U S Trends in Refractive Surgery 2014 ISRS

U. S. Trends in Refractive Surgery: 2014 ISRS Survey Richard J. Duffey, MD David Leaming, MD Refractive Subspecialty Day Chicago: October 17, 2014

The authors have no financial interests in this survey study. DUFFEY/LEAMING 2014

2014 Survey ä ä ä Sixth year of ONLINE*** Survey E-mailed to 1022 U. S. ISRS members; 486 Opened Eighteenth year of refractive data collection overall ä 15% response rate of the membership’s opened e-mail requests analyzed by October 8, 2014. ä Alphabet soup of refractive surgery including corneal and lens-based surgeries, premium IOLs, and FS cataract surg. DUFFEY/LEAMING 2014

> 5 Cases / Month 70 59 60 * 51 50 '00 '97 '04 '07 '11 '12 '13 '14 43 36 40 30 20 33 10 10 0 4 Surface Ablation LASIK RLE P-IOL 1 K Inlay Toric DUFFEY/LEAMING 2014 Presby-IOL FS-Cat

> 75 Cases / Month 30 * Peak in 2001; Valley in 2012 -13 25 '97 '01 12 20 '04 '07 15 '10 10 '11 5 1 '12 0 '14 '13 LASIK Surface Ablation DUFFEY/LEAMING 2014

Preferred Surgery For a 30 yo -10. 00 Diopter Myope * 40% LVC 50 45 40 35 30 25 20 15 10 5 0 43 27 '05 11 13 '13 1 Surface Ablation '11 '12 3 Never '08 LASIK RLE DUFFEY/LEAMING 2014 '14 P-IOL WAIT

Preferred Surgery For a 45 yo +3. 00 D Hyperope *63% LVC 100 90 80 70 60 50 40 30 20 10 0 '99 '02 53 '05 '08 4 Never Surface Ablation '11 18 10 15 '13 1 LASIK RLE P-IOL DUFFEY/LEAMING 2014 '12 WAIT '14

Preferred Surgery For 45 yo +5. 00 D Hyperope * 70 61 60 '99 50 '02 40 '05 30 19 20 7 10 0 8 1 Never Surface Ablation LASIK P-IOL DUFFEY/LEAMING 2014 '11 '12 4 RLE '08 '13 WAIT '14

Willing To Do Bilateral Surgery At Same O. R. Visit 30 23 25 19 20 '97 '00 '04 15 '07 10 '10 * '11 7 5 '12 0 '13 K Inlay RLE DUFFEY/LEAMING 2014 P-IOL '14

Family LVC Index: (LASIK or PRK Performed on Yourself and Family Members) 80 70 * >3 X the general population 60 60 '08 50 '09 35 40 31 '10 '11 22 30 15 20 '13 '14 10 0 '12 Self Spouse Children At least 1 Sibling DUFFEY/LEAMING 2014 Parents

Family Presby-IOL Index: (Presby IOL Performed on Yourself and Family Members) * 30 26 25 20 15 10 2014 7 5 2 2 Spouse Children 4 0 Self At least 1 Sibling Parents

Family FS Cat Index: (FS Cat Performed on Yourselves and Family Members) * 12 11 10 8 6 4 4 2014 2 1 2 0 0 Self Spouse Children At least 1 Sibling Parents

Excimer Laser Most Commonly Used 44 70 60 '97 * 50 '03 50 40 '06 '09 30 '10 20 '11 6 10 0 0 Vis. X Wavelight B and L DUFFEY/LEAMING 2014 Schwind '12 '13 '14

Femto. Second Cataract Laser Most Commonly Used 70 60 58 50 40 2014 30 21 12 20 6 10 0 Len. Sx Catalys Lens. AR Victus (B&L)

Flapmaker Most Commonly Used * 71% femtoflaps DUFFEY/LEAMING 2014

Preferred Flap Thickness (when no other constraints) 68 70 60 50 '04 40 '07 30 '10 30 '11 20 '12 10 '13 1 1 0 80 100 120 -130 DUFFEY/LEAMING 2014 150 -160 '14

Total Cases of Post LASIK Ectasia as the Primary Surgeon in Career 60 50 * Slight Growth Rate 40 '04 32 '06 30 '10 17 20 '11 19 '12 11 10 7 6 6 3 0 0 1 2 3 4 5 DUFFEY/LEAMING 2014 6 to 10 >10 '13 '14

Threshold of Astigmatism Offered Correction at Cataract Surgery 40 35 30 25 20 15 10 5 0 34 23 27 '12 7 6 3 0. 25 0. 75 1 1. 25 1. 5 '14 0 0 1. 75 '13 2. 0+ *68% will offer to correct astigmatism when it has reached 0. 75 D and 97% when it has reached 1. 25 D DUFFEY/LEAMING 2014

Procedure for Low Astigmatism Intervention (0. 5 to 1. 0 D) 70 * 91% LRI/AK 60 50 50 41 40 '12 30 '13 20 9 10 0 Manual LRI/AK Femto/AK DUFFEY/LEAMING 2014 Toric '14

Procedure for Medium Astigmatism Intervention (1. 12 to 2. 0 D) 77 80 70 60 50 40 '12 30 '13 12 20 '14 12 10 0 LRI/AK Femto/AK DUFFEY/LEAMING 2014 Toric

Procedure for High Astigmatism Intervention (2. 0 D plus) 97 100 90 80 70 60 50 40 30 20 10 0 '12 '13 '14 2 LRI/AK 2 Femto/AK DUFFEY/LEAMING 2014 Toric

Do You Currently Perform CXL? 90 77 80 70 60 50 '12 40 30 '13 23 '14 20 10 0 Yes No DUFFEY/LEAMING 2014

Overview of Cataract Surgery: % of All Cases of All Surgeons 70 64 60 50 40 30 2014 17 20 9 10 19 14 6 6 0 Monofocal IOL Manual LRI/AK Toric IOL Multifocal IOL Accom IOL DUFFEY/LEAMING 2014 FS ORA

Overview of FS Cataract Surgery: % of All FS Cases of All FS Surgeons 84 90 82 80 70 60 54 49 54 50 40 2014 30 20 10 0 Primary Corneal Incision Secondary Corneal Incision Capsulorhexis Lens Fragmentation DUFFEY/LEAMING 2014 AK

Total LVC Volume in ISRS (x 1000) DUFFEY/LEAMING 2014 *22% Increase in Total LVC from 2012 -13. *Ratio of PRK / Total LVC remained at 22% over past four years.

2014 ISRS FINAL SUMMARY ä ä ä Femto. Second Laser-assisted Refractive Cataract Surgery on the rise. FS, Toric and Presby. IOL are not high volume refractive surgeries yet like LASIK in its heyday, but moving forward. Multifocals trump Accomodative IOLs, but neither high penetration. More astigmatism management (even low astig. ) in cataract surgery. Healthy LVC and Premium IOL Family Indices amongst refractive surgeons themselves and their families. Post-LVC ectasia on a slight rise. DUFFEY/LEAMING 2014

Thanks to the ISRS leadership for their support and for your participation in the 2014 Survey We look forward to your response to our seventh ONLINE survey and the nineteenth survey overall next fall. ***Complete 18 years of survey results found at www. duffeylaser. com