Changing Trends In Cataract/ Refractive Surgery Reflected in New French Survey

By Ana Hidalgo-Simon, MD, Ph.D.

BRUSSELS-A preference for peribulbar anaesthesia, growing popularity of hydrophobic IOLs and increasing use of LASIK were some of the trends observed in the 1999 survey of French ophthalmologists presented by Richard Gold, MD at the XVIII Congress of the ESCRS here in Brussels.

The survey also showed that in comparison to the 1998 survey he presented last year, there was a slight decrease in the number of cataract and refractive operations performed in 1999, with a growing preference for phacoemulsification and clear corneal incision for cataract removal and IOL implantation, said Dr. Gold, Le Raincy, France. The survey was based on answers to a questionnaire which he sent to 5,800 French ophthalmologists-most of whom were between 35 and 55 years of age, out of which 1,700 responded.

Less Cataract Surgery
The total number of cataract procedures reported by respondents to the present survey was 200,000, compared with 350,000 operations performed in France last year. Refractive surgical interventions were also down from the previous survey; 37,000 compared with 75,000.

Most of the surgeons who responded were performing between 100 and 300 cataract operations per year - while more than 30% of surgeons perform between 100 and 200. The preferred extraction technique was phacoemulsification which accounted for 97.5% of procedures performed, and the preferred incision was clear cornea (more than 86%), Dr. Gold noted.

More Hydrophobic Acrylic and Less PMMA
Despite a small decrease from 1998, hydrophylic acrylics are still the IOL material of choice for 63% of respondents in 1999. The number two preference was hydrophobic acrylic, which nearly doubled its popularity in 1999, while PMMA was the third choice. That compared with the results from the 1998 survey in which PMMA occupied the second position. There was also an indication that both PMMA and silicone PMMA IOLs may be going out of favour.

With respect to multifocal IOLs, the new survey showed that while their use was not very wide spread, surgeons who performed the most cataract operations were most likely to use them. That is the percentage of multifocal IOLs implanted by surgeons who did more than 1000 cataract operations was 57% while only 5.63% of those who did fewer than 100 operations per year used multifocals.

The viscoelastic Duovisc was clearly the preferred IOL, taking more than 45% of the market. A clear decrease in the popularity of antibiotics in the bottle in France was reflected in the survey. Their use has been decreasing since 1997. In the current survey 89% of surgeons declared not to use them, versus 77% in 1998.

Peribulbar anesthetic was by far the most commonly used (over 70%), preferred to topical in France, and it is increasing in popularity. The use of topical anesthetics is decreasing.

In refractive surgery, most of the French surgeons are performing fewer than 100 procedures per year. For myopia, PRK was used most (89%), with LASIK gaining in popularity and moving into the second position. The number of surgeons who responded that use LASIK had raised from 30% in 1998 to 47% in 1999. This is a change from last year's results where clear lens extraction was the second preference.

For treating astigmatism, PRK was again first choice, although it was less popular than the previous year - 69% of surgeons compared with 75%. On the other hand, use of LASIK was clearly on the increase - from 27% in 1998 to 42% in 1999 - as second choice.

A clear ascent in the use of LASIK was also observed in the treatment of hyperopia (from 18% to 35%), beating PRK for the first position. In the 1998 survey PRK was clearly the procedure of choice for that indication. The use of phakic IOLs for hyperopia is also growing, the survey indicated.

Most of the surgeons (96%) who responded were not doing presbyopia surgery. Nevertheless preferences are changing. That is, use of both LASIK and PRK is increasing considerably - with LASIK the first preference (3.78% then PRK (2.55%) and then scleral expansion, unchanged from 1998.

No great changes were observed in the preferences for excimer laser with respect to the previous year. NIDEK was still first choice with around 36%, followed by Technolas, then Summit. As for corneal topography systems, the largest group of respondents (40%) preferred Eyesys, followed by TMS (21%) and Eyemap (20%). These choices were very similar to the 1998 survey. Regarding the use of microkeratomes, Hansatome was the most popular with 50% of respondents declaring they used it in 1999. The use of the ALK had decreased considerably from last year, when it was first choice (from 64% to 31%), Dr. Gold's survey showed.