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ASCRS survey shows refractive volume will increase
LASIK is still the most common procedure, but other options are gaining acceptance.
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SAN DIEGO — Refractive surgery volume is on the rise again, after decreasing since the peak year of 2000, said Richard J. Duffey, MD.
Gathering data from surveys mailed to 5,000 U.S. members of the American Society of Cataract and Refractive Surgery, Dr. Duffey and David Leaming, MD, found that LASIK is still the procedure of choice of most refractive surgeons for patients with refractive errors of –8 D to +3 D.
The survey, which reviewed respondents’ current practice patterns for refractive surgery, had an 11% response rate. Dr. Duffey presented results of the survey at the ASCRS meeting here.
Techniques surveyed included radial keratoplasty, astigmatic keratotomy, limbal relaxing incisions (LRIs), PRK, LASIK, laser epithelial keratomileusis (LASEK), intrastromal corneal ring segments, laser thermal keratoplasty (LTK), conductive keratoplasty (CK), phakic IOLs, refractive lens exchange (RLE) and scleral expansion procedures — a true “alphabet soup of refractive surgery,” Dr. Duffey said.
Survey respondents seemed to show continued interest in some procedures, namely LRIs, PRK, LASIK, LASEK, phakic IOLs and RLE, and less interest in other procedures, he said.
Wavefront technology for corneal refractive surgery showed increasing acceptance by respondents, Dr. Duffey said, with 55% saying they use a wavefront analyzer for diagnosis, and 51% saying they use wavefront-guided custom ablation at least some of the time in their practices.
This is the seventh year the refractive surgery survey has been done, Dr. Duffey noted.
Increase in refractive procedures
According to the survey, LASIK continues to be the most commonly used refractive surgical procedure. Interest has grown in RLE, phakic IOLs and CK, but many surgeons are waiting for these procedures to gain more acceptance with patients before adopting them, Dr. Duffey said.
In terms of LASIK volume, 51% of surgeons surveyed said they performed five or more cases per month, 25% did 25 or more cases per month, and 8% did 75 or more cases per month in 2003.
LASIK, PRK, LASEK, RLE, CK and phakic IOLs all have “apparent bright futures,” Dr. Duffey said.
Treatments are slowly emerging for patients with high myopia or high hyperopia who are not good candidates for LASIK treatment, he said. Fewer LASIK procedures are being done for patients with high myopia, and more surgeons are asking these patients to wait, most likely for approval of phakic IOLs, he said.
Similarly, fewer LASIK procedures were done for patients with high hyperopia, Dr. Duffey said. The pendulum is swinging more towards RLE for these patients, he said.
“Clear lens exchange is being performed on more patients with hyperopia, beyond +3 D,” he told attendees.
Respondents said they still plan on performing LRIs, PRK, LASIK, and LASEK in the future.
For correction of presbyopia, monovision correction currently remains the most common option, Dr. Duffey said.
The survey also showed that more surgeons had undergone refractive surgery themselves. Fourteen percent of respondents said they had undergone LASIK, a 4% increase from the previous year, he said.
“If you’ve had refractive surgery on yourself, [it’s] kind of a gauge of the acceptance,” he said.
Fees have also increased, Dr. Duffey said. Surgeons are charging an average $300 to $500 more per eye for customized wavefront-guided surgery than for conventional LASIK, he said.
Interest in RK, intrastromal corneal ring segments, LTK and scleral expansion procedures is decreasing, and Dr. Duffey labeled these procedures “dead or dying.”
| Practice plans |
| More surgeons plan on continuing to perform LRI, PRK, LASIK, LASEK, phakic IOLs and CLE. Source: Duffey RJ, Leaming D. |
Types of lasers used
The Visx excimer laser is the market leader, used by respondents 2-to-1 over all other lasers, Dr. Duffey said. Likewise the Visx wavefront analyzer was the most often preferred.
Still, wavefront-guided ablations have not been fully adopted by the surgeons surveyed. Only 4% reported using wavefront-guided ablations in more than 75% of their cases, and almost 40% of respondents who use wavefront said they used it in less than 50% of cases.
More surgeons are charging extra for wavefront, however. Sixty percent in 2002 said they did not or would not charge extra for custom laser. In 2003, 20% said they did not charge extra for it. Seventy percent said wavefront was a valuable asset to their practice and they anticipate moderate growth because of it.
Bausch & Lomb’s Hansatome was the most often used microkeratome, with 53% of respondents choosing it; 25% said they use one of four Moria microkeratomes, Dr. Duffey said.
For more on these procedures, please see the other articles in our Spotlight on Refractive Surgery section.
For Your Information:Reference:
- Richard J. Duffey, MD, can be reached at 2880 Dauphin St., Mobile, AL 36606-2494; 251-470-8928; fax: 251-470-8924; e-mail: drrduffey@hotmail.com.
- Duffey RJ, Leaming D. U.S. Trends in Refractive Surgery: 2003 ASCRS Survey. Presented at: Annual Meeting of the American Society of Cataract and Refractive Surgery; May 3, 2004; San Diego, Calif.