Survey shows slight increase in laser refractive surgery volume

Slightly more respondents reported performing surface ablation than LASIK.

REFRACTIVE SURGERY/ OCULAR SURGERY NEWS U.S. EDITION April 10, 2012

Richard J. Duffey, MDRichard J. Duffey

The overall volume of laser vision correction among International Society of Refractive Surgery members increased 6% in 2011 compared with 2010, according to the most recent online ISRS member survey.

“Surface ablation was on the increase and LASIK was on a slight decline, but not by all that much,” Richard J. Duffey, MD, said during a session on current trends in refractive surgery sponsored by ISRS during Refractive Subspecialty Day preceding the American Academy of Ophthalmology meeting in Orlando, Fla.

The proportion of PRK procedures among total laser vision correction procedures increased from 24% to 29%.

Dr. Duffey and David Leaming, MD, initiated the survey in 1996. The 2011 survey was the third one conducted online.

The survey was emailed to 1,145 ISRS members in the United States. Responses were received from 128 members, representing 34% of those who opened the survey and 11% of U.S. membership, Dr. Duffey said.

Procedures and frequency

In 2011, 93% of respondents reported performing LASIK and 96% reported doing surface ablation, Dr. Duffey said.

“We’re doing a lot of laser vision correction, surface ablation,” he said. “But [you can see] that the non-FDA-approved procedures in the United States — corneal inlays, presbyLASIK, etc. — comprise a small percentage at this point in time.”

About 12% of respondents reported performing more than 75 LASIK procedures per month, an arbitrary benchmark for high-volume surgery that was defined more than 15 years ago. High-volume surgeries peaked in 2001 and have declined since then, Dr. Duffey said.

“Twenty-seven percent of us were actually doing that number of patients or more per month at the peak of laser vision correction in 2005. It looks like we might be leveling off here over the last few years. We’re going to have to wait and see,” he said.

Results showed that 37% of respondents performed five or more surface ablation procedures and 65% performed five or more LASIK procedures per month. Nine percent performed 25 or more surface ablation procedures and 28% performed 25 or more LASIK procedures per month.

Preferred indications

Forty-eight percent of respondents cited laser vision correction as the preferred surgical procedure for a 30-year-old patient with 10 D of myopia; 39% named phakic IOL implantation as the preferred procedure.

For a 45-year-old patient with 3 D of hyperopia, 70% of surgeons favored laser vision correction and 17% preferred refractive lens exchange. Six percent of respondents preferred to delay treatment.

However, for a 45-year-old with 5 D of hyperopia, 61% of respondents favored refractive lens exchange, 11% preferred LASIK, 2% preferred surface ablation and 16% preferred to delay treatment, Dr. Duffey said.

Ninety-six percent of respondents said they would perform bilateral LASIK during one surgical session, and 96% said they would perform bilateral surface ablation. Twenty-seven percent of respondents said they would perform bilateral phakic IOL implantation, compared with less than 20% in 2010. Nine percent said they would perform bilateral refractive lens exchange in 2011.

Fifty percent of respondents said they preferred monovision and 26% favored modified monovision for the treatment of pre-cataract presbyopia.

Fifty-eight percent of respondents preferred using the Visx excimer laser, and 29% favored the WaveLight (Alcon) platform.

The Oculus Pentacam was the most preferred topography unit, followed by the Zeiss-Humphrey unit and Bausch + Lomb Orbscan, Dr. Duffey said.

Parameters and pharmacologics

Fifty-three percent of respondents preferred LASIK flap thickness of 100 µm, and 41% preferred a thickness of 120 µm to 130 µm.

Thirty-two percent preferred a minimum residual stromal bed thickness of 250 µm; 64% preferred a minimum thickness of 275 µm.

Fifty-six percent of respondents were willing to perform LASIK in a patient with central corneal thickness of 480 µm or less, assuming all other preoperative findings were normal.

The number of respondents reporting post-LASIK corneal ectasia has declined steadily for about 4 years, Dr. Duffey said.

Ninety-three percent of respondents preferred using mitomycin C prophylactically or to treat postoperative haze. Four percent preferred MMC for haze only, and 3% preferred to refrain from using MMC.

Thirty-five percent of respondents cited Vigamox (moxifloxacin 0.5%, Alcon) and 33% cited Zymar (gatifloxacin 0.3%, Allergan) as their most preferred postoperative antibiotics, Dr. Duffey said. – by Matt Hasson

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