000089_2010_Talk_and_electronic_poster by niusheng11

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									Practice Styles and Preferences of US ASCRS members – 2010 Survey

                                        26th Survey

              In 2010 the survey went out electronic (via e mail). This
              marks the second year using that format.

              3854 survey invitations were e mailed from the ASCRS main
              office to all US ASCRS members not in a training program

              460 responded for a 12% response rate, Similar to prior years
              paper surveys

              Richard Duffey MD assisted with the refractive surgery section




    Corporate financial sponsors :

    Major:      Alcon Surgical                                            David Leaming MD
                Abbott Medical Optics                                     Palm Springs, CA
                Bausch and Lomb                                           eyeopr8@aol.com
                                             Surgical Volumes
                              Phaco
  3.3                                        3.21       3.26               Cataract surgery volumes
  3.2                              3.1                                     have steadily climbed
  3.1
   3                                                                       apparently unaffected by
  2.9        2.81       2.82
                                                                   Phaco   recession.
  2.8
  2.7
  2.6
  2.5
            2003       2005       2007       2009       2010


                               LASIK
1000000       948266
900000                   865723                                            Refractive surgery volumes
800000
700000
                                    721452
                                                          680188
                                                                           showing signs of recovery
600000                                         570242

500000
                                                                           LASIK up 19% after
                                                                   LASIK
400000                                                                     declining 31% in 2009
300000
200000
100000
        0
              2004       2006       2008       2009       2010
       Specialty IOL’s                                                              Growth despite difficult financial times

Percent of cataracts you are inserting                                              Presbyopic IOL’s accounted for 14% of total
presbyopic IOL’s                                                                    IOL volume from 2008
45                                                44
40                            39                                                    In 2010 71% were using multifocal and 29%
                                                                                    accomodative IOL’s
35     34                                                             Never
30                                                                    One - five
      29
                                  26                                  six- ten
25
           22                22                                       20
20                                                    19              40
                                                                                    81% were using a presbyopic IOL, up from
                                                 16
15
            11
                                                                      60            75% in 2009
10                                     9                9             80
5                                                                     Almost 100
                                                            3
0
               2
                0.200.5
                                      21
                                         0.20              10.2.2
                                                              0                     29% say the percent of their cataract
            2008                    2009               2010
                                                                                    patients receiving Presby IOL has increased
     Percent of cataracts you are inserting
     toric IOL’s
 40
 35
           36                     3534                34
                                                                                    Toric IOL’s up 8% from 2009 (14% of IOL
 30 30
                                                  28
                                                                      Never         volume)
            27                                                        one-five
 25                                                                   six-ten
 20
                             21                                       20            87% were using a toric IOL…up from 79%
                                                                      40
 15
                                       11
                                                 13     14
                                                                      60            in 2009
 10                                                         9         80
                 7
 5                                                                    almost 100%
                  0.50 0 0            0.20 0 0                  100                 48% say the percent of their cataract
 0
                2008                2009               2010                         patients receiving Toric IOL has increased
                       Astigmatism and Cataract surgery

70
                                                66
60                                                   No change in
50                                51                 technique                             What is you most
                      45                             No change but
                                                     operate on steep axis
                                                                                           often used technique
40    37
                                                     LRI                                   in your cataract
30                29
                              25                                                           patient with significant
    21 22                                            Toric IOL
20 17                                       18                                             pre existing astig.?
                13          14
10               11                                  Excimer laser after
                              8         8
            3                               5        surg.
                        2           2            2
0
     2007        2008        2009       2010
                                                         60
                                                                           54
                                                         50
                                                                                                   44
How do you correct                                       40                                                     LASIK
significant residual                                                                                            PRK
                                                         30
astigmatism in your                                                                                             LRI
                                                         20                                                     Glasses
presbyopic IOL patients?                                         13                   14   15 14                I don't
                                                                                 10                     11 12
                                                         10           8

                                                          0
                                                                          2009                 2010
-72% use topical anesthesia with ¾ of                           Surgical Trends
those using IC lidocaine with topical                                2010
(N/C)
-68% use temporal incisions, 3%
-87% use clear corneal incisions with
48% of those using the near clear                        Usual incision size in mm
(vascular area) vs. 34% avascular area
                                          45
-25% 3% use antibiotics in the irrigant             45                           40
                                          40
with 16% (up 2%) using intracameral
                                          35                                                              3mm or more
antibiotics
                                                                                                          2.8
                                          30
-12% use microincision (<2mm) coaxial                                                                     2.6
                                          25                                           25                 2.4
phaco while 4% use bimanual
                                          20                                                              2.2
microincision (<2mm) the majority of                                                                      2
                                                     20                               15
the time                                  15              18
                                                                                                          1
                                          10                                                9             1.8
-If they were to use < 2mm incision,           11                            7
                                                                                                          1.6
                                          5
62% would use coaxial rather than                              5 1 0.4                          2 2 2 1
                                          0                          0.2 0
bimanual
                                                           2009                            2010
-77% pretreated their cataract patients
with NSAID’s with 2/3 of them starting
3 days before surg. (N/C)
    Preferred method of keratometry
                 for …
   80                                          35        35            34
                         72                         31            32
   70      70                                  30
                              Manual
                                                             29         29     Manual
   60                                          25
   50                         Auto K                                           Auto K
                                               20
   40
                              Partial          15                              Partial
   30                         Coherance                                        Coherance
                              Interferometry                                   Interferometry
                                               10
   20 18                      Topography/co                                    Topography/cor
                    16        rneal analyzer                                   neal analyzer
                                               5         5         5
   10      8         7
                4         4
    0                                          0
         2009       2010                            2009          2010


Routine IOL Calculations                       Toric IOL Calculations
Strong reliance of PCI platform for K’s         Less trusting of PCI platform for K’s
 Lasers and cataract surgery                                           Perceived out of pocket value to your cataract
                                                                       patients for the use of femtosecond laser with
                                                                       surgery?
       *86% of members have no
       opinion as to which laser                                        30                    28
       platform is best                                                 25
                                                                                  25

                                                                                        21
                                                                        20                                                       $100
                                                                                                                                 $250

Importance rating various femtosecond                                   15
                                                                                                                12
                                                                                                                                 $500
                                                                                                                                 $750
      laser cataract applications                                       10                               8
                                                                                                                         6
                                                                                                                                 $1,000
                                                                                                                                 $1500 or more
                 2010                                                    5

                                                                         0
                                                                                                  2010

     30

     20
                                  22
                                                                         Perceived out of pocket value to your
                                                                         patient to use the intraoperative
     10                                     laser capsularhexis
                                                                         aberrometer during cataract surgery?
      0                                     laser lens softening

    -10                                     laser wound construction         60
                                                                                       55

                                                                             50
    -20                                     laser LRI
                            -25                                              40                                                      $100
    -30             -32
                                                                                                                                     $250
                                                                             30                                                      $500
              -37
    -40                                                                                      22                                      $750
                     2010                                                    20                      16                              $1,000
                                                                                                                                     $1500 or more
                                                                             10
                                                                                                                5
                                                                                                                     2       1
 Max Importance = +200      Neutral = 0   Lowest Importance = -200           0
                                                                                                         2010
If insurance will not pay for/or let you bill
for femtosecond laser use during cataract
   surgery, how likely are you to use it?


          61% not likely at all
          23% only on special cases
          10% somewhat likely
          5% very likely
               Other notable findings….in 2010



-57% of members used a capsular tension ring     7%
-19% felt they had a case of TASS…little change thru the years
-Top three perceived most important technologies….
         #1 Toric IOL’s
         #2 Torsional phaco
         #3 multifocal IOL’s
-Lowest interest level in ….
         #1 microicision less than 2mm
         #2 accomadating IOL
         #3 wavefront aberrometry in cataract surgery
-97% of members participate with Medicare
      Use of computerized medical records
                    2010
    Overall 35% are using                  Time frame for implementation
     computerized medical                    45
                                                       42
                                                                           40

     records 4%
                                             40
                                             35
                                             30                       30

    Highest implementation                  25
                                                  21
                                                            26                            within one year
                                                                                          1-2 years

     appears to be in those
                                             20                                           3+ years
                                                                                16
                                             15                                      14   Don't plan to add
                                                                 12

     doing 3 – 15 cataracts
                                             10
                                             5


     per month
                                             0
                                                       2009                2010




    Large number of EMR companies…make it difficult for small companies to have
    the finances for development and support. Nexgen largest at 21%, Medflow
    14%, Epic 8%, Compulink 6%, plus at least 50 other companies being used by
    members!
                          Conclusions

Cataract surgery (and specialty IOLs) show sustained growth even in hard
financial times. LASIK starting to come back up 19%, first increase since
2004.


Specialty IOL’s are being used in approximately 14% of cataract surgeries


Keratometry used for biometry is usually done with the partial coherence
interferometry platform except when using Toric IOL’s


35% of members use computerized medical records. Large number of EMR
companies which is good and bad.


LRI’s still the predominant way to correct residual astig. in presby IOL pts.

Toric IOL positioned for strongest growth in coming years
Thanks for your continued support of the ASCRS
survey and to the ASCRS leadership for their help
to sustain this endeavor.


Please visit the “paper” poster display for a more
detailed look at last years results


Results will also be available on line at
leamingsurveys.com and duffeylaser.com

                                   Thank you,
                                   David Leaming MD
                                   Richard Duffey MD

								
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