1. U.S. Trends in Refractive Surgery: 2012 ISRS Survey - Partner of AAO - Richard J. Duffey, MD David Leaming, MD Refractive Subspecialty Day Chicago: November 10, 2012

2. The authors have no financial interests in this survey study. DUFFEY 2012

3. 2012 Survey ä ä Fourth year of ONLINE*** survey opened by 376 ISRS members of the 1150 total emailed…sixteenth year of refractive data collection overall ä ä 127 responses analyzed by October 5, 2012 for 34% of the U.S. ISRS membership who opened the emailed survey and 11% of the membership e-mailed. ä ä Alphabet soup of refractive surgery including corneal and lens-based surgeries and premium refractive IOLs.

4. DUFFEY 2012 I Am Currently Doing This Surgery * *

5. DUFFEY 2012 > 5 Cases / Month 28

6. DUFFEY 2012 > 25 Cases / Month

7. DUFFEY 2012 > 75 Cases / Month * Peaked in 2001

8. DUFFEY 2012 Preferred Surgery For 30 yo -10.00 Diopter Myope * * 45% LVC

9. DUFFEY 2012 Preferred Surgery For 45 yo +3.00 D Hyperope *70% LVC

10. DUFFEY 2012 Preferred Surgery For 45 yo +5.00 D Hyperope *

11. DUFFEY 2012 Willing To Do Bilateral Surgery At Same O.R. Visit * *

12. DUFFEY 2012 Had Refractive Surgery Performed on Yourself *33% Total

13. DUFFEY 2012 Family LVC Index: (LASIK or PRK Performed on Ourselves and Family Members) 28 * 3X the general population

14. DUFFEY 2012 Excimer Laser Most Commonly Used

15. DUFFEY 2012 “Microkeratome” Most Commonly Used * 66% femtolaser

16. DUFFEY 2012 Topography Unit Most Commonly Used

17. DUFFEY 2012 Epi-Keratome Use

18. DUFFEY 2012 Preferred Surgery for “Pre-Cataract” Presbyopia * *

19. DUFFEY 2012 Wavefront-Guided Custom Ablations in Your Practice

20. DUFFEY 2012 Wavefront Analyzer

21. DUFFEY 2012 Comanagement

22. DUFFEY 2012 When Comanaged, Who Does Day 1 Postop Exam?

23. DUFFEY 2012 Do You Routinely Measure Flap Thickness Intra-operatively ?

24. DUFFEY 2012 Preferred Flap Thickness (when no other constraints) *

25. DUFFEY 2012 Minimum Residual Stromal Bed Thickness Requirement for LASIK * 60% at 275 microns or greater

26. DUFFEY 2012 Total Cases of Post LASIK Ectasia as the Primary Surgeon in Career * Not growing

27. DUFFEY 2012 Minimum Cent. Corneal Pachymetry for LASIK (all other parameters normal) * 66% OK with 480 or less

28. DUFFEY 2012 Mitomycin-C Use (MMC)

29. DUFFEY 2012 Will You Perform Refractive Surgery on One-Eyed Patients

30. DUFFEY 2012 Post-Op Antibiotic * 88% fluoroquinolones

31. DUFFEY 2012 Post-Op Steroid

32. DUFFEY 2012 Post-Op Nonsteroidals

33. DUFFEY 2012 Location of Phakic-IOL Surgery

34. Threshold of Astigmatism Offered Correction at Cataract Sx DUFFEY 2012 * 56% will offer to correct astigmatism when it reaches 0.75 D… 80% if it reaches 1.0 D

35. Procedure for Low Astigmatism Intervention (0.5 to 1.0 D) DUFFEY 2012 * 80% LRI/AK

36. Procedure for Medium Astigmatism Intervention (1.12 to 2.0 D) DUFFEY 2012

37. Procedure for High Astigmatism Intervention (2.0 D plus) DUFFEY 2012

38. Do You Currently Perform CXL? DUFFEY 2012

39. Total LVC Volume w/i ISRS (1000s) * 8% decrease in Total LVC from 2010. Ratio of PRK / Total LVC increased from 24% to 29% over past 2 years.

40. DUFFEY 2012 2012 ISRS/AAO SUMMARY ä ä Fourth ONLINE ISRS/AAO SURVEY was a success with 34% / 11% response rate. ä ä VisX 2:1 (63%) over Wavelight (26%) and other excimers combined…stable. ä ä About 35% penetration of modern refractive surgery amongst refractive surgeons…. 3-4 X the general population. Family Index rates also continue to be high despite mixed press re: LVC in the public media a few years ago.

41. DUFFEY 2012 201 2 ISRS/AAO SUMMARY ä ä 25% of respondents are OK with bilateral P-IOL and 5% with bilateral RLE at the same surgical setting (down from last year). ä ä Multifocal IOL (15%) over accommodative IOL (4%) as a preferred lens-based presbyopia option when used for RLE (stable). ä ä Femtosecond laser use still on the rise (66%)

42. DUFFEY 2012 2012 ISRS/AAO SUMMARY ä ä Thinner flaps still on the rise: 100 micron or less flaps are favored by 57% of surgeons (up from 12% in ‘04). ä ä Preferred RSB thickness stable: 40% think 250 microns is adequate, but 60% recommend 275 microns or more. ä ä New post-LASIK ectasia cases continue to be on the decline with 50% stating no cases of their own patients in their career.

43. 2012 ISRS/AAO SUMMARY ä ä Pentacam (41%) and Z-H (43%) about equal and Orbscan II down (26%) from last year. ä ä LVC Volume down 8% within ISRS/AAO membership in 2012 relative to 2010 and down even greater from last year. ä ä Ratio of Surface Ablation / Total LVC stable at 29% over past two years. DUFFEY 2012

44. 2012 ISRS/AAO SUMMARY ä ä During cataract surgery 80% of surgeons will offer to correct astigmatism if it measures 1.0 D or more ä ä LRI/AK preferred (80%) if K astigmatism <1.0D ä ä Toric IOL preferred (76%) if K astigmatism > 1.12D ä ä CXL offered by 16% of ISRS/AAO members surveyed in the U.S. DUFFEY 2012

45. www.duffeylaser.com Additional Data at www.duffeylaser.com ä ä Types and volumes of refractive surgeries currently being performed ä ä Mitomycin-C use ä ä Post-operative use of antibiotics, steroids and nonsteroidals ä ä Surgical venues for various procedures…and more DUFFEY 2012

46. Thanks to the ISRS/AAO leadership for their support and for your participation in the 2012 Survey We look forward to your response to our fifth ONLINE survey and the seventeenth survey overall next fall. ***Complete 16 years of survey results found at www.duffeylaser.com