The 2009 U.S. Trends in Refractive Surgery Survey was completed by the ISRS membership in October 2009 with a 19.4% response rate. This was the thirteenth year of U.S. surgeon data collection and was the first time the survey was presented and completed entirely online. The survey allows ISRS members from the United States to have their voices heard on refractive surgery issues.
Summary of Results
- Overall, laser vision correction was down 15% from 2008 with 15% of laser vision procedures being performed on the corneal surface (PRK, Epi-LASIK, LASEK) and 85% as LASIK. High volume surgeon laser vision correction (defined as seventy-five or more cases per month) peaked in the year 2001 with 27% of the membership performing that level of surgery then; it has consistently dropped since, now down to 12% within the membership.
- Surgery on the ten-diopter myope was nearly equally split between phakic IOL at 43% of the membership with 40% preferring to do laser vision correction if there was enough corneal thickness present and there were no other corneal abnormalities. Extraocular refractive surgeries, such as laser vision correction, have traditionally been performed as bilateral, simultaneous procedures, but now intraocular procedures, such as refractive lens exchanges and phakic IOLs are being performed with 8%, and 18% of the membership, respectively, bilaterally and simultaneously at the same surgical setting.
- The family index of laser vision correction amongst refractive surgeons and their family members show that 25% of the membership has had laser vision correction performed on their own eyes; this represents three to four times the current penetration of LVC in the general population. An even higher index of procedures has been performed on spouses, children, and siblings of refractive surgeons.
- VISX continues to lose some its top market share to WaveLight with 58% using VISX equipment and 29% using WaveLight equipment. VISX is down from its peak of near 70% in 2000. Mechanical microkeratome use has continued to decrease with 52% of surgeons saying they now use femtosecond laser technology for flap development in LASIK surgery (46% IntraLase and 6% Zeimer).
- Topography units were listed as Zeiss-Humphrey at 39% over Orbscan at 30% over Pentacam at 23% of the ISRS membership. Presbyopic IOLs as a choice to correct presbyopia represented 9% with ReStor, 6% with CrystaLens, and 4% with the newly FDA-approved Tecnis multifocal lens implant.
- Monovision and modified monovision (with LVC or IOLs) still remains the procedures of choice to correct presbyopia at 48% and 27%, respectively.
- LASIK flaps are becoming thinner with 49% of the membership preferring 100 micron flaps and 31% preferring 120-130 micron flaps. Forty-four percent of the membership is still okay with a residual stromal bed thickness of 250 microns in LASIK patients, but 54% did prefer at least 275 or greater microns in the bed.
- Ectasia has not been increasing and reached its peak several years ago.
- Regarding central corneal thickness and LASIK surgery, 64% of the membership was okay with performing LASIK on an otherwise normal cornea that showed a central corneal thickness of 480 microns or less; 35% preferred 500 microns or more central thickness.
- Once again, the majority of ISRS members would not perform refractive surgery electively on a one-eyed patient with 59% choosing to withhold such surgery.