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ASCRS survey: number of cataract procedures dropped 4.5% in 1998
Cataract procedures were down for the first time in decades.
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SEATTLE — For the first time since the annual survey of the American Society of Cataract of Refractive Surgery (ASCRS) began in 1984, the estimated annualized volume of cataract surgery in the United States decreased by almost 100,000 cases.
According to an extrapolation of survey data on monthly surgical volume, 2,044,737 cataract procedures were performed in the United States in 1998, compared with 2,140,141 in 1997, a decrease of 4.5%.
The decrease in the number of procedures is not the result of a dwindling number of cataracts in the United States, according to David V. Leaming, MD, who presented the results of the survey of ASCRS members at the association’s annual meeting here. Rather, he suggested that the cause is an increase in the annual number of refractive procedures.
“Since higher volume cataract surgeons are the ones who are undertaking refractive surgery, and if you assume there is a finite number of procedures that a surgeon is comfortable with, then he or she cannot undertake and develop a full-blown refractive surgery practice without it affecting his or her cataract surgery practice,” Dr. Leaming said.
Refractive surgery explosion
According to the survey, the annual volume of laser in situ keratomileusis (LASIK) procedures increased by 161% in 1998 — closing in on the 500,000 mark. The volume of photorefractive keratectomy (PRK) cases decreased by about 23%, while the volume of radial keratotomy (RK) cases fell by one-half.
Dr. Leaming predicted further decreases in volume of cataract procedures and additional gains in the annual number of refractive surgery cases.
“For the next few years, you may actually see a little bit of a decrease in cataract volume, until there is a shift in which the lower volume surgeons pick up the slack,” he said. “But certainly there are not fewer cataracts out there.”
Dr. Leaming, who is in private practice in Palm Springs, Calif., mailed the survey to 5,000 U.S.-based members of the ASCRS in September 1998. By Nov. 1, 1998, the deadline for responses, 1,481 members, or about 29%, had replied. The survey not only profiles surgical practices and preferences, but also questions ophthalmologists on their attitudes toward their profession and plans for the future. The results of the 1998 survey were published in the June 1999 issue of the Journal of Cataract and Refractive Surgery.
Phaco volume down
The overall decrease in the number of cataract operations from 1997 to 1998 was led by a decrease in the number of phacoemulsification procedures from 1.93 million in 1997 to 1.8 million in 1998. Extracapsular cataract extraction volume increased to 226,240 procedures in 1998, up about 10.2% from 205,326 in 1997.
Another significant shift was reported in lens material preference. For the first time in its 50-year history, PMMA was surpassed by acrylic in 1998 as the material of choice. The use of silicone, which had been on the decline for 4 years, increased slightly in 1998. Use of hydrogel also is on the rise.
According to the survey, about 37% of cataract surgeons use topical anesthesia, and of those, about 75% use intracameral lidocaine.
“This has gone up dramatically in the last few years,” Dr. Leaming said.
Eighty-one percent of surgeons employ sutureless techniques, up from 72% in 1997. Additionally, use of the clear corneal incision is at an all-time high of 36%, marking a “substantial rise,” according to Dr. Leaming. For the first time, temporal incisions are preferred over 12-o’clock incisions.
The use of antibiotics in the irrigant has apparently peaked in popularity at about one-third of surgeons. About three-quarters use preoperative antibiotic drops and one-quarter use postoperative injectable steroids.
Refractive volume way up
Extrapolation of data on refractive surgery volume gives an estimate of 440,275 LASIK procedures performed in 1998, compared with 170,345 in 1997 — an impressive 161% increase. The estimated number of PRK procedures decreased by about 23% from 132,209 in 1997 to 101,786 in 1998.
According to the survey, 23% of ASCRS surgeons are performing RK, down from 34% in 1997. Thirty-eight percent of physicians perform PRK, unchanged since 1997, while 29% are currently performing LASIK, a 93% increase since 1997.
About 25% of respondents said they are interested in taking a LASIK training course, which indicates that the percentage of members performing LASIK may continue to increase. LASIK emerged as the high-volume surgeons’ procedure of choice, and a growing preference for LASIK was reported by surgeons at all volume levels.
Fifty-one percent of ophthalmologists who responded that they have either myopia or astigmatism have undergone RK themselves, while 25% have had LASIK and 21% have had PRK.
Attitudes, future plans
Thirty-three percent of respondents take 2 to 3 weeks vacation time per year, while 1% takes 60 days or more. Half of the respondents spend between eight and 15 days at professional meetings per year.
For Your Information:
- David V. Leaming, MD, can be reached at 1100 N. Palm Canyon, Ste. 112, Palm Springs, CA 92262-4418; (760) 320-7051; fax: (760) 320-7683. Dr. Leaming has no direct financial interest in any of the products mentioned in this article, nor is he a paid consultant for any companies mentioned.