1. Practice Styles and Preferences of US ASCRS members – 2010 Survey
26th Survey
In 2010 the survey went out electronic (via e mail). This marks the second year using that format.
3854 survey invitations were e mailed from the ASCRS main office to all US ASCRS members not in a training program
460 responded for a 12% 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
David Leaming MD
Palm Springs, CA

2. Surgical Volumes Phaco
Cataract surgery volumes have steadily climbed apparently unaffected by recession.
LASIK
Refractive surgery volumes showing signs of recovery
LASIK up 19% after declining 31% in 2009

3. Specialty IOL’s Growth despite difficult financial times
Presbyopic IOL’s accounted for 14% of total IOL volume from 2008
In % were using multifocal and 29% accomodative IOL’s
81% were using a presbyopic IOL, up from 75% in 2009
29% say the percent of their cataract patients receiving Presby IOL has increased
Toric IOL’s up 8% from 2009 (14% of IOL volume)
87% were using a toric IOL…up from 79% in 2009
48% say the percent of their cataract patients receiving Toric IOL has increased
Percent of cataracts you are inserting presbyopic IOL’s
Percent of cataracts you are inserting toric IOL’s

4. Astigmatism and Cataract surgery
What is you most often used technique in your cataract patient with significant pre existing astig.?
How do you correct significant residual astigmatism in your presbyopic IOL patients?

5. -72% use topical anesthesia with ¾ of those using IC lidocaine with topical (N/C)
-68% use temporal incisions, 3%
-87% use clear corneal incisions with 48% of those using the near clear (vascular area) vs. 34% avascular area
-25% 3% use antibiotics in the irrigant with 16% (up 2%) using intracameral antibiotics
-12% use microincision (<2mm) coaxial phaco while 4% use bimanual microincision (<2mm) the majority of the time
-If they were to use < 2mm incision, 62% would use coaxial rather than bimanual
-77% pretreated their cataract patients with NSAID’s with 2/3 of them starting 3 days before surg. (N/C)
Surgical Trends
Usual incision size in mm

6. Preferred method of keratometry for …
Routine IOL Calculations
Toric IOL Calculations
Strong reliance of PCI platform for K’s
Less trusting of PCI platform for K’s

7. Importance rating various femtosecond laser cataract applications 2010
Lasers and cataract surgery
Perceived out of pocket value to your cataract patients for the use of femtosecond laser with surgery?
*86% of members have no opinion as to which laser platform is best
Importance rating various femtosecond laser cataract applications 2010
Perceived out of pocket value to your patient to use the intraoperative aberrometer during cataract surgery?
Max Importance = Neutral = Lowest Importance = -200

8. If insurance will not pay for/or let you bill for femtosecond laser use during cataract surgery, how likely are you to use it?
61% not likely at all
23% only on special cases
10% somewhat likely
5% very likely

9. Other notable findings….in 2010
-57% of members used a capsular tension ring 7%
-19% felt they had a case of TASS…little change thru the years
-Top three perceived most important technologies….
#1 Toric IOL’s
#2 Torsional phaco
#3 multifocal IOL’s
-Lowest interest level in ….
#1 microicision less than 2mm
#2 accomadating IOL
#3 wavefront aberrometry in cataract surgery
-97% of members participate with Medicare

10. Use of computerized medical records 2010
Overall 35% are using computerized medical records 4%
Highest implementation appears to be in those doing 3 – 15 cataracts per month
Time frame for implementation
Large number of EMR companies…make it difficult for small companies to have the finances for development and support. Nexgen largest at 21%, Medflow 14%, Epic 8%, Compulink 6%, plus at least 50 other companies being used by members!

11. Conclusions
Cataract surgery (and specialty IOLs) show sustained growth even in hard financial times. LASIK starting to come back up 19%, first increase since 2004.
Specialty IOL’s are being used in approximately 14% of cataract surgeries
Keratometry used for biometry is usually done with the partial coherence interferometry platform except when using Toric IOL’s
35% of members use computerized medical records. Large number of EMR companies which is good and bad.
LRI’s still the predominant way to correct residual astig. in presby IOL pts.
Toric IOL positioned for strongest growth in coming years

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 “paper” 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