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A MARKED increase in the number of Prelex treatments for presbyopia and a discernible growth in refractive procedures across the board were among the more notable findings of the latest survey of Belgian ophthalmologists presented here at the XXI Congress of the ESCRS.
Clear corneal incision is used by 90% in France but only 74% in Belgium , and the incision of choice is temporal in France but oblique in Belgium . The incision size is also smaller in Belgium than in France .Another notable point of comparison between the countries' practices, said Dr Gold, is that Duovisc (57%) is the viscoelastic of choice in France , but the Belgians prefer Healon (64%). Furthermore, while hydrophobic acrylic is the first-choice IOL in France , hydrophilic acrylic (52%) is preferred in Belgium . In terms of refractive procedures, more French surgeons opt to treat myopia with PRK, whereas LASIK is the most common practice in Belgium .
As elsewhere in Western Europe , phacoemulsification is now almost universally established as standard in cataract surgery in Belgium , with only a tiny percentage using techniques such as extracapsular extraction (0.96%) or phaco section (0.96%). The size of the incisions used by Belgian ophthalmologists for cataract surgery confirms the growing preference for smaller incisions. In 2002, 7% of respondents said they used incisions greater than 4.0 mm compared to only 4% this year, while those using incisions between 3.2 mm and 4.0 mm declined from 45% to 27%. Most respondents (61.5%) used incisions between 2.8 mm and 3.2 mm, while those opting for incisions smaller than 2.8 mm had grown from 5% last year to 8% for 2003.
Outpatient surgery yet to dominate Ambulatory cataract surgery was practiced by one-third of Belgian respondents (33%), while 64% kept patients in hospital overnight. As with cataract surgery, only a small proportion of respondents performed refractive surgery at a high volume. Only 2% of respondents performed between 300 to 500 refractive procedures per year and about 25% performed 100 to 199 per year. Among the respondents who practiced refractive surgery, 100% treated myopia, 93 % treated astigmatism, 89% treated hyperopia, and 20% treated presbyopia (up from 9% in 2002). LASIK was the preferred option for treating myopia (80%), although PRK was also practiced by 74% of respondents compared to 62% a year earlier. Clear lensectomy was the third most widely practiced procedure for myopia (43%), while the Artisan anterior chamber IOL continues to be popular with Belgian ophthalmologists, with 28% implanting the devices in 2003. As in France , only a small proportion of respondents used refractive surgery for the treatment of presbyopia, although such procedures continue to be more widely practiced than before. The use of topographic systems has become almost universally accepted, with more than 96% of respondents now using topography in their refractive procedures. Orbscan, used by 55% of respondents is the preferred system for corneal mapping ahead of EyeMap (23%) and TMS (21%). In microkeratome use, the Hansatome (68%) is the most popular, followed by Moria Carriazo-Barraquer (23%). In terms of laser choice, two brand names, Bausch and Lomb Technolas (52%) and Nidek (25%), dominate the Belgian market. Job satisfaction One of the most intriguing findings of Dr Gold's survey concerned job satisfaction among Belgian ophthalmologists. When asked whether they would have become physicians if they had known what it would be like, 20% said they would not, compared to 17% in 2002. However, only 2.5% said that they would choose another profession other than ophthalmology if they had the opportunity to go back and change their career path. Furthermore, Dr Gold found that even among those who would have been physicians if they could do it all over again, only 53% would advise their children to do so. Moreover, among those who regretted becoming physicians, only 11% would recommend the profession to their children. Richard Gold MD
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In the second annual survey of Belgian practices in ophthalmic surgery, Richard Gold MD, former Head of the Department of Ophthalmology at the Cognacq-Jay Hospital, Paris, and now in private practice at Le Raincy, France, and his Belgian collaborators, René Trau MD, and Bernard Mathys MD, collected 138 responses to an anonymous questionnaire sent to over 1,070 Belgian ophthalmologists. The response rate of just 12.60% was considerably down on last year's figure of 21.65%. Dr Gold said that while a greater response could have been expected from Belgian ophthalmologists, the disparity could be partly explained by the fact that last year only members of the Belgian Society of Cataract and Refractive Surgeons (BSCRS) were surveyed, whereas this year all Belgian ophthalmologists received the questionnaire. 
Nonetheless, Dr Gold believed that the survey still revealed some interesting trends in Belgian ophthalmology and highlighted some key areas of difference and comparison with clinical practices of their French counterparts, which Dr Gold has been surveying since 1998. "The main differences with France are in the type of anaesthesia used. In France , there is a preference for peribulbar, whereas it is equal between peribulbar and topical in Belgium . There is also a difference in incision type and size," he said. 
Another key finding was the increase in Prelex procedures (up to 17% from just 4% a year earlier) for the treatment of presbyopia in Belgium , whereas Presbylasik (6% in 2002) remains the choice of French surgeons. The proportion of Belgian ophthalmologists with a low volume of cataract surgery remained stable, with 16% performing fewer than 100 cataract surgeries per year, compared to 14.5% in 2002. The proportion performing between 100 and 199 procedures annually increased slightly from 28% to 30%, while the proportion performing 200 to 300 per year rose from 21% to 25%. At the high volume end of the spectrum, those treating 300 to 500 cases per year declined to 20% compared to 24% for 2002, while the proportion treating 500 or more also declined from 12% to just over 8.5%. 
In terms of the preferred position of the incision, both oblique (34%) and 12' o clock (30%), had gained slightly in popularity, while temporal incisions now accounted for just under one quarter (24%) compared to 30% for last year. The proportion of respondents who always use sutures during cataract surgery remained steady at 38%, with 20% using sutures in certain instances and 41% never using them. The use of injectors for cataract surgery, which has shown a strong increase in France in recent years (61% of respondents using injectors in 2002 compared to 21% in 1998) is also echoed in the Belgian statistics. Almost two-thirds (63.5%) of respondents now used injectors compared to just half (50%) a year ago.