U.S. Trends in Refractive Surgery: 2013 ISRS Survey

Richard J. Duffey, MD

David Leaming, MD

Refractive Subspecialty Day

New Orleans: November 15, 2013

The authors have no financial interests in this survey study.

DUFFEY/LEAMING 2013

DUFFEY/LEAMING 2013

2013 Survey

Fifth year of ONLINE*** Survey E-mailed to 1150 U.S. ISRS members Seventeenth year of refractive data collection overall

144 responses analyzed by October 7, 2013 for 13% response of the membership e-mailed.

Alphabet soup of refractive surgery including corneal and lens-based surgeries and premium refractive IOLs.

DUFFEY/LEAMING 2013

> 5 Cases / Month

24

56

47 4 1

23

0

10

20

30

40

50

60

70

SurfaceAblation

LASIK AK-IOL AK RLE P-IOL K Inlay Toric Presby-IOL

FS-Cat

'97'00'04'07'11'12'13

28

50

23

*

38

DUFFEY/LEAMING 2013

> 25 Cases / Month

6

26

3

0 1 0 1 4

0

5

10

15

20

25

30

35

40

45

SurfaceAblation

LASIK LRI/IOL LRI/AK RLE P-IOL Toric Presby-IOL FS-Cat

'97'00'03'06'10'11'12'13

5

*

DUFFEY/LEAMING 2013

Preferred Surgery For a 30 yo -10.00 Diopter Myope

5

18

29

1

38

6

05

101520253035404550

Never SurfaceAblation

LASIK RLE P-IOL WAIT

'05'08'11'12'13

** 47% LVC

DUFFEY/LEAMING 2013

Preferred Surgery For a 45 yo +3.00 D Hyperope

310

48

28

010

0102030405060708090

100

Never SurfaceAblation

LASIK RLE P-IOL WAIT

'99

'02

'05

'08

'11

'12

'13

*58% LVC

DUFFEY/LEAMING 2013

Preferred Surgery For 45 yo +5.00 D Hyperope

114

9

61

1

14

0

10

20

30

40

50

60

70

Never SurfaceAblation

LASIK RLE P-IOL WAIT

'99'02'05'08'11'12'13

*

*13% LVC

DUFFEY/LEAMING 2013

Willing To Do Bilateral Surgery At Same O.R. Visit

95 97

29

128

23

0102030405060708090

100

SurfaceAblation

LASIK ICR K Inlay RLE P-IOL

'97'00'04'07'10'11'12'13

*

DUFFEY/LEAMING 2013

Family LVC Index: (LASIK or PRK Performed on Ourselves and Family Members)

4034

72

23

0

10

20

30

40

50

60

70

80

Self Spouse Children At least 1 Sibling Parents

'08'09'10'11'12'13

26

* >3X the general population

DUFFEY/LEAMING 2013

Excimer Laser Most Commonly Used

57

3

34

4 2

0

10

20

30

40

50

60

70

VisX Nidek Wavelight B and L Schwind

'97'00'03'06'09'10'11'12'13

DUFFEY/LEAMING 2013

Flapmaker Most Commonly Used

69

62 1 4

58

411

0

10

20

30

40

50

60

B-L Moria Amadeus Nidek B-D Other MK Intralase Ziemer Other FS

'98

'00

'04

'07

'10

'11

'12

'13

6

* 73% femtoflaps

DUFFEY/LEAMING 2013

Topography Unit Most Commonly Used (some physicians use more than one equally)

43

30

10

1619

45

10

05

101520253035404550

Zeiss-Hum

Orbscan EyeSys Tomey Nidek Pentacam Others

'98'00'04'07'10'11'12'13

DUFFEY/LEAMING 2013

Preferred Surgery for “Pre-Cataract” Presbyopia

38

23

6

14

7

0

10

20

30

40

50

60

Mono Modified Monovision Accommodative IOL Multifocal IOL Other

'02'05'07'10'11'12'13

*

*

DUFFEY/LEAMING 2013

Preferred Flap Thickness (when no other constraints)

0

5146

1

0

10

20

30

40

50

60

80 100 120-130 150-160

'04'07'10'11'12'13

DUFFEY/LEAMING 2013

Minimum Residual Stromal Bed Thickness Requirement for LASIK

10

38

16

42

3 00

10

20

30

40

50

60

70

80

200 225 250 275 300 325 350

'04'07'08'10'11'12'13

* 61% at 275 microns or greater

DUFFEY/LEAMING 2013

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

47

1911

7 92 4 1

0

10

20

30

40

50

60

0 1 2 3 4 5 6 to 10 >10

'04'06'10'11'12'13

* Not growing

Threshold of Astigmatism Offered Correction at Cataract Surgery

DUFFEY/LEAMING 2013

2

25

40

17

73

10 6

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

'12'13

*67% will offer to correct astigmatism when it reaches 0.75 D and 90% when it reaches 1.25 D

Procedure for Low Astigmatism Intervention (0.5 to 1.0 D)

DUFFEY/LEAMING 2013

55

32

13

0

10

20

30

40

50

60

70

LRI AK Toric

'12'13

* 88% LRI/AK

Procedure for Medium Astigmatism Intervention (1.12 to 2.0 D)

DUFFEY/LEAMING 2013

1015

75

0

10

20

30

40

50

60

70

80

LRI AK Toric

'12'13

? FS AK

Procedure for High Astigmatism Intervention (2.0 D plus)

DUFFEY/LEAMING 2013

2 2

96

0

10

20

30

40

50

60

70

80

90

100

LRI AK Toric

'12'13

Do You Currently Perform CXL?

DUFFEY/LEAMING 2013

27

73

0

10

20

30

40

50

60

70

80

90

Yes No

'12'13

*Not FDA approved

DUFFEY/LEAMING 2013

Total LVC Volume w/i ISRS (1000s)

112

339

451

0

100

200

300

400

500

600

Surface Ablation LASIK Total LVC

'08'09'10'11'12'13

* No Change in Total LVC from 2012. Ratio of PRK / Total LVC approximately

25% over past four years.

2013 ISRS FINAL SUMMARY

FemtoSesond Laser-assisted Refractive Cataract Surgery on the rise. FS, Toric and PresbyIOL are not high volume refractive surgeries yet

like LASIK in its heyday, but on the rise.

Multifocals trump Accomodative IOLs, but neither high penetration. More astigmatism management (even low amt.) in cataract surgery. Healthy LVC Family Indices amongst refractive surgeons themselves. Post-LVC ectasia on the further decline.

DUFFEY/LEAMING 2013

Thanks to the ISRS leadership for their support

and for your participation in the 2013 Survey

We look forward to your response to our sixth ONLINE survey and the eighteenth survey overall

next fall.

***Complete 17 years of survey results found at www.duffeylaser.com