1. Highlights of the 2008 ASCRS member practice style survey David Leaming MD Survey Sponsors ( *Financial Disclosure ) Alcon Surgical AMO Bausch & Lomb

2. 2008 Survey specifics…  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

3. Surgical Trends  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 Estimated annual volume of cataract surgery Estimated annual vol.

4. Specialty IOL’s  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. Presby. IOL used most often Approach to astig. with cataract surgery

5. Cataract anesthesia  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.

6. Trends in cataract surgical technique Incision locationNuclearfractis technique Incision size Perioperative medications

7. Perioperative measurements Preferred IOL formula Toric IOL K’s, preferred method Routine IOL K’s, preferred method Preferred a-scan technique

8. 13% saw a case of TASS in 2008, this is down from 19% in 2007 and 18% in 2006 Of those who have seen a case of TASS …….…percent of cases seen Number In 2008 79% pre-treated cataract patients with NSAID’s … up from 75% in 2007 and 63% in 2006 When do you start drops? (2008) 67% three day prior to surgery 21% one day before surgery 10% day of surgery 1% day after surgery

9. Refractive surgery preferences for various refractive errors.. -10 diopter myope +3 hyperope +5 hyperope

10. Refractive highlights  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.  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).

11. Refractive highlights continued  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 post- op 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.

12. 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