us trends in refractive surgery: the 2007 isrs/aao survey richard j. duffey, md ** david leaming, md...
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US Trends in Refractive Surgery: The 2007 ISRS/AAO Survey
US Trends in Refractive Surgery: The 2007 ISRS/AAO Survey
Richard J. Duffey, MD **Richard J. Duffey, MD **
David Leaming, MDDavid Leaming, MDRefractive Subspecialty DayRefractive Subspecialty Day
New Orleans - November 10, 2007New Orleans - November 10, 2007
** TLCV provided partial funding for this survey** TLCV provided partial funding for this survey
DUFFEY 2007
Lou Holtz “Rule of Tens”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 2007
2007 Survey2007 Survey
August mailing to 1407 U.S. members of August mailing to 1407 U.S. members of ISRS/AAO.ISRS/AAO.
248 responses analyzed by October 1st for 248 responses analyzed by October 1st for 18% of the U.S. ISRS/AAO membership.18% of the U.S. ISRS/AAO membership.
Eleventh year of refractive data collection.Eleventh year of refractive data collection. Alphabet soup of refractive surgery Alphabet soup of refractive surgery
including corneal and lens based surgeries.including corneal and lens based surgeries.
DUFFEY 2007
I Am Currently Doing This SurgeryI Am Currently Doing This Surgery
95 96
7368
3127
38
19 2115
4 4 10
1020
30
4050
60
7080
90
100
LASIK PRK LRI-IOL
RLE LRI CKPresb
LASEK P-IOL CKHyp
Epi-LASIK
ICR LTK KInlays
SE
'06'07
*
*
DUFFEY 2007
> 5 Cases / Month> 5 Cases / Month
25
66
6 6
35
40
83 5
1 10
10
20
30
40
50
60
70
80
PRK LASIK LASEK Epi-LASIK
LRI-IOL LRI ICR RLE P-IOL PTK CK Pres CK Hyp
'97'00'04'05'06'07
*
DUFFEY 2007
> 25 Cases / Month> 25 Cases / Month
6
33
2 15
0 1 1 20
10
20
30
40
50
60
PRK LASIK LASEK Epi-LASIK
LRI/IOL LRI RLE P-IOL PTK
'97'98'99'00'01'02'03'04'05'06'07
DUFFEY 2007
> 75 Cases / Month> 75 Cases / Month
27
13
1 1 1 10
5
10
15
20
25
30
LASIK PRK LASEK LRI/Cat PTK
'97'98'99'00'01'02'03'04'05'06'07
DUFFEY 2007
Preferred Surgery For 30 yo -10.00 Diopter MyopePreferred Surgery For 30 yo -10.00 Diopter Myope
0
10
33
2 1
41
11
0
5
10
15
20
25
30
35
40
45
Never PRK LASIK LASEK RLE P-IOL WAIT
'05'06'07
*
DUFFEY 2007
Preferred Surgery For 45 yo +3.00 D HyperopePreferred Surgery For 45 yo +3.00 D Hyperope
07
68
2
18
15
0
10
20
30
40
50
60
70
80
90
100
Never PRK LASIK LASEK RLE P-IOL WAIT
'99'00'01'02'03'04'05'06'07
*
DUFFEY 2007
Preferred Surgery For 45 yo +5.00 D HyperopePreferred Surgery For 45 yo +5.00 D Hyperope
0 2
13
0
60
5
19
0
10
20
30
40
50
60
70
Never PRK LASIK LASEK RLE P-IOL WAIT
'99'00'01'02'03'04'05'06'07
*
DUFFEY 2007
Surgery Done Bilateral At Same O.R. Visit Surgery Done Bilateral At Same O.R. Visit
9099
90 94
74
3929
410
0102030405060708090
100
PRK LASIK Epi-LASIK
LASEK CK ICR K Inlay RLE P-IOL
'97'98'00'04'05'06'07
*
DUFFEY 2007
Had Refractive Surgery Performed on YourselfHad Refractive Surgery Performed on Yourself
3
6
17
1 1 0 1 0
3
0
5
10
15
20
25
LRI PRK LASIK LASEK Epi-LASIK
ICR RLE P-IOL CK
'98'99'00'01'02'03'04'05'06'07
*32%
DUFFEY 2007
Excimer Laser Most Commonly UsedExcimer Laser Most Commonly Used
69
113
106
00
10
20
30
40
50
60
70
80
90
VisX Alcon Nidek Wavelight B and L Others
'97'98'99'00'01'02'03'04'05'06'07
*
DUFFEY 2007
Microkeratome Most Commonly UsedMicrokeratome Most Commonly Used
5
28
95 4 5
28
12
410
10
20
30
40
50
60
B-L Zyop B-L Hansa Moria C-B MoriaDisp
Moria M2 Moria LSK Intralase Amadeus Nidek B-D
'98'00'04'05'06'07
*23%
*33%
*
DUFFEY 2007
Topography Unit Most Commonly UsedTopography Unit Most Commonly Used
41
35
17
10 9
24
7
0
5
10
15
20
25
30
35
40
45
Zeiss-Hum
Orbscan EyeSys Tomey Nidek Pentacam Others
'98'00'04'05'06'07
*
1.43 units/respondent
DUFFEY 2007
Preferred Surgery for PresbyopiaPreferred Surgery for Presbyopia
42
19
2
9
16
10
0 03
0
10
20
30
40
50
60
Mono Mod Mono CK-blended CrystaLens ReStor ReZoom Technis Multifocal KInlay
Other
'02'03'04'05'06'07
*35%
*61%
DUFFEY 2007
Wavefront AnalyzerWavefront Analyzer
88
12
70
25
6 4 26
0
10
20
30
40
50
60
70
80
90
Yes No VisX Alcon B and L Tracey Allegr Other
'02'03'04'05'06'07
*
DUFFEY 2007
Wavefront-Guided Custom Ablations in Your PracticeWavefront-Guided Custom Ablations in Your Practice
8
18
6 8
60
0
10
20
30
40
50
60
0% 1-25% 26-50% 51-75% 76-100%
'03'04'05'06'07
*
DUFFEY 2007
Preferred Flap Thickness (when no other constraints)Preferred Flap Thickness (when no other constraints)
0
27
49
20
30
10
20
30
40
50
60
80 100 120-130 150-160 180+
'04'05'06'07
*
DUFFEY 2007
Minimum Residual Stromal Bed Thickness Requirement for LASIKMinimum Residual Stromal Bed Thickness Requirement for LASIK
0 1
62
17 18
1 10
10
20
30
40
50
60
70
80
200 225 250 275 300 325 350
'04'05'06'07
*
DUFFEY 2007
Total Cases of Post LASIK Ectasia as the Primary Surgeon in CareerTotal Cases of Post LASIK Ectasia as the Primary Surgeon in Career
56
1914
52 3 1 10
10
20
30
40
50
60
0 1 2 3 4 5 6 to 10 >10
'04'05'06'07
* Not growing
DUFFEY 2007
03
44
34
118
0
5
10
15
20
25
30
35
40
45
50
540microns
520 500 480 460 no limit
'05'06'07
Minimum Cent. Corneal Pachymetry for LASIK (all other parameters normal)
Minimum Cent. Corneal Pachymetry for LASIK (all other parameters normal)
*
DUFFEY 2007
Mitomycin-C Use (MMC)Mitomycin-C Use (MMC)
126
82
0
10
20
30
40
50
60
70
8090
Never Haze Only Prophylaxis andHaze
'04'05'06'07
*
DUFFEY 2007
Location of Phakic-IOL SurgeryLocation of Phakic-IOL Surgery
2
77
16
5
0
10
20
30
40
50
60
70
80
Hospital OR ASC OR In-OfficeModified
OR
CleanLASIKRoom
'05'06'07
DUFFEY 2007
2007 ISRS/AAO SUMMARY2007 ISRS/AAO SUMMARY
P-IOLP-IOL (41%)(41%) and LASIK (32%) in and LASIK (32%) in high myopeshigh myopes.. VisXVisX still > 2:1still > 2:1 ( (69%)69%) over all other lasers over all other lasers Wavefront custom ablations are increasingWavefront custom ablations are increasing with with
92%92% of surgeons performing them ( of surgeons performing them (60%60% whenever possible).whenever possible).
32%32% penetrationpenetration of modern refractive surgery of modern refractive surgery amongst refractive surgeons; amongst refractive surgeons; 4 times4 times the general the general population.population.
DUFFEY 2007
2007 ISRS/AAO SUMMARY2007 ISRS/AAO SUMMARY
MMCMMC use on the rise (82%).use on the rise (82%). 10%10% of respondents are OK with of respondents are OK with bilateralbilateral P-IOL P-IOL
(6% last year) and (6% last year) and 4% with 4% with bilateralbilateral RLE RLE at the at the same surgical setting.same surgical setting.
ReStor (16%)ReStor (16%) and and ReZoomReZoom (10%)(10%) IOL’s slightly IOL’s slightly out-paced the out-paced the CrystalensCrystalens IOLIOL (9%)(9%) for preferred for preferred lens-based presbyopia option.lens-based presbyopia option.
Femtosecond laser use on the rise (28%).Femtosecond laser use on the rise (28%).
DUFFEY 2007
2007 ISRS/AAO SUMMARY2007 ISRS/AAO SUMMARY
Thinner flapsThinner flaps on the riseon the rise; 100 micron flap ; 100 micron flap thickness is favored by thickness is favored by 27%27% of surgeons of surgeons (up from 19%).(up from 19%).
RSB Thickness on the riseRSB Thickness on the rise; 62% think 250 ; 62% think 250 microns is adequate, but 37% recommend microns is adequate, but 37% recommend 275 microns or more.275 microns or more.
New post-LASIK ectasia cases are on the New post-LASIK ectasia cases are on the declinedecline..
Thanks to the ISRS/AAO leadership for their support and for your participation in the
2007 Survey
Thanks to the ISRS/AAO leadership for their support and for your participation in the
2007 Survey We look forward to your response to We look forward to your response to
the 2008 survey next fallthe 2008 survey next fall
Complete results at Complete results at www.duffeylaser.comwww.duffeylaser.com