2004 ISRS/AAO survey shows impact of new technology

New Orleans-Results of the 2004 ISRS/AAO refractive surgery survey show some continuing trends, a few surprises, and the impact of new technology on refractive surgery practices.

The hot-off-the-press data were presented at the refractive surgery subspecialty day meeting by Richard J. Duffey, MD, a private practitioner in Mobile, AL. They represented responses from 184 surveys (12%) returned from an August mailing to 1500 members in the United States.

The analyses showed about 70% of the respondents were doing at least five cases of LASIK per month. Ninety percent indicated they were performing wavefront evaluations and the same percent reported performing wavefront-guided custom surgery.

There appears to be an interesting trend for more surgeons to be doing as many patients as they can with the customized approach, and on average, there is a $400 higher charge per eye for the wavefront-guided surgery, Dr. Duffey reported.

LASIK continued as the dominant procedure for refractive errors ranging from -8 to 3 D. For correction of high myopes, phakic IOLs topped the list of preferred procedures, while refractive lens exchange was cited as the method of choice for treating high hyperopia.

Appreciable proportions of the respondents, however, appear to be waiting for a better alternative for patients with more extreme refractive errors, Dr, Duffey noted.Monovision LASIK continues to be the preferred surgery for presbyopia (44%), but with the approval of the Crystalens (eyeonics), 14% of the respondents favor accommodating IOL implantation.

The Hansatome (Bausch & Lomb) remained the most commonly used microkeratome, but 12% of respondents were now using the IntraLase FS (IntraLase) femtosecond laser.

The vast majority of surgeons, 90% to 98%, considered it acceptable to perform bilateral, simultaneous PRK and LASIK, while a surprising 8% believed it was acceptable to perform bilateral phakic IOL implantation. Half of the respondents said they would perform refractive surgery on a monocular patient.

About 80% of the survey participants felt 250-microns was the appropriate cutoff for residual stromal thickness when performing LASIK. Less than one-third of the respondents said they measure flap thickness intraoperatively, while about 50% reported having encountered at least one case of postLASIK ectasia among patients they performed primary surgery on.

Nearly a third (29%) of the respondents had personally undergone modern refractive surgery.

That is a very interesting figure considering the penetration of refractive surgery in the general population is only 4%, Dr. Duffey said.