The fourth New Zealand cataract and refractive surgery survey: 2007.

BACKGROUND: To examine the current practice and changing trends for cataract and refractive surgery in New Zealand (NZ) between 1997 and 2007. METHODS: A self-administered confidential postal questionnaire was sent to all consultant ophthalmologists practising in NZ in 2007, eliciting surgical volumes and technique, anaesthetic, preferred equipment and patient management. Results were compared with previous NZ surveys and international surveys of surgeons in Northern America, Europe and the UK. RESULTS: From the 113 ophthalmologists surveyed 88% responded, comprising 86 cataract surgeons and 20 refractive surgeons. Key findings for cataract surgeons were: 65% routinely used sub-Tenon's anaesthetic, 20% topical anaesthetic, 24% favoured intracameral antibiotics, 88% operated via clear corneal or anterior limbal incisions and 61% used temporal incisions. Acrylic foldable intraocular lenses (IOLs) were preferred, 27% of surgeons routinely used aspheric IOLs, 31% used presbyopia-correcting IOLs and 63% expressed high interest in toric IOLs. Of the refractive surgeons, 83% would perform bilateral LASIK at the same surgical event; phakic IOL was the treatment of choice for 30-year-old -12D myopes, and clear lens exchange for 45-year-old +5D hyperopes. CONCLUSIONS: The majority of NZ cataract surgical practice remains comparable with results from international surveys. A notable exception, as in previous comparisons, is a lower use of topical anaesthetic in NZ with a higher use of sub-Tenon's anaesthetic instead. Refractive surgery practice in NZ is generally comparable with that of American Society of Cataract and Refractive Surgery members.

New Zealand cataract and refractive surgery survey 2004.

BACKGROUND: This study examines the current practice and trends for cataract and refractive surgery in New Zealand. METHODS: A confidential postal questionnaire was sent to all consultant ophthalmologists practising in New Zealand in 2004. Most questions were identical to the 2000 New Zealand survey, and were also similar to the 2003 survey of the American Society of Cataract and Refraction Surgeons (ASCRS). RESULTS: From 97 surveys there was a 92% response rate. Of those surveyed, 70 were performing cataract surgery, 17 were performing refractive surgery, subtenons anaesthetic was used for cataract surgery in 60%, clear corneal or anterior limbal incision in 86%, one-piece foldable intraocular lens in 65%. For refractive surgery, use of refractive lens surgery was recommended for high refractive errors. Advice to a 45-year-old +3.00 hypermetrope wanting refractive surgery was to have laser in situ keratomileusis (88%), laser epithelial keratomileusis (6%) or clear lens extraction (6%). Ninety-four per cent of refractive surgeons in New Zealand used a wavefront analyser. Clear lens extraction was practised by 23 ophthalmologists, phakic intraocular lenses by 16 ophthalmologists. DISCUSSION: New Zealand cataract and refractive surgery practice remains comparable to that of the members of the ASCRS. As in previous comparisons, there is a relatively low use of topical anaesthetic (New Zealand 19%vs. USA 61%vs. UK [pilot study] 33.3%). This survey showed a high uptake of wavefront analysis in refractive surgery (New Zealand 94%vs. USA 45%).

US trends in refractive surgery: 2003 ISRS/AAO survey.

PURPOSE: 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.

Trends in refractive surgery in the United States.

To determine the latest trends in refractive surgery in the United States, a survey dealing with volumes, types, preferences, and use of emerging technology was sent to 5000 U.S. members of the American Society of Cataract and Refractive Surgery. Refractive surgery techniques and the use of lasers, microkeratomes, pupillometry instruments, postoperative medications, wavefront analyzers, and topographers were examined.

Practice styles and preferences of ASCRS members--2003 survey.

A survey of the members of the American Society of Cataract and Refractive Surgery (ASCRS) with a United States ZIP code was performed in July 2003. Approximately 15.5% (985) of the 6350 questionnaires were returned for analysis. Three main profile questions were used in the cross-tabulation: age of the respondent, geographic location, and volume of cataract surgery per month. The refractive surgical questions were cross-tabulated for the volume of laser in situ keratomileusis. Results of the survey were compared with those in previous surveys of ASCRS members.

Practice styles and preferences of ASCRS members--2002 survey.

A survey of the practice styles and preferences of members of the American Society of Cataract and Refractive Surgery (ASCRS) with a United States ZIP code was performed in August 2002. Approximately 18% (1056) of the 5816 questionnaires mailed were returned. Three profile questions were used to cross-tabulate: age of the respondent, geographic location, and volume of cataract surgery per month. The refractive surgical questions were cross-tabulated for the volume of laser in situ keratomileusis (LASIK). Data in this survey were compared with those in previous surveys of ASCRS members.

US trends in refractive surgery: 2002 ISRS survey.

PURPOSE: To determine the latest trends in refractive surgery in the United States. METHODS: The full U.S. membership of the International Society of Refractive Surgery (ISRS) (approximately 900 members) was mailed the 2002 refractive surgery survey dealing with volumes, types, preferences of refractive surgery performed, and use of emerging technology. RESULTS: Questions regarding RK, AK, PRK, LASIK, LASEK, intracorneal ring segments (ICRS), laser thermal keratoplasty (LTK), conductive keratoplasty (CK), phakic intraocular lenses (PIOL), and clear lens extractions (CLE) were examined in the survey. Procedure preference for low, moderate, and high myopia, and hyperopia, were compared with the results from the surveys of the previous 5 years. Preference for unilateral versus bilateral same-day surgery, laser type, and microkeratome choice were also compared with the survey data from previous years. Incidence and frequency of co-management of refractive surgery patients were compared with 1999-2001 data. New questions regarding pupil measurement/documentation, wavefront aberrometry, and custom ablations were incorporated into the 2002 survey. CONCLUSIONS: As refractive surgery grows in the mainstream of ophthalmology, trends and changes in the United States continue to be elucidated by this professional organization survey. LASIK continues to dominate for refractive errors between -10.00 to +3.00 D. LASIK, LASEK, CLE, PIOL, and CK appear to have bright futures, whereas, RK, ICR, and LTK are on the decline. VISX continues to be utilized 2:1 over all other lasers combined, and instrumentation pupillometry is preferred 2:1 over pupil gauge cards. Currently, wavefront aberrometry and custom ablations are minimally employed but appear poised to be the wave of the future.

The New Zealand cataract and refractive surgery survey 2001.

BACKGROUND: This study documents the current practice for cataract and refractive surgery in New Zealand. METHODS: A postal questionnaire was distributed late in 2000 to all consultant ophthalmologists in New Zealand. Most questions were identical to the 2000 survey of the American Society of Cataract and Refraction Surgeons (ASCRS) enabling a comparison. RESULTS: There was an 84% return rate from the 103 surveys distributed. In regards to cataract surgery, topical anaesthesia was used by 12% of respondents, clear corneal incisions by 64%, no suture was used by 94%, diamond blades were used by 33%, disposable blades were reused by 64%, preoperative antibiotics were used by 28%, anti-biotic was used in the irrigant by 10%, postoperative injections of steroid/antibiotics were used by 63% and 41% of patients had three postoperative visits after cataract surgery. In regards to refractive surgery, 51% of respondents had access to an excimer laser and clear lens extraction was performed by 13 ophthalmologists. Advice to a 30-year-old -7.00 myope wanting refractive surgery was to have LASIK (88%), wait (8%) or have no surgery (4%). DISCUSSION: In broad terms, New Zealand ophthalmologists' cataract and refractive practice is similar to that of the members of ASCRS with the exception of the use of topical anaesthetic (NZ 12%vs USA 49%) and the higher use of postoperative injections of steroid and antibiotic at the end of surgery (NZ 63%vs USA 20%).

Practice styles and preferences of ASCRS members--2001 survey.

A survey of the practice styles and preferences of members of the American Society of Cataract and Refractive Surgery (ASCRS) with a United States ZIP code was performed in August 2001. Approximately 20% (1130) of the 5686 questionnaires mailed were returned before the November cutoff date. The response rate was undoubtedly negatively affected by the September 11 attack on the World Trade Center in New York. Three profile questions were used to cross-tabulate: age of the ophthalmologist, geographic location, and volume of cataract surgery per month. Data in this survey were compared with those in previous surveys of ASCRS members.

U.S. trends in refractive surgery: 2001 International Society of Refractive Surgery Survey.

PURPOSE: To determine the trends in refractive surgery in the United States in 2001. METHODS: The 980 U.S. members of the International Society of Refractive Surgery were mailed the 2001 refractive surgery survey dealing with volumes, types, and preferences of refractive surgery performed. Questions regarding radial keratotomy, astigmatic keratotomy, photorefractive keratectomy, laser in situ keratomileusis (LASIK), laser subepithelial keratomileusis, intracorneal rings (Intacs), laser thermal keratoplasty, conductive keratoplasty, clear lens extraction, phakic intraocular lenses, and scleral expansion procedures for presbyopia were examined in the survey. Procedure preferences for low, moderate, and high myopia and hyperopia were compared with the results from the surveys of the previous 4 years. Preference for unilateral versus bilateral same-day surgery, laser type, and microkeratome choice were also compared with the survey data from previous years. Incidence and frequency of comanagement of refractive surgery patients were compared with 2000 data. RESULTS AND CONCLUSION: LASIK remains the dominant refractive surgery for refractive errors from -12.00 to +3.00 D; the VISX excimer laser and the Hansatome microkeratome are the most frequently used instruments for LASIK.