U.S. Trends in Refractive Surgery: 2015 ISRS Survey

Richard J. Duffey, MD David Leaming, MD

Refractive Subspecialty Day

Las Vegas: November 13, 2015

The authors have no financial interests in this survey study.

DUFFEY/LEAMING 2015

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.

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

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

*

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

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

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

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

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

FemtoSecond Cataract Laser Most Commonly Used

LenSx Catalys LensAR Victus (B&L)0

10

20

30

40

50

60

70

20142015

56

28

93

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

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

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

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

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

DUFFEY/LEAMING 2015

Cataract/RLE Post-Op Antibiotic

3 3

94

Tobra/Gent Fluoroquinolone Polytrim0

102030405060708090

100

4

81

15

201320142015

DUFFEY/LEAMING 2015

LVC Post-Op Antibiotic

Tobra/Gent Fluoroquinolone Polytrim0

102030405060708090

100

'13'14'15

14

0

86

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

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

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

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

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

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

Do You Currently Perform CXL?

DUFFEY/LEAMING 2015

Yes No0

102030405060708090

22

78

'12'13'14'15

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

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%.

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

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

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