u.s. trends in refractive surgery: 2012 isrs survey - partner of aao - richard j. duffey, md david...
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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
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
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
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