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US Trends in Refractive Surgery: The 2009 ISRS Survey
US Trends in Refractive Surgery: The 2009 ISRS Survey
Richard J. Duffey, MD Richard J. Duffey, MD
David Leaming, MDDavid Leaming, MD
Refractive Subspecialty DayRefractive Subspecialty Day
San Francisco - October 24, 2009San Francisco - October 24, 2009
The authors have no financial interests in this The authors have no financial interests in this survey study.survey study.
DUFFEY 2009
DUFFEY 2009
2009 Survey2009 Survey
First year of ONLINE*** survey opened by 700 First year of ONLINE*** survey opened by 700 ISRS members of the 1307 e-mailedISRS members of the 1307 e-mailed
134 responses analyzed by October 1, 2009 for 134 responses analyzed by October 1, 2009 for 19% of the U.S. ISRS membership who opened 19% of the U.S. ISRS membership who opened the survey.the survey.
Thirteenth year of refractive data collection.Thirteenth year of refractive data collection. Alphabet soup of refractive surgery including Alphabet soup of refractive surgery including
corneal and lens-based surgeries.corneal and lens-based surgeries.
DUFFEY 2009
Total LVC Volume within ISRSTotal LVC Volume within ISRS
77 64 4012
426 415
562 492
0
100
200
300
400
500
600
PRK LASEK/Epi LASIK Total LVC
'08'09
*** 15% reduction overall
DUFFEY 2009
> 75 Cases / Month> 75 Cases / Month
12
0 0 00
5
10
15
20
25
30
LASIK PRK LASEK LRI/Cat
'97'98'99'00'01'02'03'04'05'06'07'08'09
* Peaked in 2001
DUFFEY 2009
Preferred Surgery For 30 yo -10.00 Diopter MyopePreferred Surgery For 30 yo -10.00 Diopter Myope
2
12
28
2 2
43
9
0
5
10
15
20
25
30
35
40
45
50
Never PRK LASIK LASEK RLE P-IOL WAIT
'05'06'07'08'09
** 40% LVC
DUFFEY 2009
Preferred Surgery For 45 yo +3.00 D HyperopePreferred Surgery For 45 yo +3.00 D Hyperope
16
68
2
19
12
0
10
20
30
40
50
60
70
80
90
100
Never PRK LASIK LASEK RLE P-IOL WAIT
'99'02'05'06'07'08'09
DUFFEY 2009
Preferred Surgery For 45 yo +5.00 D HyperopePreferred Surgery For 45 yo +5.00 D Hyperope
8
1
10
0
66
2
10
0
10
20
30
40
50
60
70
Never PRK LASIK LASEK RLE P-IOL WAIT
'99'02'05'06'07'08'09
*
*
DUFFEY 2009
Surgery Done Bilateral At Same O.R. Visit Surgery Done Bilateral At Same O.R. Visit
9299
78 85
25 178
18
0102030405060708090
100
PRK LASIK Epi-LASIK
LASEK ICR K Inlay RLE P-IOL
'97'00'04'06'07'08'09
**
DUFFEY 2009
Family LVC Index: (LASIK or PRK Performed on Our Own Family Member)Family LVC Index: (LASIK or PRK Performed on Our Own Family Member)
23
36
19
57
0
10
20
30
40
50
60
Self Spouse Children Siblings
'08'09
DUFFEY 2009
Excimer Laser Most Commonly UsedExcimer Laser Most Commonly Used
58
3 5
29
2 20
10
20
30
40
50
60
70
VisX Alcon Nidek Wavelight B and L Others
'97'00'03'06'07'08'09
*
DUFFEY 2009
Microkeratome Most Commonly UsedMicrokeratome Most Commonly Used
2
13
2 5 54
46
51 2
6
0
10
20
30
40
50
60
B-L Zyop B-LHansa
Moria C-B
MoriaDisp
Moria M2 MoriaLSK
Intralase Amadeus Nidek B-D Ziener
'98'00'04'07'08'09
*
*
* 52% femtolaser
DUFFEY 2009
Topography Unit Most Commonly UsedTopography Unit Most Commonly Used
3930
7
159
23
13
0
5
10
15
20
25
30
35
40
45
Zeiss-Hum
Orbscan EyeSys Tomey Nidek Pentacam Others
'98'00'04'07'08'09
DUFFEY 2009
Preferred Surgery for PresbyopiaPreferred Surgery for Presbyopia
48
27
26
9
04
0
10
20
30
40
50
60
Mono Mod Mono CK-blended CrystaLens ReStor ReZoom TMF
'02'05'07'08'09
**
DUFFEY 2009
Wavefront-Guided Custom Ablations in Your PracticeWavefront-Guided Custom Ablations in Your Practice
90
17
69
56
0
10
20
30
40
5060
70
80
90
100
YES 1-25% 26-50% 51-75% 76-100%
'03'06'07'08'09
*
DUFFEY 2009
Do You Routinely Measure Flap Thickness Intra-operatively ?Do You Routinely Measure Flap Thickness Intra-operatively ?
43
57
0
10
20
30
40
50
60
70
Yes No
'04'05'06'07'08'09
DUFFEY 2009
Preferred Flap Thickness (when no other constraints)Preferred Flap Thickness (when no other constraints)
4
49
31
13
20
5
10
1520
25
30
3540
45
50
80 100 120-130 150-160 180+
'04'07'08'09
*
DUFFEY 2009
Minimum Residual Stromal Bed Thickness Requirement for LASIKMinimum Residual Stromal Bed Thickness Requirement for LASIK
1 1
44
26 23
14
0
10
20
30
40
50
60
70
80
200 225 250 275 300 325 350
'04'07'08'09
*
* 54% at 275 microns or greater
DUFFEY 2009
Total Cases of Post LASIK Ectasia as the Primary Surgeon in CareerTotal Cases of Post LASIK Ectasia as the Primary Surgeon in Career
39
21
11 10
0 3 2 00
10
20
30
40
50
60
0 1 2 3 4 5 6 to 10 >10
'04'06'08'09
* Not growing
DUFFEY 2009
0 1
35
42
15
7
0
5
10
15
20
25
30
35
40
45
50
540microns
520 500 480 460 no limit
'05'06'07'08'09
Minimum Cent. Corneal Pachymetry for LASIK (all other parameters normal)
Minimum Cent. Corneal Pachymetry for LASIK (all other parameters normal)
* 64% OK with 480 or less
DUFFEY 2009
Will You Perform Refractive Surgery on One-Eyed PatientsWill You Perform Refractive Surgery on One-Eyed Patients
41
59
010
2030
4050
6070
8090
100
Yes No
'04'07'08'09
2009 ISRS SUMMARY2009 ISRS SUMMARY
First First ONLINE ISRS Survey ONLINE ISRS Survey was a success was a success with 19.4% response ratewith 19.4% response rate
LVC Volume LVC Volume down 15% within ISRS down 15% within ISRS membership in 2009membership in 2009
DUFFEY 2009
DUFFEY 2009
2009 ISRS SUMMARY2009 ISRS SUMMARY
VisXVisX 2:1 2:1 ( (58%)58%) over over WavelightWavelight which is on the which is on the rise (29%)rise (29%)
Wavefront custom ablations are stable Wavefront custom ablations are stable with with >>90%90% of surgeons performing them (56 of surgeons performing them (56%% whenever possible).whenever possible).
About 25%About 25% penetrationpenetration of modern refractive of modern refractive surgery amongst refractive surgeons; surgery amongst refractive surgeons; 3-4 times3-4 times the general population. the general population. Family Index rates even Family Index rates even greater.greater.
DUFFEY 2009
2009 ISRS SUMMARY2009 ISRS SUMMARY
18%18% of respondents are OK with of respondents are OK with bilateralbilateral P-IOLP-IOL and and 8% with 8% with bilateralbilateral RLE RLE at the at the same surgical setting.same surgical setting.
ReStor (9%)ReStor (9%) and and CrystalensCrystalens IOLIOL (6%)(6%) outpaced the new outpaced the new TMFTMF (4%)(4%) IOL’s for IOL’s for preferred lens-based presbyopia option.preferred lens-based presbyopia option.
Femtosecond laser use on the rise (52%).Femtosecond laser use on the rise (52%).
DUFFEY 2009
2009 ISRS SUMMARY2009 ISRS SUMMARY
Thinner flapsThinner flaps on the riseon the rise; 100 micron or ; 100 micron or less flaps are favored by 49less flaps are favored by 49%% of surgeons of surgeons (up from 12% in ‘04).(up from 12% in ‘04).
RSB Thickness on the riseRSB Thickness on the rise; 46% still think ; 46% still think 250 microns is adequate, but 54% 250 microns is adequate, but 54% recommend 275 microns or more.recommend 275 microns or more.
New post-LASIK ectasia cases are on the New post-LASIK ectasia cases are on the declinedecline..
Additional Data at www.duffeylaser.comwww.duffeylaser.comAdditional Data at www.duffeylaser.comwww.duffeylaser.com
Types and volumes of refractive surgeries Types and volumes of refractive surgeries currently being performedcurrently being performed
Preferred Epikeratomes and PupillometersPreferred Epikeratomes and Pupillometers Comanagement and Day 1 Follow-up exam Comanagement and Day 1 Follow-up exam Mitomycin-C useMitomycin-C use Post-operative use of antibiotics, steroids and Post-operative use of antibiotics, steroids and
nonsteroidalsnonsteroidals Surgical venues for various proceduresSurgical venues for various procedures
DUFFEY 2009
Thanks to the ISRS leadership for their support and for your
participation in the 2009 Survey
Thanks to the ISRS leadership for their support and for your
participation in the 2009 Survey
We look forward to your response to We look forward to your response to our second ONLINE survey next fallour second ONLINE survey next fall
***Complete 13 years of survey results ***Complete 13 years of survey results found at found at www.duffeylaser.com
