US trends in refractive surgery: 2003 ISRS/AAO survey.
OBJECTIVE
To determine the latest trends in refractive surgery in the United States.


METHODS
All U.S. members of the International Society of Refractive Surgery of the American Academy of Ophthalmology were mailed the 2003 refractive surgery survey dealing with volumes, types, preferences of refractive surgery performed, and use of new emerging technology. Questions regarding radial keratotomy (RK), astigmatic keratotomy (AK), limbal relaxing incisions (LRI), photorefractive keratectomy (PRK), laser in situ keratomileusis (LASIK), laser subepithelial keratomileusis (LASEK), intracorneal ring segments (ICRS), laser thermokeratoplasty (LTK), conductive keratoplasty (CK), phakic intraocular lenses (PIOL), clear lens extractions (CLE), and scleral expansion (SE) procedures were examined in the survey. Use of lasers, microkeratomes, pupillometry instruments, postoperative medications, wavefront analyzers, topographers, etc were examined.


RESULTS
In 2003, LASIK continued to dominate for refractive errors between -8.00 to +3 diopters. Surgeons are waiting on the PIOL for high myopes and are performing CLE for high hyperopes. Photorefractive keratectomy, LASIK, LASEK, CLE, PIOL, and CK appeared to have bright futures; whereas, RK, ICR, LTK and SE were on the decline. Bilateral LASIK at the same surgical session is offered by 98% of surgeons. VISX lasers are used 2:1 over all other lasers in the United States. Zeiss-Humphrey still dominates topographers at 37%. The Bausch & Lomb Hansatome (48%) leads microkeratomes. Surgeons are charging, on average, 300-500 dollars more per eye for custom ablations and these ablations have already been accepted and integrated into refractive practices. Comanaging of refractive surgery patients is significantly down from previous years. Fourth-generation fluoroquinolones overtook the postoperative antibiotic prescriptions, with prednisolone and fluoromethalone dominating as anti-inflammatories.


CONCLUSIONS
Trends and changes as refractive surgery grows in the mainstream of ophthalmology in the United States continue to be elucidated by this professional organization survey.
Duffey
Richard J
RJ
duffey@duffeylaser.com
Leaming
David
D
D019538:Health Care Surveys; D006801:Humans; D049008:Keratectomy, Subepithelial, Laser-Assisted / Q000639:trends; D020731:Keratomileusis, Laser In Situ / Q000639:trends; D017075:Laser Coagulation / Q000639:trends; D054018:Lasers, Excimer; D013508:Ophthalmologic Surgical Procedures / Q000639:trends*; D009885:Ophthalmology / Q000639:trends*; D018903:Photorefractive Keratectomy / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000639:trends*; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000639:trends; D054140:Refractive Surgical Procedures; D012955:Societies, Medical / Q000639:trends; D014481:United States