NEW INSIGHTS

The almost universal adoption of intracameral antibiotic use in cataract surgery, a marked trend towards higher-volume cataract surgery to cater for an increasingly older population and a dramatic increase in the use of toric intraocular lenses (IOLs) are among some of the more interesting findings of the latest survey of French ophthalmologists conducted by Richard Gold MD.

In the 17th annual survey of French practices in ophthalmic surgery, Dr Gold, in private practice in Le Raincy, France, collected 991 responses to an anonymous questionnaire sent to 3,210 French ophthalmologists. The response rate of 12.55 per cent represented a drop of almost 10 per cent compared to the 2012 figure and called into question the viability of continuing with the study in forthcoming years, said Dr Gold.

As well as providing valuable insights into trends and developments in clinical practice, Dr Gold’s questionnaire serves as a useful barometer of the current well-being of French ophthalmology in general.

The proportion of French ophthalmologists with a low volume of cataract surgery continues to decline, with about five per cent performing fewer than 100 cataract surgeries per year, down from 22 per cent in 1998 and 10 per cent in 2007.

The proportion performing between 100 and 199 procedures annually has decreased in recent years to below 15 per cent in 2013 compared to a high of 33 per cent in 2001.

The most striking trend has been the proportion of surgeons performing higher-volume cataract surgery. “This is not surprising given the reduced number of ophthalmologists in France and the fact that the population is getting older,” said Dr Gold.

More than 30 per cent of respondents now perform between 300 and 499 surgeries per year compared to 17 per cent in 2000, while those treating between 500 and 999 patients per year has increased from just eight per cent in 2000 to 18 per cent in the 2012 survey. Eight per cent of respondents perform 1,000 or more cataract surgeries, and this figure continues to increase every year.

Reflecting the wider global trend, the size of the incisions used by French ophthalmic surgeons for cataract surgery has steadily decreased in recent years, with the percentage of micro-incisions of less than 1.8mm being performed stabilising between five per cent and six per cent in the past few years. The number of surgeons using an incision size between 1.8mm and 2.2mm has climbed steadily from 25 per cent in 2009 to over 50 per cent in 2013.

Looking at premium IOL usage, Dr Gold noted that while growth has been relatively linear for multifocal and add-on IOLs in recent years, it is the toric IOLs that have really taken off, with 51 per cent of respondents in 2013 now implanting toric lenses compared to 13 per cent in 2008.

The use of intracameral antibiotics in cataract surgery is now almost universally applied in France, having been made obligatory by the national health authority in 2011, with cefuroxime the antibiotic of choice in 99 per cent of cases, said Dr Gold.

Turning to refractive surgery trends, an increasing proportion of French surgeons now use refractive surgery for the treatment of presbyopia, with PresbyLASIK the treatment of choice for more than half
of respondents.

In terms of topography use, this year confirmed the steady rise in popularity of the Pentacam (50 per cent) which has now displaced Orbscan (48 per cent) from top spot followed by OPD-Scan (17 per cent) in third place. The use of aberrometry also continues to find favour among French refractive surgeons with almost 66 per cent now using an aberrometer in their refractive practice.

The competitive landscape of the excimer laser market is also reflected in Dr Gold’s survey. The Zeiss Mel 80 (31 per cent) is the leading laser among respondents this year, followed by the Alcon Allegretto (28 per cent) and the Bausch + Lomb Technolas (23 per cent).

Richard Gold: rg@ophtalmo.net