This article is more than 5 years old. Information may no longer be current.
LASIK growth dipped in 2001, survey shows
The annual ASCRS member survey shows a decrease in LASIK, an increase in cataract surgery and a growing interest in phakic IOLs.
Click Here to Manage Email Alerts
PHILADELPHIA — The number of LASIK procedures declined last year from the previous year’s volume, according to a survey presented here.
This is the first drop in the actual number of LASIK surgeries since the refractive procedure’s initial surge of popularity.
The annual survey by David V. Leaming, MD, supported the conventional wisdom that a sluggish economy, combined with loss of consumer confidence after Sept. 11, led to a downturn in the public’s interest in refractive surgery.
“Overall LASIK volume decreased by 12%,” Dr. Leaming said at the opening session of the American Society of Cataract and Refractive Surgery meeting.
According to the survey, Practice Styles and Preferences of U.S. ASCRS members, the estimated volume of refractive procedures dropped in 2001 to 8 million, from 9 million in 2000.
This year, the rate of response to the survey also dropped.
“Only about 20% of ASCRS members participated — that’s 1,130 out of 5,686 members,” Dr. Leaming noted.
Questionnaires were mailed out in late August 2001, leading researchers to believe the poor response rate was related to the events of Sept. 11.
While LASIK rates declined for surgeons who participated in the survey, cataract surgery rates increased.
“Cataract volume increased 8% from the year before, to 2.3 million procedures in 2001,” Dr. Leaming said.
“Additionally, there was an increase in interest in innovative technologies like phakic IOLs and partial interference interferometry,” he added.
LASIK still leading
While the events of September might have played a part in LASIK’s decline, the rates of increase had been steadily falling every year since the initial “explosion” of LASIK onto the market in 1997, Dr. Leaming said.
“Between 1997 and 1998, there was a LASIK boom. LASIK grew by 158% from 1996. Then, in 1999, the growth rate dropped to a 59% increase. By 2000, it only increased by 30%,” he said.
For the 56% of ASCRS members who do some amount of LASIK every month, the majority are using the Visx excimer laser.
“Seventy-two percent of physicians surveyed are using the Visx laser, with 53% specifically using the S3 model,” Dr. Leaming said.
When surgeons were asked if they planned to use another laser in the future, 32% named Visx, while 39% said they would like to try the Alcon Summit Autonomous laser.
For microkeratomes, 57% of respondents favored the Bausch & Lomb Hansatome.
“However, when it came to the microkeratome that surgeons were interested in trying in the future, most people said the AMO Amadeus,” he said.
In the survey, 51% of LASIK surgeons said they would discontinue the procedure in the future if the reimbursement level dropped to $1,000 or less.
Other refractive procedures
“Other refractive surgeons, at 9%, are currently pursuing laser epithelial keratomileusis (LASEK),” Dr. Leaming said. The report also showed that fewer surgeons are performing older refractive procedures.
“We found 76% of surgeons don’t do PRK, 80% won’t do astigmatic keratotomy and 96% never do RK,” he noted.
However, he noted an increasing interest in phakic IOLs.
“The greatest interest in future refractive procedures is now phakic IOLs. Only about 4% are presently doing the procedure, but 56% of members plan to do phakic IOLs in the future,” he said. In addition, 31% of surgeons expressed an interest in scleral expansion bands.
The preferred anti-inflammatory agent among members was prednisolone at 49%. Fluorometholone followed with 29%.
“The majority of physicians also favored ofloxacin in the antibiotic category,” he added.
For measuring axial length for cataract surgery, partial interference interferometry has gained attention in the past year.
“Partial interference interferometry has shown the most rapid growth within the last 12 months. The technology has undergone a fourfold increase since last year, increasing from 3 to 13% in use,” Dr. Leaming said.
Cataract surgery increasing
With an increased volume of cataract surgery this year, 55% of surgeons are choosing to perform clear corneal cataract incisions for extraction.
“Sixty percent of these are temporal and 21% are at the 12 o’clock position. Nearly 90% of incisions are sutureless,” Dr. Leaming said.
Surgeons are using mostly metal blades to make these incisions, he said.
“This holds true unless surgeons are doing over 50 cataract surgeries a month; then they use the diamond blade,” he added.
According to the survey, 55% of surgeons use topical anesthesia during cataract surgery.
“This is up from 49% in 1999,” Dr. Leaming noted.
Eighty percent of surgeons are using intracameral lidocaine in addition to topical anesthesia.
“The retrobulbar with or without a facial is down 23%, and the peribulbar needle is also down to 19%,” Dr. Leaming said.
In addition, 32% percent of respondents said their total procedure time fell between 11 and 15 minutes, from “first cut” to “last touch.”
“There were 27% of surgeons who took 16 to 20 minutes for one eye, while about 1 in 5 eyes were completed in under 10 minutes,” Dr. Leaming noted.
Nearly 72% of surgeons said they would stop performing cataract surgery completely if the reimbursement rate fell to $500 or less.
Acrylic IOLs favored
“The preferred optic material for IOLs is acrylic, leading the market with 58%,” Dr. Leaming said.
Acrylic lenses are followed by monofocal silicone lenses, with 26%.
“PMMA lenses have dropped again this year, from 15 to 10%,” he added.
Other types of lenses on the market received minimal responses, he said.
According to Dr. Leaming, there is a trend in foldable lenses toward single-piece lenses.
“There are 43% of surgeons who prefer these lenses, which is an increase from only 29% of surgeons in 2000,” he added.
Assembled lenses are still chosen by 45% of respondents, which is a decrease from 57% of surgeons surveyed in 2000.
Glaucoma preferences
For glaucoma treatment, the preferred prostaglandin analog was Xalatan (Pharmacia).
“Surgeons chose Xalatan by 60%, followed by Allergan’s Lumigan at 19% and Alcon’s Travatan with 6% of respondents,” Dr. Leaming said. Fourteen percent of surgeons reported no preference among prostaglandin analogs.
For glaucoma surgical therapy, 94% of surgeons would perform cataract surgery with phacoemulsification and IOL implantation on a glaucoma patient with cataract.
“This is only for a patient whose IOP is well controlled. For those who are not well controlled, 41% of surgeons would do phaco with a trabeculectomy,” he said. Additionally, 46% of surgeons said they would do phaco with a trabeculectomy and an antimetabolite.
In the survey, surgeons were asked about their first-line therapy for a 45-year-old non-cardiopulmonary glaucoma patient with blue eyes.
“A total of 53% of surgeons choose beta-blockers for this patient, followed by prostaglandin analog with 30% of the responses,” Dr. Leaming said.
When surgeons were asked how they would treat the same patient with a cardiopulmonary condition, 60% would choose a prostaglandin analog, he added.
Dr. Leaming hopes the information from the 2001 survey will allow surgeons to grasp a better understanding of the current trends in ophthalmic practice.
“Keep in mind how these trends may affect your practice now and in the future,” he said.
For Your Information:
- David V. Leaming, MD, can be reached at Vision Professionals, 1180 N. Indian Canyon Drive, Suite 130, Palm Springs, CA 92262. (760) 320-7051; e-mail: eyeopr8@aol.com. Dr. Leaming is a paid consultant for Alcon, Advanced Medical Optics, Bausch & Lomb and Pharmacia.
- Data from: Practice Styles and Preferences of U.S. ASCRS Members: 2001 Survey with International Comparisons.