2004

Procedure Future Index (Doing Now and/or Plan in Future)Procedure Future Index (Doing Now and/or Plan in Future)

94

7988 91

4651

7

26

7970

15

0

10

20

30

40

50

60

70

80

90

100

LASIK RLE P-IOL PRK LASEK CK LTK ICR LRI/Cat LRI alone SE

'00'01'02'03'04

DUFFEY 2004

Microkeratome Most Commonly UsedMicrokeratome Most Commonly Used

45

96 8

2

128

52 10

10

20

30

40

50

60

B-L Hansa Moria C-B MoriaDisp

Moria M2 Moria LSK Intralase Amadeus Nidek B-D FlapM

'98'99'00'01'02'03'04

DUFFEY 2004

Preferred Surgery for PresbyopiaPreferred Surgery for Presbyopia

44

22

12

41 1

14

10

5

10

15

20

25

30

35

40

45

50

Mo-LASIK MMLASIK CK-blended Multi-IOL SE IR3000 Accom IOL Other

'02'03'04

DUFFEY 2004

Wavefront AnalyzerWavefront Analyzer

89

11

61

12 101 2 10

10

20

30

40

50

60

70

80

90

Yes No VisX Alcon B and L Tracey WavefrSci

Other

'02'03'04

DUFFEY 2004

Wavefront-Guided Custom Ablations in Your PracticeWavefront-Guided Custom Ablations in Your Practice

91

9

28

1116

35

010

2030

4050

6070

8090

100

Yes No 1-25% 26-50% 51-75% 76-100%

'03'04

DUFFEY 2004

ComanagementComanagement

42

58

29

73 3

0

10

20

30

40

50

60

70

80

Yes No 1-25% 26-50% 51-75% 76-100%

'00'01'03'04

DUFFEY 2004

Do You Intra-operatively Measure Flap Thickness?Do You Intra-operatively Measure Flap Thickness?

31

69

0

10

20

30

40

50

60

70

Yes No

'04

DUFFEY 2004

Preferred Flap Thickness (when no other constraints)Preferred Flap Thickness (when no other constraints)

1

12

36 37

14

0

5

10

15

20

25

30

35

40

80 100 120-130 150-160 180+

'04

DUFFEY 2004

Minimum Residual Stromal Thickness RequirementMinimum Residual Stromal Thickness Requirement

1 2

79

11 80 00

10

20

30

40

50

60

70

80

200 225 250 275 300 325 350

'04

DUFFEY 2004

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

4239

10

31 2 1 00

5

10

15

20

25

30

35

40

45

0 1 2 3 4 5 6 to 10 >10

'04

DUFFEY 2004

Mitomycin-C Use (MMC)Mitomycin-C Use (MMC)

36

12

52

0

10

20

30

40

50

60

Never Haze Only Haze and Prophy

'04

DUFFEY 2004

Will You Perform Refractive Surgery on One-Eyed PatientsWill You Perform Refractive Surgery on One-Eyed Patients

51 49

0102030405060708090

100

Yes No

'04

DUFFEY 2004

’04 ISRS/AAO Survey Conclusions’04 ISRS/AAO 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 for high myopes (40%). P-IOL for high myopes (40%). RLE for high hyperopes (43%).RLE for high hyperopes (43%). LASIK, LASEK, RLE, P-IOL, PRK, CK, and LRI LASIK, LASEK, RLE, P-IOL, PRK, CK, and LRI

all with apparent bright futures. all with apparent bright futures. RK, LTK, and SE fading…fad…f….RK, LTK, and SE fading…fad…f…. ICR making a limited comeback (? niche proced.).ICR making a limited comeback (? niche proced.).

DUFFEY 2004

Conclusions continued...Conclusions continued...

VisX at > 2:1 over all other lasers.VisX at > 2:1 over all other lasers. Orbscan leveled off after 6 years of growth (23%).Orbscan leveled off after 6 years of growth (23%). Intralase is increasing market share (12%).Intralase is increasing market share (12%). Pupillometry 2:1 IR instrument over card.Pupillometry 2:1 IR instrument over card. Wavefront custom ablations further growth:Wavefront custom ablations further growth: 90% use wavefront analyzers.90% use wavefront analyzers. 90% perform custom ablations…and at increasing 90% perform custom ablations…and at increasing

frequencies (38% whenever possible).frequencies (38% whenever possible).

DUFFEY 2004

Conclusions continued...Conclusions continued...

Surgeons are charging approximately $400 more Surgeons are charging approximately $400 more per eye for custom ablations.per eye for custom ablations.

Fourth generation fluoroquinolones have over-Fourth generation fluoroquinolones have over-taken the post-refractive surg. market (Z>V).taken the post-refractive surg. market (Z>V).

PF and FML lead post-op steroids/anti-PF and FML lead post-op steroids/anti-inflammatories.inflammatories.

Co-management significantly decreasing in Co-management significantly decreasing in surgeons participating and percentage of patients surgeons participating and percentage of patients being comanaged over last 2 years (down half).being comanaged over last 2 years (down half).

29% penetration of refrac sx amongst ref surgeons29% penetration of refrac sx amongst ref surgeons

DUFFEY 2004

Conclusions continued...Conclusions continued...

Mono-LASIK is the most sought goal for Mono-LASIK is the most sought goal for presbyopic patients seeking refract surgery (44%).presbyopic patients seeking refract surgery (44%).

Less than one-third of refractive surgeons (31%) Less than one-third of refractive surgeons (31%) measure true flap thickness in the OR.measure true flap thickness in the OR.

Over half of surgeons (56%) have had at least one Over half of surgeons (56%) have had at least one documented case of post-LASIK ectasia in his/her documented case of post-LASIK ectasia in his/her surgical patients over a career.surgical patients over a career.

80% think 250 microns is adequate for RST.80% think 250 microns is adequate for RST. Most desired flap thickness is 120-160 microns.Most desired flap thickness is 120-160 microns.

DUFFEY 2004

Conclusions continued...Conclusions continued...

64% use MMC for prophylaxis and/or haze.64% use MMC for prophylaxis and/or haze. 51% OK with refractive surgery on one-eyed pt.51% OK with refractive surgery on one-eyed pt. Preop exam usually (82%) included in refractive Preop exam usually (82%) included in refractive

surgery price.surgery price. 8% of respondents OK with 8% of respondents OK with bilateralbilateral P-IOL at the P-IOL at the

same surgical setting.same surgical setting. Crystalens accommodative IOL on radar screen Crystalens accommodative IOL on radar screen

for preferred presbyopia option (14%).for preferred presbyopia option (14%).

Thanks to the ISRS/AAO leadership for their support and for your participation in the

2004 Survey

Thanks to the ISRS/AAO leadership for their support and for your participation in the

2004 Survey We look forward to your response to We look forward to your response to

the 2005 survey next fallthe 2005 survey next fall

Complete results at Complete results at www.duffeylaser.comwww.duffeylaser.com