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U.S. Trends in Refractive Surgery: 2015 ISRS Survey
Richard J. Duffey, MD David Leaming, MD
Refractive Subspecialty Day
Las Vegas: November 13, 2015
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The authors have no financial interests in this survey study.
DUFFEY/LEAMING 2015
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DUFFEY/LEAMING 2015
2015 Survey
Seventh year of ONLINE*** Survey E-mailed to 1022 U.S. ISRS members; 486 Opened Twentieth year of refractive data collection overall
55 responses analyzed by October 27, 2015 for 9.8% response of the membership’s opened e-mail requests
Alphabet soup of refractive surgery including corneal and lens-based surgeries, premium IOLs, and FS cataract surg.
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DUFFEY/LEAMING 2015
> 5 Cases / Month
Surface Ablation LASIK RLE P-IOL K Inlay Toric Presby-IOL FS-Cat0
10
20
30
40
50
60
70
28
'00'97'04'07'11'12'13'14'15
4
45 47
*
4
5856
11
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DUFFEY/LEAMING 2015
> 25 Cases / Month
Surface Ablation LASIK RLE P-IOL Toric Presby-IOL FS-Cat05
1015202530354045
6
22'97'00'03'06'10'11'12'13'14'15
7
4 07
26
*
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DUFFEY/LEAMING 2015
Preferred Surgery For a 30 yo -10.00 Diopter Myope
Never Surface Ablation LASIK RLE P-IOL WAIT05
101520253035404550
915
29
4
33
11
'05'08'11'12'13'14'15
* 44% LVC
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DUFFEY/LEAMING 2015
Preferred Surgery For a 45 yo +3.00 D Hyperope
Never Surface Abla-tion
LASIK RLE P-IOL WAIT0
102030405060708090
100
'99'02'05'08'11'12'13'14'15
*61% LVC
11 11
50
17
0
11
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DUFFEY/LEAMING 2015
Preferred Surgery For 45 yo +5.00 D Hyperope
Never Surface Abla-tion
LASIK RLE P-IOL WAIT0
10
20
30
40
50
60
70
'99'02'05'08'11'12'13'14'15
10 2
6
*74
08
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DUFFEY/LEAMING 2015
Family LVC Index: (LASIK or PRK Performed on Yourself and Family Members)
Self Spouse Children At least 1 Sibling Parents0
10
20
30
40
50
60
70
80
30 35
50
8
'08'09'10'11'12'13'14'15
28
* >3X the general population
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DUFFEY/LEAMING 2015
Excimer Laser Most Commonly Used
VisX Wavelight B and L Schwind0
10
20
30
40
50
60
70
54
40
'97'00'03'06'09'10'11'12'13'14'15
2 2
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FemtoSecond Cataract Laser Most Commonly Used
LenSx Catalys LensAR Victus (B&L)0
10
20
30
40
50
60
70
20142015
56
28
93
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DUFFEY/LEAMING 2015
Flapmaker Most Commonly Used
B-L Moria Amadeus Nidek B-D Intralase Ziemer Other FS0
10
20
30
40
50
60
29
'98'00'04'07'10'11'12'13'14'15
6
* 76% femtoflaps
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DUFFEY/LEAMING 2015
Topography Unit Used (some physicians use more than one)
Zeiss-Hum Orbscan EyeSys Tomey Pentacam Others0
10
20
30
40
50
60 50
21
25
'98'00'04'07'10'11'12'13'14'15
Orb II Tomey Other
55
18
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DUFFEY/LEAMING 2015
Preferred Surgery for “Pre-Cataract” Presbyopia
Mono Modified Monovision Accommodative IOL Multifocal IOL05
1015202530354045
'02'05'07'10'11'12'13'14'15
45
25
125
Other
11
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DUFFEY/LEAMING 2015
Minimum Residual Stromal Bed Thickness Requirement for LASIK
200 225 250 275 300 325 3500
10
20
30
40
50
60
70
80
'04'07'08'10'11'12'13'14'15
* 61% at 275 microns or greater
0 0
39
16
43
2 0
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DUFFEY/LEAMING 2015
Total Cases of Post LASIK Ectasia as the Primary Surgeon in Career
0 1 2 3 4 5 6 to 10 >100
10
20
30
40
50
60
'04'06'10'11'12'13'14'15
* Continued Decline
54
13 138
62 0
4
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DUFFEY/LEAMING 2015
Cataract/RLE Post-Op Antibiotic
3 3
94
Tobra/Gent Fluoroquinolone Polytrim0
102030405060708090
100
4
81
15
201320142015
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DUFFEY/LEAMING 2015
LVC Post-Op Antibiotic
Tobra/Gent Fluoroquinolone Polytrim0
102030405060708090
100
'13'14'15
14
0
86
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DUFFEY/LEAMING 2015Pred FML Lotepr Dex Durezol
0
10
20
30
40
50
60
70
80
90
61
010
0
28
'06
'09
'10
'11
'12
'13
'14
'15
Cataract/RLE Post-Op Steroid
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DUFFEY/LEAMING 2015
Pred FML Lotepr Dex Durezol0
10
20
30
40
50
60
70
80
90
64
8 146 6
'06
'09
'10
'11
'12
'13
'14
'15
LVC Post-Op Steroid
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Threshold of Astigmatism Offered Correction at Cataract Surgery
DUFFEY/LEAMING 2015
0.25 0.5 0.75 1 1.25 1.5 1.75 2.0+05
10152025303540
6
39
28
17
4
2 24
'12'13'14'15
*68% will offer to correct astigmatism when it has reached 0.75 D and 97% when it has reached 1.25 D
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Procedure for Low Astigmatism Intervention (0.5 to 1.0 D)
DUFFEY/LEAMING 2015
Manual LRI/AK Femto/AK Toric0
10
20
30
40
50
60
70
43 43
14
'12'13'14'15
* 86% LRI/AK
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Procedure for Medium Astigmatism Intervention (1.12 to 2.0 D)
DUFFEY/LEAMING 2015
LRI/AK Femto/AK Toric0
10
20
30
40
50
60
70
80
1017
73
'12'13'14'15
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Procedure for High Astigmatism Intervention (2.0 D plus)
DUFFEY/LEAMING 2015
LRI/AK Femto/AK Toric0
102030405060708090
100
0 0
100
'12'13'14'15
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Do You Currently Perform CXL?
DUFFEY/LEAMING 2015
Yes No0
102030405060708090
22
78
'12'13'14'15
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Overview of FS Cataract Surgery: % of All FS Cases of All FS Surgeons
Primary Corneal Incision
Secondary Corneal Incision
Capsulorhexis Lens Fragmentation AK0
102030405060708090
100
20142015
DUFFEY/LEAMING 2015
3825
90 93
71
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DUFFEY/LEAMING 2015
Total LVC Volume in ISRS (x1000)
121113
428
285
549
398
0
100
200
300
400
500
600
Surface Ablation LASIK Total LVC
'08'09'10'11'12'13'14'15
*27% Decrease in Total LVC from 2014. *Ratio of PRK / Total LVC stable at 28%.
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2015 ISRS FINAL SUMMARY
FemtoSecond Laser-assisted Refractive Cataract Surgery up from 19% to 29% over the last year.
FS, Toric and PresbyIOL are not high volume refractive surgeries yet like LASIK in its heyday, but moving forward.
Multifocals trump Accommodative IOLs, but neither high penetration. More astigmatism management (even low) in cataract surgery. Healthy LVC and Premium IOL Family Indices amongst refractive
surgeons themselves. Post-LVC ectasia on the decline. DUFFEY/LEAMING 2015
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Additional Data at www.duffeylaser.com
Types and volumes of refractive surgeries currently being performed.
Post-operative use of antibiotics, steroids, and NSAIDs.
Surgical venues for various procedures…and more.
DUFFEY/LEAMING 2015
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Thanks to the ISRS leadership for their support
and for your participation in this Final 2015 Survey
We Could Not Have Done It Without YOU!!
***Complete 20 years of survey results found at www.duffeylaser.com