US Trends in Refractive Surgery: 2006 ASCRS Survey

Richard J. Duffey, MDRichard J. Duffey, MDDavid Leaming, MDDavid Leaming, MD

San Diego: April 28, 2007San Diego: April 28, 2007

DUFFEY 2006

Disclosures

The authors actually spend some of their The authors actually spend some of their own hard-earned dollars to cover the annual own hard-earned dollars to cover the annual printing and analyzing costs of this survey.printing and analyzing costs of this survey.

Author (RD) receives partial travel Author (RD) receives partial travel expenses from TLCVision. expenses from TLCVision.

DUFFEY 2006

Lou Holtz “Rule of Tens”

Fewer than 10% of you will remember Fewer than 10% of you will remember more than 10% of what I said more than 10 more than 10% of what I said more than 10 minutes after I said it.minutes after I said it.

So, look for the *So, look for the *

DUFFEY 2006

2006 ASCRS Survey Sept. mailing to 4797 U.S. members of ASCRSSept. mailing to 4797 U.S. members of ASCRS 628 responses representing 13% of the U.S. ASCRS 628 responses representing 13% of the U.S. ASCRS

membershipmembership Tenth year of refractive data collection allowing Tenth year of refractive data collection allowing

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

Alphabet soup of refractive surgery.Alphabet soup of refractive surgery. Added questions in recent years as the field has Added questions in recent years as the field has

incorporated new laser and refractive technologies incorporated new laser and refractive technologies including premium IOL’s.including premium IOL’s.

DUFFEY 2006

Preferred Surgery for 30 yo -10.00 Diopter Myope

5

9

25

20

3 4

2427

5 5

36 35

0

5

10

15

20

25

30

35

40

PRK LASIK LASEK P-IOL RLE WAIT

'05'06

*

DUFFEY 2006

Preferred Surgery for 45 yo +3.00 D Hyperope

4

45

30 2

22 23

0

10

20

30

40

50

60

70

PRK LASIK LASEK CK P-IOL RLE WAIT

'99'00'01'02'03'04'05'06

*

DUFFEY 2006

Preferred Surgery for 45 yo +5.00 D Hyperope

0

9

06

51

33

0

10

20

30

40

50

60

70

PRK LASIK LASEK P-IOL RLE WAIT

'99'00'01'02'03'04'05'06

*

DUFFEY 2006

Had Refractive Surgery Performed on Yourself

5

2

4

14

0

23

0

2

4

6

8

10

12

14

RK AK/LRI PRK LASIK LASEK CK Cat Sx

'98'99'00'01'02'03'04'05'06

*Greater than 4times the pene-tration comparedto general public

DUFFEY 2006

Surgeon Willing to do Bilateral Surgery at the Same Visit

8695

90

55

76

113

73

45

0102030405060708090

100

PRK LASIK LASEK ICR CK P-IOL RLE Epi-Lasik

CorneaInlays

'97'98'99'00'01'02'03'04'05'06

*

DUFFEY 2006

Microkeratome Used Most

40

2

9 95

14

1217

0

10

20

30

40

50

60

70

Hansa/Zy Moria LSK Moria CB Moria Disp Moria M2 B-D Nidek Amadeus Intralase

'98'99'00'02'05'06

25%*

DUFFEY 2006

Epi-Keratome Use

7

69

18

7 7

0

10

20

30

40

50

60

70

Yes MoriaEpi-K

AmadOpus 2

VisijetEpi

Cent SES

'05'06

DUFFEY 2006

Excimer Used Most

77

11

3 3 16

0

10

20

30

40

50

60

70

80

VisX Alcon Nidek B and L LaserSight WaveLight

'97'98'99'00'01'02'03'04'05'06

*

DUFFEY 2006

Wavefront-Guided Custom Ablations in Your Practice

10 106

11

37

25

0

510

1520

2530

354045

50

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

'03'04'05'06

*

DUFFEY 2006

Preferred Surgery for Presbyopia

39

2420

48

0 2 40

10

20

30

40

50

60

Monovis Micromono ReStor Accom IOL ReZoom Tecnis CK Other

'02'03'04'05'06

*

DUFFEY 2006

Do You Intra-operatively Measure Flap Thickness?

28

72

0

10

20

30

40

50

60

70

80

Yes No

'04'05'06

*

DUFFEY 2006

Preferred Flap Thickness (when no other constraints)

1

16

46

29

8

0

510

1520

2530

3540

4550

80 100 120-130 150-160 180+

'04'05'06

*

*

DUFFEY 2006

Minimum Residual Stromal Bed Thickness Requirement

0 0

61

2113

40

10

20

30

40

50

60

70

80

<225 225 250 275 300 Other

'04'05'06

*

DUFFEY 2006

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

52

29

12

2 3 1 00

10

20

30

40

50

60

70

80

0 1 2 3 4 5 >5

'05'06

79x8=632 cases in ASCRS.Total ASCRS LASIK 7.4Meyes done in U.S. since 1996. Thus, 1 per 11,500 eyes.*tends to underestimate

DUFFEY 2006

Minimum Preop Corneal Pachymetry for LASIK (all other parameters normal)

912

3640

200

5

10

15

20

25

30

35

40

45

No Limit 460 480 500 520 540

'04'05'06

*

*

*

DUFFEY 2006

Mitomycin-C Use (MMC)

25

8

67

0

10

20

30

40

50

60

70

Never Haze Only Haze and Prophy

'04'05'06

*

DUFFEY 2006

Will You Perform Refractive Surgery on One-Eyed Patients

36

64

0

1020

3040

5060

7080

90100

Yes No

'04'05'06

*

DUFFEY 2006

When Co-managed, Who Sees Postop LASIK Patient on Day 1 ?

74

26

0

10

20

30

40

50

60

70

80

Surgeon Comanager

'05'06

DUFFEY 2006

Minimum “OR” Location for Phakic-IOL Surgery

1

89

63

0

10

20

30

40

50

60

70

80

90

Hospital OR ASC OR In-OfficeModified OR

Clean LASIKRoom

'05'06

*

DUFFEY 2006

Refractive Surgery Volumes (extrapolated data in thousands)

866

151207

0

100

200

300

400

500

600

700

800

900

1000

LASIK PRK LASEK/Epi-L

'97'98'99'00'01'02'03'04'05'06

*

DUFFEY 2006

2006 ASCRS SUMMARY

Volume of LVC (U.S.) in 2006: Volume of LVC (U.S.) in 2006: 1.24 M eyes1.24 M eyes (1.09M in ’05). 9 M since 1996.(1.09M in ’05). 9 M since 1996.

P-IOLP-IOL (27%)(27%) and LASIK (20%) in high myopes. and LASIK (20%) in high myopes. VisXVisX still at > 3:1 ( still at > 3:1 (76%)76%) over all other lasers over all other lasers Ectasia rate of Ectasia rate of 1 case per 11,5001 case per 11,500 eyes in U.S. eyes in U.S. Wavefront Wavefront custom ablations are increasing with custom ablations are increasing with

90%90% of surgeons performing them (74% last of surgeons performing them (74% last year).year).

22%22% penetrationpenetration of modern refractive surgery of modern refractive surgery amongst refractive surgeons; small growth.amongst refractive surgeons; small growth.

DUFFEY 2006

2006 ASCRS SUMMARY

Most desired flap thickness is 120-160 microns. 100 Most desired flap thickness is 120-160 microns. 100 micron flap thickness is favored by micron flap thickness is favored by 16%16% of surgeons (up of surgeons (up from 11%).from 11%).

75%75% (rising) use MMC for prophylaxis / haze. (rising) use MMC for prophylaxis / haze. Epi-LASIK and Advanced Surface Ablation on the rise.Epi-LASIK and Advanced Surface Ablation on the rise. 11%11% of respondents are OK with of respondents are OK with bilateralbilateral P-IOL (6% last P-IOL (6% last

year) and 3% with RLE at the same surgical setting.year) and 3% with RLE at the same surgical setting. ReStor ReStor (20%)(20%) and ReZoom (8%) IOL’s quickly out-paced and ReZoom (8%) IOL’s quickly out-paced

the accommodative IOL (4%) for preferred lens-based the accommodative IOL (4%) for preferred lens-based presbyopia option.presbyopia option.

Thanks to ASCRS leadership for their support and for your

participation in the 2006 Survey

We look forward to your responses in We look forward to your responses in the 2007 survey this autumn.the 2007 survey this autumn.

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