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5 • 2018 ASCRS Clinical Survey Key findings Only 8% of cataract patients receive femtosecond laser-assisted cataract surgery (FLACS), on average, ac- cording to respondents. U.S. respondents perform FLACS more often, with 10% of cataract patients going to U.S. surgeons receiving FLACS vs. 6% seen by non-U.S. sur- geons. Seventeen percent of U.S. respondents perform FLACS on 21% or more of their patients needing cata- ract surgery. As for why some surgeons are not offering FLACS, most cited cost and not enough evidence proving clinical benefits. Of those who do offer FLACS, 62% think it has had a positive financial impact on their practice. "Adoption of FLACS usually requires an initial capital investment, which can be significant, so surgeons have been reluctant to take the risk that might involve potential loss of capital. In addition, results from large studies have been either ambiguous or have not shown a clear advantage to FLACS over traditional phacoemulsification. The data is still mixed and many of us are waiting for additional data on small subsets of patients in which FLACS may be particularly beneficial (mature cataract, Fuchs' dys- trophy, loose zonules). Those of us who use FLACS think that it makes surgery easier and allows us to put less energy into the eye, even though this may not translate to improvements in refractive results in all cases." —Kendall Donaldson, MD ASCRS Cataract Clinical Committee Laser-assisted cataract surgery COPYRIGHT 2018 AMERICAN SOCIETY OF CATARACT AND REFRACTIVE SURGERY (ASCRS). ALL RIGHTS RESERVED. NO PART OF THIS SURVEY MAY BE REPRODUCED WITHOUT WRITTEN PERMISSION FROM ASCRS, 4000 LEGATO ROAD, SUITE 700, FAIRFAX, VA 22033. DRAFT OF 2018 ASCRS CLINICAL SURVEY - DO NOT PUBLISH/DISTRIBUTE What percentage of your cataract patients currently receive femtosecond laser cataract surgery? • On average 8% of all respondents' cataract patients currently receive femtosecond laser cataract surgery • U.S. respondents are 4% higher than Non-U.S. respondents, 10% to 6% • More than 60% of respondents do not perform any femtosecond laser cataract surgery, 61% • 78% of those responded None, and have no plans to • For 17% of U.S. respondents, 21% or more of their cataract patients receive femtosecond laser cataract surgery All 8% US 10% NonUS 6% Average Pct n=856 60 What are your top TWO reasons for not currently offering femtosecond cataract surgery? (Select 2) • Overall, 64% of respondents selected Not a viable economic option for my practice • U.S.: 58% • Non-U.S.: 75% • More than half of the respondents think there is not enough data proving clinical benefits, 51% • U.S.: 59% • Non-U.S.: 38% n=522 61 Do you think LACS has had a positive financial impact on your practice? • Yes: 62% • U.S. respondents are 29% points higher than Non-U.S. respondents, 71% to 42% n=337 68

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