SEATTLE — Laser in situ keratomileusis (LASIK) is the fastest growing refractive procedure in the United States, according to a survey of U.S.-based members of the American Society of Cataract and Refractive Surgery (ASCRS) and the International Society of Refractive Surgery (ISRS).
The survey also found that high-volume surgeons prefer LASIK to photorefractive keratectomy (PRK) and that the number of simultaneous bilateral LASIK cases is on the upswing. In regard to volume, the survey found that ISRS surgeons tend to be more aggressive and more likely to be in higher-volume practices, compared with the ASCRS colleagues.
The second annual survey, conducted by Richard J. Duffey, MD, in private practice in Mobile, Ala., and David Leaming, MD, in private practice in Palm Springs, Calif., was mailed to 5,000 ASCRS members, some of whom also are members of the ISRS. Twenty-nine percent, or 1,431, responded. Ophthalmologists were asked to share their views and preferences on radial keratotomy (RK), automated lamellar keratoplasty (ALK), PRK, LASIK, intracorneal rings (ICRs), phakic IOLs, excimer lasers, microkeratomes and topography systems. Survey results represent 1998 data.
Volume vs. style
According to the survey, low volume ASCRS and refractive surgeons — defined as those who perform between five and 24 cases per month — prefer LASIK. Twenty-four percent of low-volume ASCRS members are performing between five and 24 LASIK procedures per month, 300% more than in 1997. Five percent and 4% are performing between five and 24 PRKs and RKs, respectively. Those numbers remain unchanged from 1997 data, the first year of the study.
Fifty percent of ISRS members are performing between five and 24 procedures per month, while 10% perform between five and 24 PRKs and 9% performed between five and 24 RKs.
“If you compare the ISRS data with the ASCRS data throughout this presentation, you can see that a higher percentage of ISRS members are doing high volumes of surgery … with LASIK predominating,” Dr. Duffey told attendees of the annual meeting of the ASCRS, held here.
Moderate volume surgeons were defined for the purposes of the study as those performing between 25 and 74 refractive procedures per month. Nine percent of ASCRS members who fit into this category use LASIK — again a three-fold increase compared with 1997 data — while no surgeons in this category used PRK or RK. Of the ISRS survey respondents in this group, 31% use LASIK, while 1% use PRK and RK, respectively.
“Again, this shows that ISRS surgeons tend to be more aggressive, higher-volume surgeons and tend to favor LASIK at an even higher rate,” Dr. Duffey said.
According to the study, the surgical preference for LASIK is most apparent in the high-volume group — those physicians who perform more than 75 cases per month. Three percent of ASCRS members are performing this volume of surgery, and all use LASIK. Thirteen percent of ISRS members perform this level of surgery, entirely with LASIK. The number of high-volume ASCRS physicians who use LASIK increased 300% since 1997. No high-volume physicians from either association reported using PRK or RK.
The survey also asked physicians which type of procedure they would recommend for a low, moderate and high myope. Fifty-one percent of ASCRS members said LASIK would be their procedure of choice for a –4 D or under patient. About one-third reported they would opt for PRK. ISRS members overwhelmingly selected LASIK for this category of patient.
LASIK again was the majority’s choice among ASCRS and ISRS members for myopes in the range of –7 D, or moderate myopia. Eighty percent of ASCRS member and 89% of ISRS would use LASIK for these patients. Twelve percent of ASCRS members would use PRK, while only 7% of ISRS members would.
Not surprisingly, LASIK also was the procedure of choice for high myopia. Seventy percent of ISRS members and 60% of ASCRS members would use LASIK on patients who are –12 D. Twenty-one percent of ISRS members and 33% of ASCRS members responded, how ever, that for patients with such severe myopia, they are more likely to delay treatment until a better option is available.
Bilateral simultaneous surgery is convenient for both surgeon and patient, and according to Dr. Duffey’s survey, is increasing in popularity. To determine when ASCRS and ISRS members chose to use bilateral procedures, Dr. Duffey identified four types of refractive surgery and asked physicians when they would operate on both eyes at once. For PRK, 61% of respondents said they would never perform a bilateral procedure; 27% said they might; and 12% said they perform bilateral PRK when possible. For LASIK, 29% of respondents said they would never perform a bilateral procedure; 31% said they might; and 49% said they routinely do bilateral LASIK when possible. For ICRs, 87% of respondents said they would never perform a bilateral procedure; 10% said they might; and 2% said they routinely do bilateral ICR implantation when possible.
According to survey results, RK is dying and phakic IOLs and ICRs are the refractive tools of the future. Twenty-nine percent of respondents said they will never perform RK again. Thirty percent of respondents said they plan to implant ICRs in the future, while 46% said they plan to implant phakic IOLs. Currently, 24% of respondents perform RK, 38% perform PRK, and 29% perform LASIK. None currently uses ICRs regularly, and 2% use phakic IOLs.
According to the survey, the EyeSys Premier systems (Irvine, Calif.) are used by 40% of respondents. Tomey (Waltham, Mass.) is the second most popular brand, with 29% of respondents reporting use or ownership.
Seventy-six percent and 74% of ASCRS and ISRS members, respectively, use a Visx (Santa Clara, Calif.) excimer laser. The Bausch & Lomb Surgical (Claremont, Calif.) Automated Corneal Shaper (no longer being sold) is the most popular microkeratome.
For Your Information:
- Richard J. Duffey, MD, can be reached at 2880 Dauphin St., Mobile AL 36606; (334) 473-1900; fax: (334) 470-8802. Dr. Duffey has no direct financial interest in any of the products mentioned in this article, nor is he a paid consultant for any companies mentioned.