us trends in refractive surgery: the 2006 isrs/aao survey richard j. duffey, md ** david leaming, md...
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US Trends in Refractive Surgery: The 2006 ISRS/AAO Survey
US Trends in Refractive Surgery: The 2006 ISRS/AAO Survey
Richard J. Duffey, MD **Richard J. Duffey, MD **
David Leaming, MDDavid Leaming, MDISRS / AAO MeetingISRS / AAO Meeting
Las Vegas- November 11, 2006Las Vegas- November 11, 2006** Author receives some travel expenses from TLCV ** Author receives some travel expenses from TLCV
** TLCV provided partial funding for this survey** TLCV provided partial funding for this survey
DUFFEY 2006
Why is this presentation LAST?Why is this presentation LAST?
Saving the best for last…flattering but NOSaving the best for last…flattering but NO Least damaging to attendance... Probably Least damaging to attendance... Probably
Not Not
Data just arrived via email from Analyze Data just arrived via email from Analyze yesterday and is literally…Hot Off the Press yesterday and is literally…Hot Off the Press
DUFFEY 2006
2006 Survey2006 Survey August mailing to 1500 U.S. members of ISRS/AAO.August mailing to 1500 U.S. members of ISRS/AAO. 167 responses analyzed by October 1st for 11% of the 167 responses analyzed by October 1st for 11% of the
U.S. ISRS/AAO membership.U.S. ISRS/AAO membership. Tenth year of refractive data collection.Tenth year of refractive data collection. Alphabet soup of refractive surgery.Alphabet soup of refractive surgery. Many new questions on flap thickness preference and Many new questions on flap thickness preference and
measurements, MMC use, enhancement tests, one-measurements, MMC use, enhancement tests, one-eyed patients, ectasia, co-management, SOC, etc., etc.eyed patients, ectasia, co-management, SOC, etc., etc.
DUFFEY 2006
I Am Currently Doing This SurgeryI Am Currently Doing This Surgery
94 94
71
57 57
26 27 30
18 2011
2 3 0010
2030
40
5060
70
8090
100
LASIK PRK LRI-IOL
RLE LRI CKPresb
LASEK P-IOL CKHyp
Epi-LASIK
ICR LTK KInlays
SE
'06
DUFFEY 2006
> 5 Cases / Month> 5 Cases / Month
24
63
5 5
27
1 0
8 5 3 3 00
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
DUFFEY 2006
> 25 Cases / Month> 25 Cases / Month
3
33
0 15
0 1 10
10
20
30
40
50
60
PRK LASIK LASEK Epi-LASIK LRI/IOL LRI P-IOL PTK
'97'98'99'00'01'02'03'04'05'06
DUFFEY 2006
> 75 Cases / Month> 75 Cases / Month
27
13
10
5
10
15
20
25
30
LASIK PRK
'97'98'99'00'01'02'03'04'05'06
DUFFEY 2006
Preferred Surgery For 30 yo -10.00 Diopter MyopePreferred Surgery For 30 yo -10.00 Diopter Myope
1 1
710
40
31
35
03
3535
1315
0
5
10
15
20
25
30
35
40
Never PRK LASIK LASEK RLE P-IOL WAIT
'05'06
*
DUFFEY 2006
Preferred Surgery For 45 yo +3.00 D HyperopePreferred Surgery For 45 yo +3.00 D Hyperope
0
10
66
4 0
16
1 40
10
20
30
40
50
60
70
80
90
100
Never PRK LASIK LASEK CK RLE P-IOL WAIT
'99'00'01'02'03'04'05'06
DUFFEY 2006
Preferred Surgery For 45 yo +5.00 D HyperopePreferred Surgery For 45 yo +5.00 D Hyperope
1 1
8
0
61
7
23
0
10
20
30
40
50
60
70
Never PRK LASIK LASEK RLE P-IOL WAIT
'99'00'01'02'03'04'05'06
*
DUFFEY 2006
Surgery Done Bilateral At Same O.R. Visit Surgery Done Bilateral At Same O.R. Visit
8796
89 89 86
41
26
1 50
102030405060708090
100
PRK LASIK Epi-LASIK
LASEK CK ICR K Inlay RLE P-IOL
'97'98'00'04'05'06
DUFFEY 2006
Had Refractive Surgery Performed on YourselfHad Refractive Surgery Performed on Yourself
3
7
19
0 0 0 0
3
0
5
10
15
20
25
LRI PRK LASIK LASEK ICR RLE P-IOL CK
'98'99'00'01'02'03'04'05'06
32%
DUFFEY 2006
Excimer Laser Most Commonly UsedExcimer Laser Most Commonly Used
67
17
3 6 800
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
DUFFEY 2006
Microkeratome Most Commonly UsedMicrokeratome Most Commonly Used
3
30
9 8 6 4
2014
6
00
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
27
33
DUFFEY 2006
Topography Unit Most Commonly Used Topography Unit Most Commonly Used
32
24
12
79 9
6
0
5
10
15
20
25
30
35
40
45
Zeiss-Hum
Orbscan EyeSys Tomey Nidek Pentacam Others
'98'00'04'05'06
*
DUFFEY 2006
Epi-Keratome Use Epi-Keratome Use
18
53
40
37
0
10
20
30
40
50
60
Yes Moria E-K
AmadOpus 2
VisijetEpi
Cent SES
'98'99'00'01'02'03'05'06
DUFFEY 2006
Pupil Gauge Instrument UsePupil Gauge Instrument Use
44
38
5 3 1
10
05
101520253035404550
Colvard Card Procyon Neuroptic Pupilscan Other
'02'03'04'05'06
DUFFEY 2006
Preferred Surgery for PresbyopiaPreferred Surgery for Presbyopia
42
20
5 6
16
10
0 00
10
20
30
40
50
60
Mono Mod Mono CK-blended CrystaLens ReStor ReZoom Array Technis
'02'03'04'05'06
DUFFEY 2006
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
DUFFEY 2006
Wavefront-Guided Custom Ablations in Your PracticeWavefront-Guided Custom Ablations in Your Practice
1115
6
13
55
0
10
20
30
40
50
60
0% 1-25% 26-50% 51-75% 76-100%
'03'04'05'06
DUFFEY 2006
ComanagementComanagement
56
4440
92 5
0
10
20
30
40
50
60
70
80
Yes No 1-25% 26-50% 51-75% 76-100%
'00'01'03'04'05'06
DUFFEY 2006
Do You Intra-operatively Measure Flap Thickness?Do You Intra-operatively Measure Flap Thickness?
3135 37
6965 63
0
10
20
30
40
50
60
70
Yes No
'04'05'06
DUFFEY 2006
Preferred Flap Thickness (when no other constraints)Preferred Flap Thickness (when no other constraints)
1
20
53
21
6
0
10
20
30
40
50
60
80 100 120-130 150-160 180+
'04'05'06
DUFFEY 2006
Minimum Residual Stromal Thickness Requirement for LASIKMinimum Residual Stromal Thickness Requirement for LASIK
0 1
64
18 17
1 00
10
20
30
40
50
60
70
80
200 225 250 275 300 325 350
'04'05'06
DUFFEY 2006
Total Cases of Post LASIK Ectasia as the Primary Surgeon in CareerTotal Cases of Post LASIK Ectasia as the Primary Surgeon in Career
60
1613
5 3 1 2 00
10
20
30
40
50
60
0 1 2 3 4 5 6 to 10 >10
'04'05'06
DUFFEY 2006
14
48
32
13
4
0
5
10
15
20
25
30
35
40
45
50
540microns
520 500 480 460 no limit
'05'06
Minimum Cent. Corneal Pachymetry for LASIK (all other parameters normal)
Minimum Cent. Corneal Pachymetry for LASIK (all other parameters normal)
80%
DUFFEY 2006
Mitomycin-C Use (MMC)Mitomycin-C Use (MMC)
18
9
74
0
10
20
30
40
50
60
70
80
Never Haze Only Prophylaxis andHaze
'04'05'06
DUFFEY 2006
Will You Perform Refractive Surgery on One-Eyed PatientsWill You Perform Refractive Surgery on One-Eyed Patients
4555
0
1020
3040
5060
7080
90100
Yes No
'04'05'06
DUFFEY 2006
Post-Op AntibioticPost-Op Antibiotic
48 49
1 0 2 0 0 00
10
20
30
40
50
60
Zymar Vigamox Ocuflox Quixin Ciloxan Tobra Gent Other
'02'03'04'05'06
DUFFEY 2006
82
105 3
0 10
10
20
30
40
50
60
70
80
90
Pred FML Lotepr Dex Vexol Other
'06
Post-Op SteroidPost-Op Steroid
DUFFEY 2006
Post-Op NonsteroidalsPost-Op Nonsteroidals
63
19
108
10
10
20
30
40
50
60
70
Acular-L Nevanac Xibrom Voltaren Other
"06
DUFFEY 2006
Location of Phakic-IOL SurgeryLocation of Phakic-IOL Surgery
2 2
78 79
16 15
4 4
0
10
20
30
40
50
60
70
80
Hospital OR ASC OR In-OfficeModified OR
Clean LASIKRoom
'05'06
DUFFEY 2006
’06 ISRS/AAO Survey Conclusions’06 ISRS/AAO Survey Conclusions
LASIK dominates between -10D and +3D.LASIK dominates between -10D and +3D. P-IOL for higher than -10D myopes. P-IOL for higher than -10D myopes. RLE for high hyperopes (61%).RLE for high hyperopes (61%). Monovision is the most sought goal for presbyopic Monovision is the most sought goal for presbyopic
patients seeking refract surgery (42%), but 33% patients seeking refract surgery (42%), but 33% are now implanting modern presbyopic IOL’s.are now implanting modern presbyopic IOL’s.
Trend toward thinner flaps (mechanical or laser).Trend toward thinner flaps (mechanical or laser). Almost one-third of us (32%) have had modern Almost one-third of us (32%) have had modern
refractive surgery done on our refractive surgery done on our ownown eyes! eyes!
DUFFEY 2006
King….Queen….Rising PrinceKing….Queen….Rising Prince
LASIKLASIK PRKPRK RLERLE VISX StarVISX Star Alcon LADAR ------Alcon LADAR ------ HansaHansa MoriaMoria IntraLaseIntraLase Zeiss-HumZeiss-HumOrbscanOrbscan PentacamPentacam ReStorReStor ReZoomReZoom ------------ Zymar/VigaZymar/Viga ------------ ------------ Acular-LAcular-L NevanacNevanac ------------
Thanks to the ISRS/AAO leadership for their support and for your participation in the
2006 Survey
Thanks to the ISRS/AAO leadership for their support and for your participation in the
2006 Survey We look forward to your response to We look forward to your response to
the 2007 survey next fallthe 2007 survey next fall
Complete results at Complete results at www.duffeylaser.comwww.duffeylaser.com