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THE latest ASCRS survey on the practice style and preferences of its members indicates that LASIK continued its anaemic growth rate in 2002. However, analysts remain optimistic about the chances of a growing market for refractive surgery as the US and world economies recover. Richard Duffey MD provided the latest information on refractive surgery from the most recent ASCRS survey. The survey compiled responses from 17% of the 5,686-strong ASCRS membership. This is a healthy response that gives a good idea of what the members are thinking and doing in terms of refractive procedures, he told Euro Times. The rate of LASIK expansion in the US was greatest between 1999 and 2000. It then dropped by half the following year, and by half again the year after that. The growth rate was also down slightly in 2001, particularly after September 11th. In 2002, the year the current survey covers, the number of LASIK procedures remained flat, with best annual surgery estimates in the range of one million operations performed. More than half of the members responding said they do perform LASIK as part of their practices. Some eight percent would be considered very high volume surgeons, performing more than 50 procedures per month. Another 14% perform between 16 and 50 LASIK procedures monthly. Approximately one third of respondents perform between one and 15 procedures in a month. One noteworthy trend is a possible consolidation of the LASIK market. The survey results suggested that fewer surgeons fall into the moderate volume category. With the number of LASIK procedures steady or slightly higher in 2002, the implication is that fewer surgeons are doing more of the work, he noted. No resurgence in surface ablations The survey indicates that few US surgeons perform PRK any more, with 74% doing no procedures, while 25% perform somewhere between one and five procedures per month. It does not appear that they perform LASEK very much either, with 87% of respondents saying they don’t perform that procedure at all. Only two percent of respondents reported doing more than five LASEK operations per month. "I was a little surprised by the dearth of participation in LASEK. We’re seeing a little bit of growth in PRK in the US, although not to the extent seen in Europe. LASIK was embraced very enthusiastically early on when the excimer lasers were approved here. PRK had not really caught on as much as it had in other countries. I think there is also a perception that LASEK is merely PRK in disguise, with some scepticism about the advantage of LASEK. If we find that LASIK flaps detract from custom ablation outcomes, we may see more interest in PRK and LASEK," he said. Very few surgeons appear to be performing radial keratotomy. The vast majority, 96%, say they never perform the procedure. A few surgeons perform between one and five such procedures in a given month. Laser theramokeratoplasty also appears to be on the endangered list, with 98% reporting they do not perform that procedure. Conductive keratoplasty had apparently not caught on in 2002, with only one percent of those surveyed saying they five or more cases per month. When asked what they would recommend for a 30-year-old with three dioptres of myopia, 80% of the doctors said they would suggest LASIK. A few would suggest PRK or IOL approaches. Interestingly, nine percent said they would recommend doing nothing, while another three percent would advise waiting. Some 90% of respondents would also recommend LASIK to a 30-year-old –7D myope. A few would suggest other options such as LASEK or phakic IOLs, while more than eight percent would again suggest waiting. LASIK not favoured for higher myopes ASCRS member surveys of three and four years ago indicated that 60% of surgeons would consider offering LASIK to a -12 D myope in the same age range. In the 2002 survey this had dropped considerably, to only 21%. Some 15% would recommend phakic IOLs to such patients, even though none had been approved in the US. More than half, 52%, would counsel patients to do nothing or to wait. "We now know more about importance of corneal thickness, pupil size, corneal curvature. I would expect the use of phakic IOLs will increase with FDA approval of that approach," commented Dr Duffey. What about a 45-year-old with one dioptre of hyperopia? Half of respondents would recommend LASIK for such patients. Only three percent of respondents would suggest LTK, a significant decline from the 15% who favoured it in 2001. There was a concomitant rise in those recommending CK, with eight percent now favouring that approach. More than one third of the surgeons would advise waiting. Nearly two-thirds of surgeons would recommend LASIK for a 45-year-old patient with 3 D hyperopia. However, only 17% would continue to suggest LASIK for patients with higher degrees of hyperopia. A surprisingly high 27% would counsel patients to consider clear lens exchange. However, nearly half would recommend that a 5 D hyperope simply wait. The survey also served to put wavefront sensing and custom ablation in perspective. Despite the considerable attention these receive at medical conferences, the survey indicated that only ten percent of respondents currently use a wavefront analyser. Of available systems, the VISX Waveprint appeared to be the most popular, followed by the Alcon LADARVision® system, the Tracey ray tracing system and the Bausch and Lomb Zyoptix™ system. When asked about the potential value of customised ablation for ametropic eyes, some 58% commented that is was ‘moderately’ or ‘extremely’ valuable. The remaining 41% felt it was of little or no value. Dr Duffey noted that the current survey was done in early September 2002, prior to the FDA approval of LADARVision®, and well before the approval of the VISX Custom Vue system. Next years survey will probably reflect a strong upsurge in interest in custom ablation procedures. "There has been significant change in the market since we did the survey. I have a file of patients that I’ve been saving for custom ablation. I think in the next three months there will be a substantial growth in interest in wavefront guided treatments for myopia and myopic astigmatism." Richard J. Duffey, MD, |
