Survey: popularity of wavefront technology increases

A survey of ASCRS/ESCRS members shows an increased interest in wavefront technology and surface refractive procedures.

PHILADELPHIA, U.S.A. — Interest in wavefront-guided ablation increased significantly in 2001, according to data from an international survey presented here. Surgeons’ interest in surface ablation seems to have been rekindled as well.

The annual refractive surgery survey, presented by Kerry D. Solomon, MD, showed that the use of wavefront technology increased internationally by 8%.

“In 2000, wavefront ablation was performed by just 2.5% of ophthalmologists worldwide. Last year, it rose to 10%,” reported Dr. Solomon, who spoke at the meeting of the American Society of Cataract and Refractive Surgeons (ASCRS).

Data from the Refractive Surgery Survey 2001 was collected from 1,407 members of ASCRS and the European Society of Cataract and Refractive Surgeons (ESCRS). The response rate, 17%, was lower compared with last year’s — a possible result of the attacks on the United States on Sept. 11, Dr. Solomon said.

In addition to wavefront technology, the survey found an increased interest in the surface procedures, laser epithelial keratomileusis (LASEK) and photorefractive keratectomy.

“During the past year, the number of surgeons who have undergone these refractive procedures themselves was 4.2%,” Dr. Solomon said.

This figure is higher than the yearly number of those in the general public who undergo refractive procedures.

“Therefore, the research indicates that the comfort level is fairly high for ophthalmologists using these innovative procedures. It also shows a growing support for refractive procedures in the ophthalmic world,” Dr. Solomon said.

Wavefront building momentum

“In the study, 10% of surgeons surveyed were performing refractive surgery with wavefront technology, and of those surgeons, 75% believed that the technology was improving the quality of their patients’ vision,” Dr. Solomon reported.

More than 75% of LASIK surgeons reported that if the results of wavefront technology are shown to be better with PRK, they would switch from LASIK to PRK.

“This is a dramatic change from surgeons surveyed in 2000,” Dr. Solomon said. “It shows that surgeons are happy with results and increasingly more interested in achieving the best possible outcome with wavefront technology, no matter what the refractive procedure.”

Leading lasers

Of lasers being used for refractive surgery, Visx is the most commonly used by surgeons practicing in the United States and London.

In contrast, surgeons in Europe, New Zealand and Australia most often use the Technolas 217 laser from Bausch & Lomb. In Asia and Latin America the Nidek EC-5000 is the most popular for refractive surgery.

“This difference shows that there is not just one brand of lasers dominating the market,” Dr. Solomon said.

Hansatome favored

For microkeratomes, however, one device is used more frequently than all others — the Hansatome from Bausch & Lomb.

“The Hansatome was the most widely used microkeratome around the globe. In popularity and use, [it] is followed by Moria’s [M2] microkeratome, and also by Allergan’s Amadeus,” Dr. Solomon said.

Since the 2000 survey, there has been a “significant increase” in the popularity of the Amadeus microkeratome in North America, Latin America and Europe, he said.

While this year’s survey shows a variety of lasers and microkeratomes being used worldwide, the application of devices appears to be consistent.

“What is interesting is that we found about 70% of surgeons treating large pupils with these lasers and microkeratomes, regardless of whether the patient had low myopia or high myopia,” Dr. Solomon said. “This shows a similarity of practice patterns.”

Refractive surgery to increase

“The survey also found that the volume of LASIK procedures every month was consistent with last year’s survey,” Dr. Solomon said. “But people are looking to increase their volume in the future.”

More than 50% of surgeons who responded to the survey perform five to 10 LASIK procedures a month. Ten percent are high-volume surgeons, performing more than 80 LASIK cases a month, Dr. Solomon added.

“For those performing LASIK every month, the majority of them keep the cornea’s standard residual bed between 250 to 275 µm,” he said. However, Dr. Solomon said he noticed no similarity of residual bed parameters among surgeons who perform other surface procedures, such as LASEK.

“When it comes to LASEK, the majority of surgeons use it only for selected cases,” Dr. Solomon said. “Surgeons are waiting to see more long- and short-term data on LASEK surgeries before they incorporate it into their daily practices.”

In fact, a significant number of surgeons said LASEK is more uncomfortable than LASIK, while 50% said LASEK is more uncomfortable than PRK. The survey also found an increase in the number of phakic IOLs implanted monthly.

“An interest in phakic IOLs for refractive surgery has a majority of surgeons implanting five or less every month,” Dr. Solomon said.

The Artisan lens by Ophtec BV, posterior chamber silicone lenses and implantable contact lenses are the most popular phakic IOL models.

Survey participants said they were looking to decrease their volume of radial keratotomy, intrastromal corneal rings and LTK.

Common complications

Dry eye is by far the most common complication after refractive surgery, Dr. Solomon said.

“In terms of frequency of complications, glare and diffuse lamellar keratitis are the next most common complications after dry eye syndrome,” he said.

According to Dr. Solomon, 6% of surgeons saw infections in their patients after LASIK; less than 2% saw infections in their PRK patients and less than 1% in their LASEK patients.

“Keep in mind that this difference in number of infections, when compared to LASIK, is probably due to the significant difference in volume of procedures performed yearly, and not to the procedures themselves,” Dr. Solomon said.

The majority of infections reported were infectious keratitis, caused by viral or bacterial organisms, Dr. Solomon said. There were no reported cases of fungal keratitis, he noted.

Transplants and flap problems

The survey also estimated that 92 corneal transplants had been performed worldwide in 2001 on patients who had undergone refractive surgery.

“The most common reason we found for performing keratoplasty was due to ectasia, followed by irregular astigmatism, PRK haze and corneal decomposition from phakic IOLs,” Dr. Solomon said.

Additionally, researchers found more than 75 corneal flaps were amputated after LASIK surgery. “Eight percent of respondents reported having to amputate the flap. Unfortunately, this is a higher percentage than we expected,” he said.

Surgeons carrying out LASIK en-hancements mostly preferred to lift the flap when possible instead of recutting it, Dr. Solomon said. He said a majority of surgeons reported having to completely remove one flap after LASIK surgery.

“In fact, this year we found an increased number of surgeons who had removed more than one flap,” he said.

Comanagement stable

When surgeons were asked by the survey about their practice management styles, 56% of them reported that they currently comanage some percentage of patients in their practice.

“This statistic hasn’t changed very much from 2000. However, about 20% of surgeons have either increased or decreased their comanagement cases,” Dr. Solomon added.

The majority of surgeons who are comanaging patients are sharing the duties for only 25% of their patients. Dr. Solomon said that only 2% to 5% of surgeons are comanaging a significantly larger number of patients.

“On a positive note, we found that twice as many surgeons in 2001 than in 2000 were following the ASCRS and American Academy of Ophthalmology guidelines for comanagement,” Dr. Solomon said. “These results represent responses from a percentage of ASCRS physician membership.”

According to Dr. Solomon, surgeons can use the information presented in the Refractive Surgery Survey 2002 to help them assess where their practice styles fit in relation to other surgeons in their region, as well as worldwide.

For Your Information:

• Kerry D. Solomon, MD, can be reached at the Storm Eye Institute, 167 Ashley Ave. P.O. Box 250676, Charleston, SC 24925 U.S.A.; +(1) 843-792-8854; fax: +(1) 843-792-6347; e-mail: solomonk@musc.edu.
• Data from: The Refractive Surgery Survey 2002, conducted by Storm Eye Care, Medical University of South Carolina, in cooperation with the American Society of Cataract and Refractive Surgery.