US Trends in Refractive Surgery: 2007 ASCRS Survey Richard J. Duffey, MD David Leaming, MD Chicago: April 8, 2008

DUFFEY 2008 Disclosures n The authors actually spend some of their own hard-earned dollars to cover the annual printing and analyzing costs of this survey.

DUFFEY 2008 Lou Holtz “Rule of Tens” n Fewer than 10% of you will remember more than 10% of what I said more than 10 minutes after I said it. n So, look for the *

DUFFEY ASCRS Survey n Sept. mailing to 4797 U.S. members of ASCRS n 628 responses representing 13% of the U.S. ASCRS membership n Eleventh year of refractive data collection allowing analysis and comparison of trends amongst ASCRS U.S. surgeons n Alphabet soup of refractive surgery. n Added questions in recent years as the field has incorporated new laser and refractive technologies including premium IOL’s.

DUFFEY 2008 > 5 Cases per Month

DUFFEY 2008 > 25 Cases per Month

> 75 Cases per Month DUFFEY 2008

Preferred Surgery for 30 yo Diopter Myope *

DUFFEY 2008 Preferred Surgery for 45 yo D Hyperope *

DUFFEY 2008 Preferred Surgery for 45 yo D Hyperope *

DUFFEY 2008 Currently are a Refractive Surgeon and have had Refractive Surgery Performed on Yourself *Greater than 4 times the pene- tration compared to general public

DUFFEY 2008 Surgeon Willing to do Bilateral Surgery at the Same Visit *

DUFFEY 2008 Present or Future Practice Plans

DUFFEY 2008 Topography Unit Owned

DUFFEY 2008 Microkeratome Used Most 25% *

DUFFEY 2008 Epi-Keratome Use

DUFFEY 2008 Excimer Used Most *

DUFFEY 2008 Wavefront Analyzer

DUFFEY 2008 Wavefront-Guided Custom Ablations in Your Practice *

DUFFEY 2008 Preferred Surgery for Presbyopia *Multifocal IOLs 36%

DUFFEY 2008 Post-Op Antibiotic

DUFFEY 2008 Post-Op Anti-Inflammatory

DUFFEY 2008 Post-Op Non-Steroidal

DUFFEY 2008 Do You Intra-operatively Measure Flap Thickness? *

DUFFEY 2008 Preferred Flap Thickness (when no other constraints) * *

DUFFEY 2008 Minimum Residual Stromal Bed Thickness Requirement *

DUFFEY 2008 Total Cases of Post LASIK Ectasia as the Primary Surgeon in Career *the numbers are not growing

DUFFEY 2008 Minimum Preop Corneal Pachymetry for LASIK (all other parameters normal) * * *

DUFFEY 2008 Minimum Final Corneal Thickness Allowable Following PRK (including epithelium)

DUFFEY 2008 Mitomycin-C Use (MMC) *

DUFFEY 2008 Will You Perform Refractive Surgery on One-Eyed Patients *

DUFFEY 2008 Comanagement

DUFFEY 2008 When Co-managed, Who Sees Postop LASIK Patient on Day 1 ?

DUFFEY 2008 Minimum “OR” Location for Phakic-IOL Surgery *

DUFFEY 2008 Refractive Surgery Volumes (extrapolated data in thousands)

DUFFEY 2008 ’07 ASCRS Survey Conclusions n Volume of LVC (U.S.) in 2007: 1.08 M eyes (1.24M in ’06) n LASIK dominates between -8D and +3D. n Bilateral extraocular sx same O.R. visit is SOC. n P-IOL (36%) and LASIK (23%) in high myopes. n RLE (51%) for high hyperopes. n LASIK, LASEK, Epi-LASIK, RLE, P-IOL, PRK, CK, corneal inlays, and LRI all with apparent bright futures.

DUFFEY 2008 Conclusions continued... n VisX still at > 3:1 (72%) over all other lasers combined. n Occulus Pentacam at 16% usage amongst members (5% last year). n Intralase is increasing market share (22%), but mechanical microkeratomes still dominate (78%). n Fourth generation fluoroquinolones (97%) dominate the post-refractive surg. market (Z>V).

DUFFEY 2008 Conclusions continued... n >30% penetration of modern refractive surgery amongst refractive surgeons. n One-third of refractive surgeons (32%) measure true flap thickness in the OR. n 57% (dropping) think 250 microns is adequate for RST. (39% say microns). n Most desired flap thickness is microns. 100 micron flap thickness is favored by 20% of surgeons (up from 11% two years ago). n 50% of surgeons not OK with LASIK in corneas <500 um.

DUFFEY 2008 Conclusions continued... n 84% (still rising) use MMC for prophylaxis and/or haze. n 40% OK with refractive surgery on one-eyed pt. n 1% of respondents are OK with bilateral P-IOL (11% last year) and 4% with RLE at the same surgical setting. n Monovision is the most sought goal for presbyopic patients seeking refract surgery (39%), but 36% are now implanting modern presbyopic IOL’s (25% two years ago). n ReStor (18%) and ReZoom (10%) IOL’s quickly out- paced the accommodative IOL (8%) for preferred lens- based presbyopia option.

DUFFEY 2008 Conclusions continued... n ASC OR is preferred location for P-IOL surgery (85%). 10% OK with “In Office” modified OR and 4% OK with clean LASIK room. n About one-third of surgeons surveyed (34%) have had a documented case of post-LASIK ectasia in his/her surgical patients over a career. n Co-management is practiced by almost one-half of respondents overall (46%) with 2/3 of these comanaging fewer than one-third of their patients. n When comanageing with another doctor, 74% of surgeons see their own patients on the first post-op day.

DUFFEY ASCRS SUMMARY n Volume of LVC (U.S.) in 2007: 1.08 M eyes (1.12 M in ’06). 10 M since n P-IOL (36%) and LASIK (23%) in high myopes. n VisX still at > 3:1 (72%) over all other lasers n Greater than 30% penetration of modern refractive surgery amongst refractive surgeons. n 84% (still rising) use MMC for prophylaxis / haze.

DUFFEY ASCRS SUMMARY n Most desired flap thickness is microns. 100 micron flap thickness is favored by 20% of surgeons (up from 11% two years ago). n Only 1% of respondents are OK with bilateral P-IOL (11% last year) and 4% with RLE at the same surgical setting. n ReStor (18%), ReZoom (10%) and accommodative IOLs (8%) are gaining popularity as lens-based presbyopia options.

Thanks to ASCRS leadership for their support and for your participation in the 2007 Survey We look forward to your responses in the 2008 survey this autumn. Complete results this Friday at