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8 | 2019 ASCRS CLINICAL SURVEY CLINICAL SURVEY 2019 T Corneal refractive surgery The survey asked about primary reasons for not performing corneal refractive surgery. The largest percentage (37.6%) said it was not economically viable for the practice, while 34.6% said it was outside their training or they had not kept up to date with the technology. When asked what has the least impact on the corneal biomechanical properties, 44% of respondents indicated SMILE (as compared to femtosecond flap LASIK), and 33.9% said they think there is no clinically significant differences between the two options. Refractive lens exchange was indicated by 53% to have the highest predictability in achieving the desired postop refraction in a 45-year-old hyperope. "As a refractive surgeon whose practice foundation clinically, sur- gically, and economically is refractive surgery, I look at the 2019 ASCRS Clinical Survey feeling a bit melancholy. Daily I experience the joy that refractive corneal surgery can bring to the right candidates desiring less dependence on optical devices. I have witnessed fellow ophthalmic surgeons experience the joy and fulfillment of working hard to learn refractive surgery (including proper patient education) and subsequently experience the pro- fessional and personal satisfaction of meeting, or exceeding, their patient's expectations. That same refractive surgery experience is also wonderful for optimizing cataract surgery refractive results, especially with modern day premium implants achieving such amazing results when refractive outcomes are optimized. In that context I am disheartened that 37.6% of survey participants said they are not performing corneal refractive surgery because it is not economically viable for their practice. Furthermore, this number goes up every year (32% in 2018 and 26% in 2017). Equally troublesome to me is that even though technology has gotten better, 34.6% think corneal refractive surgery is outside their training and/or they have not kept up to date with the advancements in knowledge and technology. "I think we, and industry, owe it to our colleagues to teach and mentor our fellow ophthalmic surgeons on ways (clinically, surgically, and economically) to make this wonderful area of oph- thalmology that is so impactful on patients' lives more accessible to their practice." Vance Thompson, MD ASCRS Refractive Surgery Clinical Committee IF YOU ARE NOT PERFORMING CORNEAL REFRACTIVE SURGERY, WHAT ARE YOUR PRIMARY REASONS? (Select all that apply.) OTHER THAN SURFACE ABLATION, WHICH DO YOU THINK HAS THE LEAST IMPACT ON THE CORNEAL BIOMECHANICAL PROPERTIES? WHICH OF THE FOLLOWING PROCEDURES DO YOU THINK HAS THE HIGHEST PREDICTABILITY IN ACHIEVING THE DESIRED POSTOP REFRACTION IN A 45-YEAR-OLD HYPEROPE (+2.50 D)?

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