US Trends in Refractive Surgery: 2005 ASCRS Survey Richard J. Duffey, MD David Leaming, MD Steve Wexler, MD San Francisco: March 18, 2006

DUFFEY 2006 Thanks n …to TLCVision for their financial support in 2005 for this refractive survey’s cost of printing, distribution, and analysis. n Disclosure- TLCVision pays for partial travel expenses for the presenter at this meeting.

DUFFEY ASCRS Survey n Sept. mailing to 4645 U.S. members of ASCRS n 723 responses representing 16% of the U.S. ASCRS membership n Ninth year of refractive data collection allowing analysis and comparison of trends amongst ASCRS U.S. surgeons n Alphabet soup of refractive surgery. n Many new questions on flap thickness preference and measurements, MMC use, lens-based surgery, one-eyed patients, ectasia, co-management, etc.

DUFFEY 2006 > 5 Cases per Month

DUFFEY 2006 > 25 Cases per Month

DUFFEY 2006 > 75 Cases per Month

DUFFEY 2006 Preferred Surgery for 30 yo Diopter Myope

DUFFEY 2006 Preferred Surgery for 45 yo D Hyperope

DUFFEY 2006 Preferred Surgery for 45 yo D Hyperope

DUFFEY 2006 Had Refractive Surgery Performed on Yourself

DUFFEY 2006 Surgeon Willing to do Bilateral Surgery at the Same Visit

DUFFEY 2006 Present or Future Practice Plans

DUFFEY 2006 Topography Unit Owned

DUFFEY 2006 Microkeratome Used Most

DUFFEY 2006 Epi-Keratome Use

DUFFEY 2006 Excimer Used Most

DUFFEY 2006 Wavefront Analyzer

DUFFEY 2006 Wavefront-Guided Custom Ablations in Your Practice

DUFFEY 2006 Preferred Surgery for Presbyopia

DUFFEY 2006 Post-Op Antibiotic

DUFFEY 2006 Post-Op Anti-inflammatory

DUFFEY 2006 Do You Intra-operatively Measure Flap Thickness?

DUFFEY 2006 Preferred Flap Thickness (when no other constraints)

DUFFEY 2006 Minimum Residual Stromal Bed Thickness Requirement

DUFFEY 2006 Total Cases of Post LASIK Ectasia as the Primary Surgeon in Career

DUFFEY 2006 Minimum Preop Corneal Pachymetry for LASIK (all other parameters normal)

DUFFEY 2006 Minimum Final Corneal Thickness Allowable Following PRK (including epithelium)

DUFFEY 2006 Mitomycin-C Use (MMC)

DUFFEY 2006 Will You Perform Refractive Surgery on One-Eyed Patients

DUFFEY 2006 Comanagement

DUFFEY 2006 When Co-managed, Who Sees Postop LASIK Patient on Day 1 ?

DUFFEY 2006 Minimum “OR” Location for Phakic-IOL Surgery

DUFFEY 2006 ’05 ASCRS Survey Conclusions n LASIK dominates between -10D and +3D. n Bilateral extraocular sx same O.R. visit is SOC. n P-IOL and LASIK in high myopes (24% vs. 25%). n RLE (49%) for high hyperopes. RLE up from 11% last year to 22% this year for moderate hyperopes. n LASIK, LASEK, Epi-LASIK, RLE, P-IOL, PRK, CK, and LRI all with apparent bright futures. n RK, LTK, and SE are gone.

DUFFEY 2006 Conclusions continued... n VisX still at > 2:1 over all other lasers combined. n Orbscan leveled off after 6 years of growth (15%). n Intralase is increasing market share (13%), but mechanical microkeratomes still dominate (87%). n Wavefront custom ablations are stable with 74% of surgeons performing them…and at increasing frequencies (38% whenever possible).

DUFFEY 2006 Conclusions continued... n Fourth generation fluoroquinolones (95%) dominate the post-refractive surg. market (Z>V). n 16-20% penetration of refractive surgery amongst refractive surgeons, stable with no growth. n Less than one-quarter of refractive surgeons (23%) measure true flap thickness in the OR. n 69% think 250 microns is adequate for RST. n Most desired flap thickness is microns. n 45% of surgeons not OK with LASIK in corneas <500 um.

DUFFEY 2006 Conclusions continued... n 64% (rising) use MMC for prophylaxis and/or haze. n 38% OK with refractive surgery on one-eyed pt. n 6% of respondents are OK with bilateral P-IOL and 5% with RLE at the same surgical setting. n Monovision is the most sought goal for presbyopic patients seeking refract surgery (40%), but 25% are now implanting modern presbyopic IOL’s. n Restor IOL (18%) quickly out-paced the accommodative IOL (4%) for preferred lens-based presbyopia option.

DUFFEY 2006 Conclusions continued... n ASC OR is preferred location for P-IOL surgery (84%). 9% OK with “In Office” modified OR and 3% OK with clean LASIK room. n Less than one-third of surgeons surveyed (28%) have had a documented case of post-LASIK ectasia in his/her surgical patients over a career, but 7% with 3 or more cases now. n Co-management is practiced by one-third of respondents overall with 2/3 of these comanageing fewer than one-third of their patients. n When comanageing with another doctor, 76% of surgeons see their own patients on the first post-op day.

Thanks to ASCRS leadership for their support and for your participation in the 2005 Survey We look forward to your responses in the 2006 survey this autumn. Complete results at