1. US Trends in Refractive Surgery: The 2005 ISRS/AAO Survey
Richard J. Duffey, MD
David Leaming, MD
ISRS / AAO Meeting
Chicago- October 14, 2005

2. 2005 Survey August mailing to 1500 U.S. members of ISRS/AAO.
246 responses analyzed by October 1st for 16.4% of the U.S. ISRS/AAO membership.
Ninth year of refractive data collection.
Alphabet soup of refractive surgery.
Many new questions on flap thickness preference and measurements, MMC use, enhancement tests, one-eyed patients, ectasia, co-management, SOC, etc., etc.
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3. I Am Currently Doing This Surgery
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4. > 5 Cases / Month
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5. > 25 Cases / Month
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6. > 75 Cases / Month
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7. Preferred Surgery For 30 yo -12.00 Diopter Myope
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8. Preferred Surgery For 30 yo -10.00 Diopter Myope
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9. Preferred Surgery For 45 yo +3.00 D Hyperope
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10. Preferred Surgery For 45 yo +5.00 D Hyperope
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11. Surgery Done Bilateral At Same O.R. Visit
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12. Procedure Future Index (Doing Now and/or Plan in Future)
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13. Had Refractve Surgery Performed on Yourself
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14. Excimer Laser Most Commonly Used
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15. Microkeratome Most Commonly Used
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16. Topography Unit Most Commonly Used
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17. Epi-Keratome Use
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18. Pupil Gauge Instrument Use
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19. Preferred Surgery for Presbyopia
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20. Wavefront Analyzer
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21. Wavefront-Guided Custom Ablations in Your Practice
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22. Comanagement
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23. Do You Intra-operatively Measure Flap Thickness?
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24. When Did You Start Measuring?
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25. Preferred Flap Thickness (when no other constraints)
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26. Minimum Residual Stromal Thickness Requirement for LASIK
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27. Total Cases of Post LASIK Ectasia as the Primary Surgeon in Career
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28. Minimum Cent. Corneal Pachymetry for LASIK (all other parameters normal)
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29. Mitomycin-C Use (MMC)
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30. Will You Perform Refractive Surgery on One-Eyed Patients
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31. Post-Op Antibiotic
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32. Post-Op Anti-inflammatory
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33. Location of Phakic-IOL Surgery
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34. ’05 ISRS/AAO Survey Conclusions
LASIK dominates between -10D and +3D.
P-IOL for higher than -10D myopes.
RLE for high hyperopes (56%).
Monovision is the most sought goal for presbyopic patients seeking refract surgery (53%), but 17% are now implanting modern presbyopic IOL’s.
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35. Conclusions continued...
VisX still at > 2:1 over all other lasers.
Intralase is increasing market share (22%).
Epi-Keratome has increased users (18%).
90% use wavefront analyzers.
90% perform custom ablations…and at increasing frequencies (40% whenever possible).
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36. Conclusions continued...
Fourth generation fluoroquinolones dominate the post-refractive surgery market (96%).
Co-management is on the rebound after several years of decline (increased from 40% to 60% from ’04 to ’05).
>25% penetration of refractive surgery on self amongst refractive surgeons.
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37. Conclusions continued...
One-third of refractive surgeons now measuring true flap thickness in the OR.
Less than half of surgeons surveyed (44%) have had a documented case of post-LASIK ectasia in his/her surgical patients over a career (7% with 3 or more).
66% think 250 microns is adequate for RST after LASIK. 11% recommend 300 microns.
Most desired flap thickness is microns.
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38. Conclusions continued...
77% use MMC for prophylaxis and/or haze (up from 64% last year).
43% OK with refractive surgery on one-eyed pt.
Bilateral extraocular sx at same O.R. visit is SOC.
4% of respondents OK with bilateral P-IOL at the same surgical setting (down from 8% last year).
ASC OR is preferred location for P-IOL surgery (78%). 19% OK with “In Office” modified OR.
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39. Thanks to the ISRS/AAO leadership for their support and for your participation in the 2005 Survey
We look forward to your response to the 2006 survey next fall
Complete results at