1. Practice Styles and Preferences of US ASCRS members – 2009 Survey David Leaming MD Palm Springs, CA eyeopr8@aol.com In 2009 the survey went out electronic (via e mail) for the first time 3778 survey invitations were e mailed from the ASCRS main office to all US ASCRS members not in a training program 518 Responded for a 14% 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 Minor: Zeiss/Meditec 25 th Survey

2. Surgical Volumes Phaco Refractive Surg. Cataract surgery volumes have steadily climbed…up 2% from 2008 Refractive surgery volumes have continued to decline..(Sept. 2009) LASIK down 31% PRK down 19%

3. Specialty IOL’s Growth despite difficult financial times Percent of time inserting presbyopic IOL’s Percent of time inserting toric IOL’s Presbyopic IOL’s up 24%, accounted for 13% of total IOL volume from 2008 In 2009 2/3 of presbyopic IOL’s were multifocal and 1/3 were accommodative 75% were using a presbyopic IOL..up from 70% in 2008 Toric IOL’s up 19% from 2008 79% were using a toric IOL…up from 60% in 2008

4. Astigmatism and Cataract surgery 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.?

5. Surgical Trends -72% use topical anesthesia with ¾ of those using IC lidocaine with topical -71% use temporal incisions -85% use clear corneal incisions with 60% of those using the near clear (vascular area) vs 40% avascular area -29% use antibiotics in the irrigant with 14% (up 4%) using intracameral antibiotics -7% use microincision (<2mm) coaxial phaco while 5% use bimanual microincision (<2mm) the majority of the time -If they were to use < 2mm surgery 75% would use coaxial rather than bimanual -76% pretreated their cataract patients with NSAID’s with 2/3 of them starting 3 days before surg. Usual incision size in mm

6. Preferred method of keratometry for … Routine IOL CalculationsToric IOL Calculations

7. Other notable findings….in 2009 -50% of members used a capsular tension ring -15% felt they had a case of TASS, down from 19% in 2007 -Top three perceived most important technologies…. #1 Toric IOL’s #2 Torsional phaco #3 presbyopic IOL’s -Lowest interest level in …. #1 corneal inlays #2 mixing different types of presby. IOL’s, #3 visible light filtering IOL’s

8. Patient with cataracts and pressures poorly controlled on medication (28) previous ALT Cataract surgical plan? Trending toward less anti-metabolite use

9. Use of computerized medical records 2009 Overall 31% are using computerized medical records Overall 31% are using computerized medical records Highest implementation appears to be in those doing 3 – 15 cataracts per month Highest implementation appears to be in those doing 3 – 15 cataracts per month Time frame for implementation

10. Cataract surgery (and specialty IOLs) show sustained growth even in hard financial times unlike LASIK. While 89% are using an incision 2.8mm or smaller only about 2% routinely use a smaller than 2mm incision. When going to a microincsion (<2mm) the majority (75%) would opt for coaxial microincision phaco over bimanual microincision phaco. Keratometry used for biometry is usually done with the IOL master except for when calculating Toric IOL power. Antimetabolites are loosing favor as drainage devices are becoming more popular. Less than a third of members use computerized medical records but almost 2/3rds plan to implement them in the next two years. Conclusions

11. 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