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9 • 2018 ASCRS Clinical Survey Key findings On average, respondents said they perform about 130 laser vision correction surgeries each year, with non- U.S. respondents performing an average of 173 annually compared to the average of U.S. respondents being 107. Fifty percent of respondents do not perform laser vision correction at all; just over 20% of U.S. respondents had offered laser vision correction but no longer do so. Of respondents who do offer laser vision correction, patient satisfaction postop is measured, most often, by sub- jective feedback provided by the patient and noted on their chart. Slightly more than 10% use a visual function index validated survey and less than 10% use a survey developed by their practice. Forty-five percent of respon- dents think femtosecond intrastromal lenticule extraction has the least impact on corneal biomechanics, com- pared to the creation of a femtosecond LASIK flap, while 38% think there is not a clinically significant difference between the two. "Having been involved with the research and devel- opment and clinical delivery of refractive surgery via the cornea, lens, and phakic IOL technology for the last 28 years, I find this survey to represent my impression of the current state of corneal refractive volumes. I think we see such a range in volumes in this era of refractive surgery because thanks to mod- ern-day lasers and refinements in technology, there are now many general ophthalmologists who are comfortable with refractive surgery. Regarding the findings on corneal biomechanics of different proce- dures, many feel the anterior third of the cornea pro- vides the most structural support, due to the anatom- ical nature of the collagen fibrils. Thus, a procedure that cuts the least amount of tissue in the anterior third of the cornea is predicted to leave the cornea in a stronger biomechanical state. I think that with time SMILE will become known as the most biomechani- cally stable lamellar corneal refractive procedure. I'm a big fan of PRK, LASIK, and SMILE, and I think every patient deserves a thorough discussion on the pluses and minuses of each for a fully informed decision." —Vance Thompson, MD ASCRS Refractive Surgery Clinical Committee What is your average ANNUAL volume of laser vision correction (e.g., LASIK, SMILE, PRK, etc.) surgery? • Respondents average approximately 130 laser vision correction surgeries annually, 131 • The average annual surgical volume for Non-U.S. respondents is 62% higher than U.S., 173 to 107 • Half of respondents do not perform laser vision correction, 50% • Only 7% of those not currently performing laser vision correction plan to in the next 12 months All 131 US 107 NonUS 173 Average n=833 112 All US Non US Corneal refractive Other than surface ablation, which do youthink has the LEAST impact on the corneal biomechanical properties? • 45% of respondentsthink SMILE has the least impact • 38%think there is no clinically significant difference between these options n=206 119 "Laser vision correction volume is correlated to consumer confidence. As such, we have seen an upswing in refrac- tive surgery volume. We think there is a movement toward evaluation of patient reported outcomes in refractive surgery, and this will shift from the research realm to more common- place in practice. Corneal biomechanics is a hot topic, and we predict that eventually direct, in vivo, in-clinic measurement of biomechanics will become mainstream for candidacy determination. However, we are still in the validation pro- cess on a number of technologies and are still learning how different eyes respond to different treatments. The fact that not all eyes are created equally illustrates the opportunity for direct biomechanical ocular assessment; it helps us better understand which treatment is most appropriate for a given patient." —George Waring IV, MD ASCRS Refractive Surgery Clinical Committee

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