U.S. Trends in Refractive Surgery: The 2006 ISRS/AAO Survey

Richard J. Duffey, M.D., of Mobile, Ala., and David Leaming, M.D., of Palm Springs, Calif., annually survey the membership of the International Society of Refractive Surgery (ISRS) to collect data on such issues as LASIK, Refractive Lens Exchange (RLE), enhancement tests, ectasia and co-management. Following are results of their 10th annual survey:

Program With the Consumer in Mind
So you not only have to provide a service that patients want, but you also have to provide it in such a way that they (on-) demand your channel and not someone else�s. If you do not have the programming that patients want, they will look for a channel that does.
You cannot control their decisions. You can only set up your channel and determine the programming. With enough planning, and a bit of luck, you will offer selections that patients want, whether it be for illness medicine, consumer medicine or a little of each.

- LASIK dominates between -10 D and +3 D
- Phakic IOL preferred for higher than -10 D myopes
- Refractive lens exchange preferred for high hyperopes (61%)
- Monovision is the most sought goal for presbyopic patients seeking refractive surgery (42%), but 33% are now choosing modern presbyopic IOLs
- The trend is toward thinner flaps (mechanical or laser)
- Almost one-third of those ophthalmologists surveyed (32%) have had modern refractive surgery done on their own eyes
- VISX still at >2:1 over all other lasers
- IntraLase market share stabilizing at 20% of procedures
- Epikeratome users stable (18%)
- Stable 88% of respondents use wavefront analyzers
- Stable 89% of respondents perform custom ablations, but at increasing frequencies (55% whenever possible)
- Fourth-generation fluoroquinolones dominate the post-refractive surgery market (97%)
- Comanagement is still on the rebound after several years of decline (increased from 40% to 56% from 2004 to 2006)
- 37% of refractive surgeons now measuring true flap thickness in the OR
- Less than half of surgeons surveyed (40%) have had a documented case of post-LASIK ectasia in surgical patients over their career
- 64% think 250 �m is adequate for residual stromal thickness after LASIK
- The most desired flap thickness is 120-130 �m
- 83% use mitomycin C for prophylaxis and/or haze (up from 62% from 2 years ago)
- 5% of respondents are OK with bilateral phakic IOL implantation at the same surgical setting (down from 8% in past)
- ASC is preferred location for phakic IOL surgery (79%); 15% are OK with �in office� modified OR. OM

About these data: A mailing to 1,500 U.S. members of ISRS/AAO was sent out and 167 responses were analyzed by Oct. 1, 2006 (11% of the U.S. ISRS/AAO membership). This is the tenth year of refractive data collection. This data may be found in its entirety on Dr. Duffey�s Web site at www.duffeylaser.com/physicians_resources.php.