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Summary of 2019 Modern Optometry Clinical Survey

• Developed with The Fundingsland Group together with several Modern Optometry Editorial Board members

• Goal: assess the clinical opinions and practice patterns of today’s optometrists

• Conducted in Summer 2019• 59 questions• 8 sections:

• General• Cataract Surgery• Refractive IOLs• Inflammation / Infection / Allergy• Ocular Surface / Cornea• Glaucoma• Corneal Refractive Surgery• Retina

• The following is a summary of some of the key findings

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General Overview: Demographics

• 567 survey respondents

• 65% Female• 35% Male

• 91% US• 9% OUS

• 37% in the first 5 years of practice

What describes your primary mode of practice?

15%

37%13%

13%

9%

6%7%

Solo private practice

Group OD private practice

Private practice, employed by anophthalmologistRetail optical chain / corporate-owned center

Academia

Hospital based

Other

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Cataract Surgery: Of your comanaged cataract surgery patients, what percentage of them do you recommend delaying surgery because of ocular surface disease?

10%

32%

24% 25%

5% 3%

None 1-5% 6-10% 11-20% 21-40% Unsure

On average, 8% of comanaged cataract surgery patients are delayed due to OSD

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Refractive IOLs: What percentage of your current referred/comanaged cataract patients receive…

14%

40%

17% 16%13%

5%

34% 32%

20%

8%

None 1-5% 6-10% 11-20% 21-40%

presbyopia-correcting IOLs toric IOLs

On average, 10% receive presbyopia-correcting IOLs

On average, 9% receive toric IOLs

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Refractive IOLs: How likely are you to discuss presbyopia-correcting IOL options with your patients who need cataract surgery?

24%

45%

9%

19%

4%

Highly likely Likely Not sure Unlikely Very unlikely

69% are likely and highly likely to discuss presbyopia-correcting IOL options with cataract surgery patients

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Refractive IOLs: What do you think is the future of presbyopia correction in 10 years from now?

1%

19%

4%

1%

8%

67%

Other

Medical to alter structure of the lens

Medical to control the pupil size

Scleral

Corneal based

Lens based

The majority of respondents believe that lens-based technology is the future of presbyopia correction

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Inflammation, Infection, Allergy: What percentage of your comanaged cataract patients have 1+ cells/flare or greater 3-7 days postoperatively?

5%

23%25% 24%

13%

5% 5%

0% Under 1% Under 2% 2-5% 6-10% 11-20% More than20%

On average, 4% of comanaged cataract patients have 1+ cells/flare or greater 3-7 days postoperatively

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Inflammation, Infection, Allergy: What level of inflammation 3-7 days after cataract surgery do you believe has a clinically significant impact on…

12%

25%

44%

19%

4%

23%

55%

18%

0.5+ cell/flare 1+ cell/flare 2+ cell/flare 3+ cell/flare

visual acuity/quality patient satisfaction

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Inflammation, Infection, Allergy: How important do you believe that it is to prescribe both NSAIDs and corticosteroids to manage postoperative inflammation following routine cataract surgery?

39%44%

9% 7%0%

Very important Important Neither Unimportant Very unimportant

83% believe that it is important and very important to prescribe both NSAIDs and corticosteroids to manage postop inflammation

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Ocular Surface / Cornea: On average, how many patients do you see per month who are on a prescription medication (i.e. need more than just tears) for dry eye or who have had punctal occlusion?

7%

36%

19% 21%

12%

3% 2%

None 1-5 6-10 11-25 26-50 51-99 More than100

On average, 16 patients are seen each month who are on prescription medication for dry eye or have had punctal occlusion

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Ocular Surface / Cornea: What percentage of your ocular surface disease patients do you believe have meibomian gland dysfunction?

11%

27%

18%

23%

10% 10%

Less than 50% 60% 70% 80% 90% Nearly 100%

Overall, respondents believe that 70% of OSD patients have MGD

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Ocular Surface / Cornea: Are you systematically screening patients for dry eye symptoms?

23%

47%

30%

1%

Yes, in all cases Yes, in most cases Only when the patientpresents with dry eye

symptoms

Rarely to never

69% are systematically screening patients for dry eye symptoms in all and most cases

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Ocular Surface / Cornea: Are you incorporating the following tear film diagnostics in your practice?

12%27%

62%

Yes, in themajority of

patients

On a case-by-casebasis

Not using

Schirmer test

32%42%

26%

Yes, in themajority of

patients

On a case-by-casebasis

Not using

Tear meniscus height

57%40%

2%

Yes, in themajority of

patients

On a case-by-casebasis

Not using

Corneal and conjunctival staining

68%

31%

2%

Yes, in themajority of

patients

On a case-by-casebasis

Not using

Tear Break-up Time

10%22%

68%

Yes, in themajority of

patients

On a case-by-casebasis

Not using

Tear osmolarity

6%24%

70%

Yes, in themajority of

patients

On a case-by-casebasis

Not using

Meibography

5%23%

72%

Yes, in themajority of

patients

On a case-by-casebasis

Not using

MMP-9

58%

30%12%

Yes, in themajority of

patients

On a case-by-casebasis

Not using

Meibomian gland evaluation

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Ocular Surface / Cornea: Are you currently comanaging corneal collagen cross-linking patients?

55% are or intend to comanage corneal collagen cross-linking patients in the next 12 months

25%

20%

26%

29%

No, and I have no plans to comanagecrosslinking procedures

No, because it is unavailable in my area

No, but I plan to comanage crosslinkingprocedures in the next 12 months

Yes

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Glaucoma: Which of the following do you use to diagnose glaucoma? (Select all that apply.)

3%

19%

2%

18%

21%

21%

17%

Other

OCT

Corneal hysteresis

Pachymetry

Visual field test

Ophthalmoscopy

Gonioscopy

A number of tools are used to diagnose glaucoma

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Glaucoma: What percent of your patients are currently prescribed more than two topical medications to control their glaucoma, do you believe are not compliant?

On average, 25% of patients on more than 2 topical medications are believed to be noncompliant

5%

42%

33%

14%6%

0%

0% 1-20% 21-40% 41-60% 61-80% 81-100%

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Glaucoma: What percentage of your glaucoma patients would you estimate are candidates for a minimally invasive glaucoma surgery (MIGS) procedure?

10%

17%

24%

12% 14%10% 12%

0% 1-5% 6-10% 11-15% 16-20% 21-40% More than40%

On average, 16% of glaucoma patients are estimated to be candidates for MIGS

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Corneal Refractive Surgery: How likely are you to discuss corneal refractive surgery with your vision-corrected patients?

4%

73%

24%

I never refer for corneal refractive surgery andprefer not to discuss it at all

I discuss pros and cons of corneal refractivesurgery only if the patient asks about it

I always discuss it as one option for visioncorrection

Almost three-quarters of respondents discuss the corneal refractive surgery only if the patient asks about it

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Corneal Refractive Surgery: How would you rate your patients’ outcomes after corneal refractive surgery?

16%

67%

13%2% 1%

All satisfied Most satisfied Mix of satisfiedand dissatisfied

Most dissatisfied All dissatisfied

84% of patients are satisfied with their corneal refractive surgery outcomes

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Retina: What percentage of your wet / neovascular AMD patients do you manage independently vs refer or comanage with a retina specialist?

5%13%

7%

24%

52%

All managedindependently

Mostindependently,

some comanaged

Even split Most comanaged,some

independently

All comanaged

76% of wet/neovascular AMD patients are comanaged.

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Retina: What is your confidence in understanding the potential impact on patient outcomes of emerging wet / neovascular AMD therapies that will be available in the coming years?

9%

51%

27%

11%

2%

Very confident Confident Neutral Unconfident Not confident at all

60% of respondents are confident and very confident in their understanding

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Retina: In what percentage of your patients do you perform OCT prior to cataract surgery?

23% 23%

7% 6%

13%

29%

0% 1-25% 26-50% 51-75% 76-99% 100%

On average, 49% of patients have OCT before cataract surgery

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Retina: What is your belief on the current value of OCT angiography?

4%

11%

47%

18%

20%

I don’t believe this will add significant value to my practice

Not sure

Likely to be valuable, but awaiting more data

Intend to incorporate this in the next 12 months

Valuable and currently incorporating it as a routinepart of my practice

Only 38% of respondents believe that OCT-A is valuable and is or will be incorporated into their practice

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Retina: What imaging technique(s) do you use at the time of diagnosis for wet / neovascular AMD patients? (Select all that apply.)

3%

37%

4%

8%

7%

40%

Other

Fundus photos

Indocyanine green angiography

Fluorescein angiography

OCT angiography

OCT

The top 2 imaging techniques for wet/neovascular AMD patients are OCT and Fundus photos

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Retina: What percentage of your standard wet / neovascular AMD patients are dry on OCT 6 months after your initial first-line treatment?

18%

40%

20%

12%8%

2%

Nearly 0% 20% 40% 60% 80% Nearly 100%

On average, 32% of wet/neovascular AMD patients are dry on OCT at 6 months

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Retina: What level of involvement do you have in the anti-VEGF treatment of your comanaged retina patients?

60%

2%

4%

25%

9%

I’m not involved in the treatment decisions process with my comanaging ophthalmologists.

My treatment recommendations are never followedby my comanaging ophthalmologists.

My treatment recommendations are rarely followedby my comanaging ophthalmologists.

My treatment recommendations are sometimesfollowed by my comanaging ophthalmologists.

My treatment recommendations are always followedby my comanaging ophthalmologists.

34% are involved in the majority of treatment recommendations

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Contact Lens: How many contact lens patients do you see each week (include full exams, follow-up visits, fittings, etc.)?

18% 19%

38%

17%

10%

Fewer than 5 5-10 11-25 26-40 More than 40

65% see more than 10 contact lens patients each week