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Survey shows increasing number of retinal procedures performed in ASCs
In addition, 98% of U.S. respondents and about half of international respondents give injections in the office.
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U.S. retina specialists reported in a survey doing a majority of their procedures in ambulatory surgical centers and preferring to give bilateral intravitreal injections on the same day.
Thomas Stone, MD, presented results of the Preferences and Trends Survey at the 2013 American Society of Retina Specialists meeting.
The 15th annual survey had a 34.2% response rate, the highest to date, and included international ASRS members in record numbers.
Results showed that 780 ASRS members, both U.S. and international, responded to the survey, a 24% increase over 2012 and a 104% increase over 2011, according to the ASRS website.
“That was very gratifying for us because, without that participation, it’s hard to get good numbers,” Stone said.
Thomas Stone
Of those responding to the 2013 survey, 227 were international ASRS members, which allowed for a statistically significant comparison between U.S. responses and international responses.
Stone said that the next survey will be out in early April. ASRS members will receive an email about it and will be able to access the survey on the ASRS website.
Surgical preferences
For the first time, a majority of members reported operating in ASCs, Stone said.
“Over 50% of the people now claim that they do that for at least half their cases,” he said. “That’s a pretty big trend for us over the past 5 or 10 years and for the first time achieved that tipping point.”
The survey showed that, internationally, the majority of retina specialists performed cataract surgery themselves at the time of vitreous surgery, whereas in the United States, cataract surgery was generally done by another provider.
“The cataract surgery was done primarily by the same surgeon 77% of the time internationally and 8% of the time in the U.S. That’s pretty striking,” Stone said.
The survey showed a decrease in laser photocoagulation for diabetic macular edema.
“You basically have had an increase in anti-VEGF use over the years. We don’t have a lot of trending data on that, but laser has decreased as well,” he said.
In looking at dyes used by retina surgeons, most U.S. respondents preferred indocyanine green and most international respondents preferred brilliant blue G.
“They’ve had more experience with brilliant blue dye than we have,” Stone said.
Pharmacologic practices
For the first time, U.S. members reported a preference for giving bilateral injections to patients on the same day.
“Initially, there was a little hesitancy to do that,” Stone said. “Now we see that with more regularity.”
Stone said that Avastin (bevacizumab, Genentech) was the preferred agent to treat new cases of wet age-related macular degeneration, although the use of Eylea (aflibercept, Regeneron) and Lucentis (ranibizumab, Genentech) has increased over the past 2 years.
Bevacizumab has also gained as the treatment of choice for branch retinal vein occlusion.
“Three years ago, if people didn’t have any success with Avastin, just about half or so would go to laser,” he said. “Now, that’s down to about a third. People who used to go to Lucentis was about a quarter, and now that’s up to about 40%. People are now more comfortable going from one agent to the other more quickly.”
In addition, 98% of U.S. respondents and about half of international respondents reported giving injections in their offices.
“That’s not necessarily a trend, but that was one of the things that really jumped out between the U.S. and non-U.S.,” Stone said.
Twenty-seven percent of respondents said they used Avastin less because of concerns about compounding pharmacies that arose in 2012.
“For Avastin, about 70% of U.S. and international members did not change their prescribing patterns despite recent compounding concerns,” he said. “That’s a pretty notable change from what we’ve seen.” – by Matt Hasson and Patricia Nale, ELS