Eyeworld

HIGHLIGHTS FROM THE 2025 ASCRS CLINICAL SURVEY T he ASCRS Clinical Survey is conducted among ASCRS physician members across specialties to gain practice insights, identify trends, and better understand changing demographics. In addition, it informs educational initiatives and activities. Members were asked at the 2025 ASCRS Annual Meet- ing in Los Angeles, California, April 25–28, to complete the ASCRS Clinical Survey. Objectives of the survey were to measure the practice of cataract, astigmatism management, presbyopia correction, cornea, glaucoma, and retina. There were 981 respondents to the survey, the ma- jority (62%) of whom practiced within the U.S. While the average years in practice among respondents was 15, 28% of respondents had 0–5 years in practice, 13% 6–10 years, 21% 11–20 years, 17% 21–30 years, and 11% more than 30 years; 10% were residents or fellows. Sixty-seven percent of respondents were male and 33% were female. Most respondents performed surgery in an ambulatory surgery center (49%) or at a hospital outpatient department (26%), but 6% had in-office surgical suites. The majority (35%) of respondents practiced in a multispecialty ophthalmology group, while 26% practiced in an academic setting, 18% in a single specialty ophthalmology group, and 9% were in solo practice. As usual, this survey is a great summary of what sur- geons around the country are thinking and doing. There was only one item that surprised me. In the Cataract section, the two ancillary items used by the most surgeons were trypan blue, at 78%, and capsular tension hooks, at 70%. Pupil expansion devices were only used by 47% of surgeons. While I am not surprised by the high trypan number, I am surprised at how much higher the CTR number is above the pupil expansion devices. The advent of these expanders has dramatically changed how we do cataract surgery, and this has become an indispensable item to me. I often use several of these in a given day, as I see many small pupil patients for surgery. On the other hand, while the CTR may save the day for patients with loose zonules, I very rarely use them. Being that the need for the CTR is so rare relative to the need for a pupil expansion device, I would have expected many sur- geons to not be as comfortable with using these and perhaps send out cases that need them. On the other hand, many patients with zonular issues also have pupil issues. I would have expected most surgeons who do use CTRs to also be comfortable using pupil expansion devices. The survey also looked at shifting trends from 2024 to 2025 in some of the clinical areas. In Cataract, there were 22% of patients with ocular comorbidities, compared to 36% in 2024. Respondents' favorite nuclear fragmentation techniques shifted slightly. Divide and conquer remained the favorite, up to 41% compared to 36% in 2024, and horizon- tal chop was the second favorite, up to 30% from 25% in 2024. Trypan blue and capsule tension rings remained the ancillary devices/instruments/implants that were used the most in cataract surgery (at similar percentages between the two years). Respondents answered similarly about their comfort level in performing anterior vitrectomy, with 52% comfortable with a limbal approach only (compared to 56% in 2024), 6% comfortable with a pars plana approach only (same in both years), and 22% comfortable with both (down from 27% in 2024). The number of respondents per- forming FLACS decreased from 42% in 2024 to 35% in 2025. In terms of Astigmatism Management, the number of respondents indicating, "I do not have a 'sweet spot'" saw the most change in response from 2024 (14%) to 2025 (26%). Meanwhile, 14% said they target 0.5 D or greater with-the-rule (compared to 16% in 2024), 33% target 0.3 D with-the-rule (compared to 39% in 2024), and 20% target 0 D (compared to 21% in 2024). Looking at reasons for not implanting toric IOLs, response rates were up for those who do not implant in eyes with significant irregular astigmatism (13% compared to 3% in 2024). The average degrees of postop rotational error acceptable to respondents was noted as 8.6, compared to 10 in 2024. Looking at Presbyopia Correction, lack of accessibility to laser vision correction to correct residual error was the most common reason respondents gave as to why they are not performing a presbyopia-correcting procedure. This was 10% (compared to 11% in 2024). Concern over quality of vision was 8% (compared to 16% in 2024). The spherical deviation from the intended target considered visually sig- nificant shifted slightly. Thirty percent of respondents noted ≥0.25 D and ≤0.50 D (down from 38% in 2024), and 50% answered >0.50 D and ≤0.75 D (similar to 47% in 2024). In Cornea, comparing 2023 and 2025 data, respondents indicated guidelines used when assessing and treating the ocular surface, and 21% noted the ASCRS Preoperative OSD Algorithm (compared to 20% in 2023). Those using DEWS II decreased from 26% in 2023 to 21%, and the number of respondents who said they don't use any of the guidelines also decreased. Barriers to performing corneal crosslinking were similar. Respondents also indicated their preference for posterior cornea transplant, 35% DMEK and 13% DSEK. Half of respondents said they would not implant a premium IOL in an irregular cornea. —Kenneth Beckman, MD

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