Practice Styles and Preferences of US ASCRS members – 2010 Survey

26 th Survey In 2010 the survey went out electronic (via e mail). This marks the second year using that format.

3854 survey invitations were e mailed from the ASCRS main office to all US ASCRS members not in a training program 460 responded for a 12% response rate, Similar to prior years paper surveys Richard Duffey MD assisted with the refractive surgery section

Corporate financial sponsors :

Major: Alcon Surgical Abbott Medical Optics Bausch and Lomb David Leaming MD

Palm Springs, CA [email protected]

Surgical Volumes

Phaco

3.3

3.2

3.1

3 2.9

2.8

2.7

2.6

2.5

2.81

2.82

3.1

3.21

2003 1000000 900000 800000 700000 600000 500000 400000 300000 200000 100000 0 948266 2004 2005 2007

LASIK

2009 865723 2006 721452 2008 570242 2009 3.26

2010 680188 2010 Phaco LASIK

Cataract surgery volumes have steadily climbed apparently unaffected by recession.

Refractive surgery volumes showing signs of recovery LASIK up 19% after declining 31% in 2009

Specialty IOL’s

Growth despite difficult financial times

Percent of cataracts you are inserting presbyopic IOL’s 25 20 15 10 5 0 45 40 35 30 34 29 22 11 2 0.200.5

2008 39 22 26 9 2 10.20

2009 44 16 19 9 3 10.2

2010 Never One - five six- ten 20 40 60 80 Almost 100

Presbyopic IOL’s accounted for 14% of total IOL volume from 2008 In 2010 71% were using multifocal and 29% accomodative IOL’s 81% were using a presbyopic IOL, up from 75% in 2009 29% say the percent of their cataract patients receiving Presby IOL has increased

Percent of cataracts you are inserting toric IOL’s 40 36 35 30 30 27 25 20 15 10 5 0 7 0.50 0 0 2008 3534 21 11 0.20 0 0 2009 28 13 34 14 9 2010 1 0 0 Never one-five six-ten 20 40 60 80 almost 100%

Toric IOL’s up 8% from 2009 (14% of IOL volume) 87% were using a toric IOL…up from 79% in 2009 48% say the percent of their cataract patients receiving Toric IOL has increased

Astigmatism and Cataract surgery

70 66 60 50 45 40 10 37 30 20 17 21 22 3 0 2007 29 1311 2008 2 14 8 25 51 2009 2 18 8 5 2010 2 No change in technique No change but operate on steep axis LRI Toric IOL Excimer laser after surg.

How do you correct significant residual astigmatism in your presbyopic IOL patients?

What is you most often used technique in your cataract patient with significant pre existing astig.?

60 50 40 30 20 10 0 13 8 54 2009 10 14 44 15 14 11 12 2010 LASIK PRK LRI Glasses I don't

72% use topical anesthesia with ¾ of those using IC lidocaine with topical (N/C) -68% use temporal incisions, 3% -87% use clear corneal incisions with 48% of those using the near clear (vascular area) vs. 34% avascular area -25% 3% use antibiotics in the irrigant with 16% (up 2%) using intracameral antibiotics -12% use microincision (<2mm) coaxial phaco while 4% use bimanual microincision (<2mm) the majority of the time -If they were to use < 2mm incision, 62% would use coaxial rather than bimanual -77% pretreated their cataract patients with NSAID’s with 2/3 of them starting 3 days before surg. (N/C)

Surgical Trends 2010 Usual incision size in mm 30 25 20 15 45 40 35 10 5 11 0 45 20 18 5 10.40.20

2009 7 40 15 25 9 2010 2 2 2 1 3mm or more 2.8

2.6

2.4

2.2

2 1 1.8

1.6

Preferred method of keratometry for …

80 70 60 70 50 40 30 20 18 10 8 0 2009 4 72 16 7 2010 4 Manual Auto K Partial Coherance Interferometry Topography/co rneal analyzer

Routine IOL Calculations Strong reliance of PCI platform for K’s

35 30 31 35 29 25 32 34 29 20 15 10 5 0 5 5 2009 2010 Manual Auto K Partial Coherance Interferometry Topography/cor neal analyzer

Toric IOL Calculations Less trusting of PCI platform for K’s

Lasers and cataract surgery *86% of members have no opinion as to which laser platform is best Importance rating various femtosecond laser cataract applications 2010

30 20 10 0 -10 -20 -30 -40 -37 -32 2010 -25 22 laser capsularhexis laser lens softening laser wound construction laser LRI

Max Importance = +200 Neutral = 0 Lowest Importance = -200 Perceived out of pocket value to your cataract patients for the use of femtosecond laser with surgery?

30 25 20 15 10 5 0 25 21 28 8 12 6 $100 $250 $500 $750 $1,000 $1500 or more 2010

Perceived out of pocket value to your patient to use the intraoperative aberrometer during cataract surgery?

60 50 40 30 20 10 0 55 22 16 2010 5 2 1 $100 $250 $500 $750 $1,000 $1500 or more

If insurance will not pay for/or let you bill for femtosecond laser use during cataract surgery, how likely are you to use it?

   

61% not likely at all 23% only on special cases 10% somewhat likely 5% very likely

Other notable findings….in 2010 -57% of members used a capsular tension ring 7% -19% felt they had a case of TASS…little change thru the years -Top three perceived most important technologies….

#1 Toric IOL’s #2 Torsional phaco #3 multifocal IOL’s -Lowest interest level in ….

#1 microicision less than 2mm #2 accomadating IOL #3 wavefront aberrometry in cataract surgery -97% of members participate with Medicare

Use of computerized medical records 2010

  Overall 35% computerized medical records 4% are using Highest implementation appears to be in those doing 3 – 15 cataracts per month Time frame for implementation

45 40 35 30 25 20 15 10 5 0 21 42 26 12 30 40 16 14 within one year 1-2 years 3+ years Don't plan to add 2009 2010

Large number of EMR companies…make it difficult for small companies to have the finances for development and support. Nexgen largest at 21%, Medflow 14%, Epic 8%, Compulink 6%, plus at least 50 other companies being used by members!

Conclusions Cataract surgery (and specialty IOLs) show sustained growth even in hard financial times. LASIK starting to come back up 19%, first increase since 2004.

Specialty IOL’s are being used in approximately 14% of cataract surgeries Keratometry used for biometry is usually done with the partial coherence interferometry platform except when using Toric IOL’s 35% of members use computerized medical records. Large number of EMR companies which is good and bad.

LRI’s still the predominant way to correct residual astig. in presby IOL pts.

Toric IOL positioned for strongest growth in coming years

Thanks for your continued support of the ASCRS survey and to the ASCRS leadership for their help to sustain this endeavor.

Please visit the “paper” poster display detailed look at last years results for a more Results will also be available on line at leamingsurveys.com

and duffeylaser.com

Thank you, David Leaming MD Richard Duffey MD