ESCRS PRACTICE SURVEY

Correcting astigmatism and preventing endophthalmitis remained popular endeavours among European cataract and refractive surgeons in 2013. More than half reported using toric intraocular lenses (IOLs) while two-thirds now inject intracameral antibiotics, according to the 2013 ESCRS Member Practice Survey, conducted by David Leaming MD, Palm Springs, California, US. Dr Leaming will present his findings at the XXXII ESCRS Congress in London, UK.

Of those that correct astigmatism at cataract surgery, half favoured toric IOLs for correcting astigmatism of 1.12 to 1.87 D, with three-quarters opting for them in cases with 2.0 D or more. At 21 per cent, blade-cut limbal relaxing incisions remained the top choice for correcting 0.5 to 1.0 D cylinder, though 64 per cent responded they don’t treat such low astigmatism.

Alcon’s AcrySof Toric remained the preferred toric IOL with 46 per cent naming it, down slightly from 50 per cent in 2012. Abbott Medical Optic’s Tecnis Toric came in second at 11 per cent, up from six per cent last year. Those responding they don’t use toric lenses fell to 27 per cent, down from 30 per cent in 2012 and 42 per cent in 2010.

Interest in toric and multifocal toric lenses was also high among ESCRS members, scoring +108 and +61 respectively on a scale ranging from -200 to +200. By comparison, preloaded lens injectors scored +132 and multifocal lenses +67, both up significantly from 2012. Of less interest were accommodating lenses at -28, light-adjustable IOLs -31, corneal inlays for presbyopia -64, excimer laser for presbyopia -74 and intracorneal femtosecond laser for presbyopia -81.

Presbyopia correction

Just over half of ESCRS members responding reported using multifocal IOLs in 2013, essentially unchanged since 2011. By comparison, only six per cent reported using accommodating IOLs, six per cent multifocal LASIK and four per cent presbyopic corneal inlays.

The presbyopic IOL most often used in 2013 was the AcrySof IQ ReSTOR which 52 per cent reported using most often, followed by Oculentis M Plus at nine per cent, AT LISA Tri at eight per cent, Tecnis Multifocal and Trifocal FineVision at seven per cent and AT LISA or AT LISA Toric at six per cent.

About 10.4 per cent of surgeons responded that they implant presbyopia correcting lenses in more than 10 per cent of patients. When asked what kind of lens they would choose if having cataract surgery without astigmatism next week, 72 per cent selected monofocal aspheric lenses, 21 per cent multifocal, five per cent accommodating and two per cent other.

Medications

Dexamethasone remained the most preferred steroidal drop for both cataract and refractive surgery, chosen by 62 per cent and 42 per cent respectively. However, those numbers are down in both groups from recent years, with prednisolone and betamethasone gaining ground.

Femto-cataract surgery

Access to femtosecond lasers for cataract surgery by ESCRS members increased to 17 per cent in 2013, up from 10 per cent in 2012 and five per cent in 2011. However, only nine per cent reported using femtosecond lasers for cataract in 2013, up from seven per cent in 2012 and two per cent in 2011. The most common platform was the Alcon LensSx at 54 per cent followed by the Bausch + Lomb Technolas at 22 per cent and Optimedica at six per cent.

Nearly 45 per cent said they had no plans to add femto-cataract surgery. Reasons for not doing so were ‘lack of cost-effectiveness’ at 70 per cent, ‘no good data to prove benefit’ at 34 per cent and ‘procedure takes too long’ at nine per cent.

However, many surgeons expressed interest in femto-cataract, with overall interest at +8 on a -200/+200 scale. Lens softening attracted the most interest at +15 followed by capsulorhexis at +8. These interest figures roughly track surgeons’ self-reported problems with capsule ruptures, with 45 per cent saying the
most often run into problems during nuclear dismantling followed by 33 per cent during cortical clean-up and 10 per cent during capsulorhexis.

The survey was conducted by Dr Leaming in November 2013. A total of 2,924 surveys were emailed to ESCRS members of which 486 were completed for a 17 per cent response rate. Corporate sponsors were Bausch + Lomb Europe and Abbott Medical Optics.

David Leaming: eyeoper8@aol.com