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LASIK volume up more than 25%, ASCRS survey finds
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WASHINGTON — The volume of LASIK procedures grew 26% from 2003 to 2004, according to an annual survey of practice preferences presented here at the American Society of Cataract and Refractive Surgery meeting.
Other notable findings of the survey of U.S. members of ASCRS included an overwhelming preference for acrylic IOLs, a unanimous interest in accommodating IOLs and a near-doubling of the use of clear corneal incisions from 5 years ago.
David V. Leaming, MD, sent his annual survey on general ophthalmic trends to 6,296 physicians; 773 returned the questionnaire. He reported the results of the survey here in a presentation and a poster.
According to Dr. Leaming, in 2004, 62% of survey respondents used topical plus intracameral anesthesia in cataract surgery.
Over a 5-year period, from 1999 to 2004, the use of clear corneal incisions almost doubled, from 40% to 72%, according to survey responses. Surgeons said they prefer a metal blade to a diamond blade by a two-to-one ratio, Dr. Leaming reported.
As in recent years, acrylic IOLs remained the preferred IOL material among respondents, followed by silicone, PMMA and hydrogel. More than half the respondents — 57% — said they prefer a single-piece foldable IOL
For use with ultrasmall-incision cataract surgery in the future, 38% of respondents said an acrylic lens is the most promising IOL, and 29% of respondents said an injectable lens material holds the most promise.
In a change from last year, 61% of respondents said they prefer implanting a clear IOL rather than a blue-light-filtering IOL. In 2003 47% reported preferring clear lenses.
The survey also addressed refractive surgery topics. As noted above, respondents reported an increase in LASIK volume by 26% in the year since the 2003 survey.
Seventy-five percent of respondents said 250 µm is the threshold for the residual stromal bed below which they would not perform LASIK.
Asked about what refractive procedures they were interested in adopting, 84% of respondents said they were not interested in scleral expansion, 49% were not interested in conductive keratoplasty, 54% were not interested in LASEK and 50% were interested in phakic IOL implantation.
Respondents said they charge an average $500 additional to perform customized LASIK over their fee for conventional LASIK.
Dr. Leaming noted that in 2003 respondents said only 9% of patients were offered wavefront LASIK. In 2004, every patient was offered the option of wavefront, he said.
Regarding glaucoma, the survey posed a series of scenarios and asked what drug the respondents would prescribe. For first-line therapy in a 45-year-old patient, 60% said they would prescribe prostaglandins if the patient was blue-eyed with no cardiopulmonary complications, and 77% would prescribe prostaglandins if the patient had brown eyes and no cardiopulmonary complications. For a blue-eyed patient with a history of cardiopulmonary complications 83% would prescribe prostaglandins, and for a brown-eyed patient, 94%.
Regarding medical liability, 17% of respondents said they pay a malpractice insurance premium of $10,000 per year; 14% each said they pay $7,500, $12,500 or $15,000.