Transcript Highlights of the 2008 ASCRS member practice style survey

Highlights of the 2008
ASCRS member
practice style survey
David Leaming MD
Survey Sponsors
( *Financial Disclosure )
Alcon Surgical
AMO
Bausch & Lomb
2008 Survey specifics…

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4980 questionnaires mailed out to all US ASCRS
members not in residency in October 2008.
Over 634 returned in two months (13%).
Mostly multiple choice with a few fill in the blank.
Presented in lecture and poster format.
Richard Duffey MD assisted with the refractive
surgery section
Continuation of annual survey started in 1984
Surgical Trends
Estimated annual volume of
cataract surgery

4
3
Mil. Per
year

2
1
0
1998
1.2
1
0.8
0.6
0.4
0.2
0
2002
2006

Estimated annual vol.
LASIK
PRK
Total
1998 2000 2002 2004 2006 2008
Phaco has shown slow steady
growth over last 10 years
except for a small dip in 1999
when LASIK volume shot up
LASIK grew exponentially
between 1998 and 2000 but
then leveled off and declined
over last 3 years
17% of the membership were
doing LASIK in 1997 which
rose to 60% doing LASIK in
2000 …now 41% of members
are doing LASIK
Specialty IOL’s
Presby. IOL used most often

70
60
62
59
56
50
40
35
30
28
20
ReSTOR
ReZOOM
Crystalens

18 18
10
10
10
0
2006
2007
2008
Approach to astig. with cataract surgery
45
45
40
37
No change in
technique
No change but
operate on steep axis
LRI
35
30
29
25
20
21
22
17
15
13
10
5
3
2
0
2007
Toric IOL
11
2008
Excimer laser after
surg.

Now 60% of members are
using presbyopic IOL’s up from
48% in 2006
Toric IOL use is growing faster
than presbyopic IOL
use…Toric IOL grew 53% in
last year vs. 5% growth for
presbyopic IOL’s
Toric IOL’s have taken over
LRI as the preferred method to
tackle concomitant
astigmatism with cataract
surgery.
Cataract anesthesia
70
60
62
58
50
70
66
RB
49
Periocular
40
30
Topical
2624
2019
20
1719
17
14
10
2
0
2000
2002
2
Blunt cannula
subtenons
1214
2
2004
2
2006
2008
90
80
81
79
81
77
70
73
77
76
75
76
Topical only
60
50
40
30
20
10
19
18
14
5
0
1999
3
23
24
3
2001
24
21
2003
25
24
2
2005
2008
Topical w
intracameral
Topical/subconj.

Between 1995
and 2000 topical
anesthesia went
from 11% to 50%.
 Of those using
topical anesthesia
for cataract
surgery 76% use
it with intracameal
lidocaine.
Trends in cataract surgical
technique
Incision location
Nuclearfractis technique
80
70
70
60 61
60
50
50
At 12 o/c
Temporal
At steepest K
Oblique
Percent 40
30
20
Percent
1997
1999
2001
2003
2005
53
30
2001
60
58
40
25
19
10
9
3
0
0.30.70.2
2007
27
27
27
30
2005
Four quadrant
Two section
Chopping
Phaco flip
Other
2008
57 56 59
54 56
50
50
3mm or more
2.75mm
2.5mm
2.25mm
2mm
1.75mm
1.5mm
50
20
50
Perioperative medications
70
30
53
Year
Incision size
60
25
2003
Year
62
51
15 16
11 12 6 12 12 13 13
7
5 43
4 55 53 43 53 63
3
0
1998
2008
24
23
22
20 19
0
1995
53
44
10 9
1993
55
40
10
0
56
15
45 45
40
30
2008
27
30 30 28 28 30
29
26
26
20
10
6
1 0.50.3
Antibiotics in irrigant
39
7
10
6
9
12 10 10 10
0
2000 2001 2002 2003 2004 2005 2006 2007 2008
Intrcameral injected
antibiotics
Intracameral lidocaine
Perioperative measurements
Routine IOL K’s, preferred method
Preferred a-scan technique
100
9595
90
90
80
80
73
70
70
65
61
60
58
Percent 50
49
47
35
40
32
30
27
22
21
20201817
20
17
16
13
10 55 77 912
9
00 3
0
Immersion
Applanation
Partial
coherence
interferometry
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Preferred IOL formula
50
Manual
40
Auto K
30
25
20
11
10
5
2008
SRK
SRKII
SRK/T
Holladay 1
Holladay 2
Haigis
Other
25
21
20
15
11
10
3
1
33
31
30
27
5
2
28
2008
Manual
25
Auto K
20
15
10
IOL Master
7
5
0
0
Topography
/corneal
analyzer
0
35
30
IOL Master
Toric IOL K’s, preferred method
34
35
59
60
2008
Topography/
corneal
analyzer
13% saw a case of TASS in
2008, this is down from 19% in 2007
In 2008 79% pre-treated cataract
patients with NSAID’s … up from 75% in
and 18% in 2006
2007 and 63% in 2006
60
60
45
54
50
Number 35
30
1
40
26
2
3
4
5 or more
28
20
10
42
40
50
30
41
8
11
5
17
11
11
5
2007
31
34
6
2
4
2008
Of those who have seen a case of
TASS
…….…percent of cases seen
Acular
Acular LS
30
25
20
10
Nevanac
Voltaren
Xibrom
Other
18
15 11
15
10
4
3
5
0
2006
38
8
6
3
0
2006
2007
3
1
0.4
2008
When do you start drops? (2008)
67% three day prior to surgery
10% day of surgery
21% one day
before surgery
1% day
after surgery
Refractive surgery preferences for various
refractive errors..
+3 hyperope
70
69
60
51
47
4545
50
40
-10 diopter myope
Percent
30
40
40
36
35
10
30
27
25
25
25
24
22
20 20
Percent 20
23
22
15
11
10
9
5
0
25
22
221
2
20
35
33
8
2
3
11
No surg.
PRK
9
6
34 5
0 22111 2
No surg.
PRK
33332
LASIK
32223
LASEK
RLE
Phakic
IOL
Wait
+5 hyperope
60
5
1
2005
2006
2007
2008
22
22
17
17
10
2003
2005
2006
2007
2008
LASIK
4
4
33
LASEK
Phakic
IOL
3
54
2
RLE
50
Wait
40
30
30
20
10
9
2
0
PRK
5
1
LASIK LASEK
P-IOL
RLE
WAIT
'03
'04
'05
'06
'07
'08
Refractive highlights
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VisX still at > 3:1 (73%) over
all other lasers combined.
IntraLase is increasing market
share (33%), but mechanical
microkeratomes still dominate
(66%).
Greater than 30% penetration
of modern refractive surgery
amongst refractive surgeons.
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One-third of refractive
surgeons (32%) measure true
flap thickness in the OR.
52% (still dropping) think 250
microns is adequate for RST.
47% say 275-300 microns is
better (21% in ’04).
Most desired flap thickness is
120-130 microns (50%). 100
micron flap thickness is
favored by 32% of surgeons
(up from 11% three years ago).
Refractive highlights continued
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48% of surgeons not OK with
LASIK in corneas <500 um.
83% (stable) use MMC for
prophylaxis and/or haze.
39% (stable) OK with refractive
surgery on one-eyed pt.
ASC OR is preferred location for
P-IOL surgery (84%).
Co-management is practiced by
under one-half of respondents
overall (44%) with most of these
co-managing fewer than one-third
of their patients.
When co-managing with another
doctor, still 74% of surgeons see
their own patients on the first postop day.

14% of respondents are OK with
bilateral P-IOL (11% two years
ago) and 5% with RLE at the
same surgical setting.
 Monovision is the most sought
goal for presbyopic patients
seeking refract surgery (43%).
 ReStor (15%) and CrystaLens
accommodative IOL (14%) have
outpaced ReZoom (3%) IOL’s for
preferred lens-based presbyopia
options
 Over 30% of those doing
refractive surgery have had it
performed on themselves…at
least 4 times higher than the
general population.
Thanks for your continued support of the ASCRS
survey and to the ASCRS leadership for their help
to sustain this endeavor.
Please visit the poster display for a more detailed
look at last years results
Results will also be available on line at
leamingsurveys.com and duffeylaser.com
Thank you,
David Leaming MD
Richard Duffey MD