US REFRACTIVE SURGERY

Nearly one-quarter of US refractive surgeons performed five or more femtosecond laser-assisted cataract procedures per month in 2013, while five per cent did 25 or more, Richard J Duffey MD, Mobile, Alabama, US, told the 2013 annual meeting of the American Academy of Ophthalmology in New Orleans. He reported results from the 17th annual survey of US members of the International Society of Refractive Surgery, which Dr Duffey conducts with David Leaming MD, Palm Springs, California, US.

Last year was the first time the survey asked about femtocataract surgery. “Already five per cent of us are doing 25 cases or more per month, which I thought was significant,” Dr Duffey said. Toric and presbyopia correcting lenses are also gaining ground, with 50 per cent and 37 per cent reporting five or more cases in 2013. However, while volumes are growing, they are not as high as LASIK in its heyday, Dr Duffey said.

By contrast, reported laser refractive surgery volume was flat at 451,000 in 2013, the same as 2012 but down from 500,000 to 560,000 over the previous five years. Only 56 per cent reported doing five or more LASIK cases monthly, down from 64 per cent in 2011, while 26 per cent reported 25 cases or more, about even with 28 per cent in 2011 and 23 per cent in 2012. Surface ablation volume dropped more, with just 24 per cent reporting five or more procedures and just six per cent 25 or more in 2013, compared with 37 per cent and nine per cent in 2011.

Laser vs lens

For a 30-year-old -10.0 D myope, laser vision correction remained the top choice, with 47 per cent opting for either surface ablation or LASIK. Phakic IOLs came in second at 38 per cent. These rates have remained stable for the past three years. Laser vision correction, including LASIK and surface ablation, was also the top choice for a 45-year-old +3.0 hyperope, with 58 per cent, with refractive lens exchange (RLE) in second at 28 per cent. This marks an upward trend in RLE over the past decade, from about 11 per cent in 2005.

For a 45-year-old +5.0 D hyperope, RLE remained the clear choice with 61 per cent in 2013, virtually unchanged since 2005, with laser correction also stable around 13 per cent, while phakic IOLs dropped to one per cent. Those opting to wait fell to a new low of 14 per cent, indicating most surgeons are now comfortable with the available correction options, Dr Duffey noted.

Astigmatism

Surgeons were also more comfortable correcting astigmatism at cataract surgery, with two-thirds offering to correct at a preoperative level of 0.75 D cylinder or less, up from just over half in 2012. For 0.5 to 1.0 D, limbal relaxing incisions or arcuate keratotomy were the choices for 88 per cent. For 1.12 to 2.0 D, 75 per cent favoured toric lenses, rising to 96 per cent in cases with more than 2.0 D preoperative cylinder.

In LASIK, trends toward thinner flaps and thicker residual stroma continued with 97 per cent looking for flaps of 130 microns or less, and 61 per cent residual stroma of 275 microns or more. Nearly three-quarters now use femtosecond laser flap cutters. Reported post-LASIK ectasia rates continue to drop, Dr Duffey reported. “This is an important finding.”