Lasik Eyes Surgery - More ectasia scare tactics from WizKid

Author

More ectasia scare tactics from WizKid

Glenn - USAEyes.org

2004-10-31, 7:11 pm

>Iatrogenic ectasia (post-LASIK ectasia) does not just happened. It is
>induced. Apparently, you have not taken the time to understand the
>mechanics and the strucuture of the cornea. I encourage you to do so.
>Once you have become acquainted with the underlying science, you will
>grasp the nature and seriousness of ectasia. WK

Com'on WizKid. Show us the peer reviewed studies. Show us the
studies that have determined that a healthy cornea with at least 250
microns of untouched tissue is going to develop ectasia every time.
You know, all that "underlying science" you've been talking about.
That reproducible cause and effect.

Lamellar surgery has been around for the better part of 50 years. It
doesn't seem likely that you would be the only one to know this
apparently unknowable "fact".

Considering the millions worldwide who have had lamellar transplants,
ALK, epikeratophakia, and LASIK, you should be able to produce
something more substantial than your often repeated gloom and doom.

Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance

Email to glenn dot hagele at usaeyes dot org

http://www.USAEyes.org
http://www.ComplicatedEyes.org

I am not a doctor.

Wizkid

2004-11-01, 2:10 am

Glenn, when the time comes, that is when all of this is in the open, I
promise not to have you eat your words....however, patients who have
been misled and end up with ectasia may have a different point of
view. WK

Glenn - USAEyes.org <glenn.hageleSTOPSPAM@USAEyes.org> wrote in message news:<t0lao0tdem5kg7qa2n4vggb06bphr83vl5@4ax.com>...
>
> Com'on WizKid. Show us the peer reviewed studies. Show us the
> studies that have determined that a healthy cornea with at least 250
> microns of untouched tissue is going to develop ectasia every time.
> You know, all that "underlying science" you've been talking about.
> That reproducible cause and effect.
>
> Lamellar surgery has been around for the better part of 50 years. It
> doesn't seem likely that you would be the only one to know this
> apparently unknowable "fact".
>
> Considering the millions worldwide who have had lamellar transplants,
> ALK, epikeratophakia, and LASIK, you should be able to produce
> something more substantial than your often repeated gloom and doom.
>
> Glenn Hagele
> Executive Director
> Council for Refractive Surgery Quality Assurance
>
> Email to glenn dot hagele at usaeyes dot org
>
> http://www.USAEyes.org
> http://www.ComplicatedEyes.org
>
> I am not a doctor.

Glenn - USAEyes.org

2004-11-01, 2:10 am

On 31 Oct 2004 23:11:15 -0800, gospa68@aol.com (Wizkid) wrote:

>Glenn, when the time comes, that is when all of this is in the open, I
>promise not to have you eat your words....however, patients who have
>been misled and end up with ectasia may have a different point of
>view. WK

In other words, there is not substantiation to support such claims.
Just your often repeated nebulous "just wait until someday" scare
tactics.

Look at Dr. Trattler's post in this thread. He is reporting a 0.06%
rate in his first 3,000 patients. Is this the sky that is falling?

Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance

Email to glenn dot hagele at usaeyes dot org

http://www.USAEyes.org
http://www.ComplicatedEyes.org

I am not a doctor.

Rebecca

2004-11-01, 11:09 am

Glenn - USAEyes.org <glenn.hageleSTOPSPAM@USAEyes.org> wrote in message news:<t0lao0tdem5kg7qa2n4vggb06bphr83vl5@4ax.com>...
>
> Com'on WizKid. Show us the peer reviewed studies. Show us the
> studies that have determined that a healthy cornea with at least 250
> microns of untouched tissue is going to develop ectasia every time.
> You know, all that "underlying science" you've been talking about.
> That reproducible cause and effect.

I am confused. Has WK claimed that healthy corneas with at least 250
microns of untouched tissue will develop ectasia "every time"? I did
not see that.

With respect to peer-reviewed studies, almost by definition
peer-reviewed medical literature, while the most valuable source we
have over time, cannot reflect the most current experience of doctors.
Today's clinical events are the peer reviewed studies of - 2006 at the
very earliest, more likely 2007 and 8. That is why it is necessary to
also rely on what doctors themselves are saying.

Glenn - USAEyes.org

2004-11-01, 7:12 pm

>I am confused. Has WK claimed that healthy corneas with at least 250
>microns of untouched tissue will develop ectasia "every time"? I did
>not see that.

What WizKid has said, and continues to express, is that ectasia is
some dark dreary malady that will someday be creeping up on everyone
who has ever had LASIK. Okay, that's a bit over the top, but not all
that much more than WizKid's the ectasia sky is falling campaign.

He makes no exception for healthy corneas. He makes no exception for
corneas with at least 250 microns of untouched tissue. He has
provided absolutely no substantiation of his outlandish claims, with
the exception of the anonymous tome published only at Hanson's
anti-just-about-everything-and-every-one website. Furthermore, when
challenged, he simply repeats his lonely mantra rather than offering
proof.

>With respect to peer-reviewed studies, almost by definition
>peer-reviewed medical literature, while the most valuable source we
>have over time, cannot reflect the most current experience of doctors.
>Today's clinical events are the peer reviewed studies of - 2006 at the
>very earliest, more likely 2007 and 8. That is why it is necessary to
>also rely on what doctors themselves are saying.

I would agree with you if we were talking about something new, but we
are not.

Lamellar surgery started in the 1950s. ALK was popular in the 1980s.
Epikeratophakia around the same time. LASIK has been around the US
for nearly 10 years and the world much longer.

We are not talking about a procedure with only a few cases performed
yesterday. We are talking about millions of related surgeries over
decades.

WizKid does not even come up with something that is not peer reviewed,
such as a small study published in a trade journal, to substantiate
his unsubstantiated claims.

For whatever reason, WizKid has created in his own mind a crisis that
does not exist and there is years of evidence that affirms it will
never exist. Unfortunately, rather than keeping it in his own mind,
it is spilling out all over the place in this public forum.

That does not mean that ectasia does not occur, nor does it mean that
ectasia is not a real problem. Even doctors who have extensive
practical knowledge will on occasion have a patient develop ectasia.
One such doctor has acknowledged in this thread that his personal
experience is a rate of 0.06%. That, in medical terms, does not
constitute the crisis that WizKid continues to promote.

Rebecca, do you view ectasia to be the problem that WizKid has
presented it to be?

Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance

Email to glenn dot hagele at usaeyes dot org

http://www.USAEyes.org
http://www.ComplicatedEyes.org

I am not a doctor.

Wizkid

2004-11-02, 2:09 am

Glenn, you must attend the courses when you attend the various medical
meetings....did you attend this course at the ESCRS in Paris in
September?

INSTRUCTIONAL COURSE ON COMPLICATIONS PREVENTION AND MANAGEMENT
This was course run by a panel consiting of Dr Michael Assouline, Dr
Nico Trap, Dr Jerry Tan, Dr John Kanellopoulos, and Dr Sheraz Daya.

Screening for ECTASIA was discussed at great length, and comments
about or examples of ectasia came up repeatedly throughout the
session. During the pre-operative screening part, many opinions were
shared about how to identify the borderline cases. Considerable
emphasis was placed on Orbscan and attendees were encouraged to buy
one if they didn't already have one.

There was an interesting discussion about "whether we are creating an
ectasia time bomb with the forme fruste keratoconus patients" and an
acknowledgement that THIS MIGHT BE THE CASE. There was considerable
discussion about how much stroma to leave. Dr Kanellopoulos stated
that he always leaves 280um under the flap. Another doctor commented
that if he does that he "MUST TURN AWAY AN AWFUL LOT OF PATIENTS". He
said no, he simply does a smaller zone on the basis that HE'D RATHER
HIS PATIENT HAVE NVD THAN ECTASIA – but he discusses it all up front
with the patient and leaves it up to the patient to decide whether to
proceed with surgery.

As I stated in an earlier post, I will not ask you to eat your words
when this all comes out. But those who ended up with ectasia may...
WK

Glenn - USAEyes.org <glenn.hageleSTOPSPAM@USAEyes.org> wrote in message news:<pquco091bmrnlffvcvvrll5pl77uvjjldn@4ax.com>...

>
>

Rebecca

2004-11-02, 11:14 am

Glenn - USAEyes.org <glenn.hageleSTOPSPAM@USAEyes.org> wrote in message news:<pquco091bmrnlffvcvvrll5pl77uvjjldn@4ax.com>...

> Rebecca, do you view ectasia to be the problem that WizKid has
> presented it to be?

Glenn, it's not an easy question to answer because we seem to have
different impressions about what WizKid is saying about ectasia.
Possibly because I don't read all the posts in this forum, I don't
know. Perhaps WK can clarify.

I do view the rise in ectasia with deep concern and I have been saying
so publicly for quite some time now, although my emphasis is usually
on educating patients who are considering which procedure to select,
and counseling patients considering retreatment about their heightened
risk of complications including ectasia.

The consequences of ectasia are among the most serious of any
complication of LASIK. If the incidence is enough to prompt extensive
talk amongst ophthalmologists, which is indubitably the case, as well
as to prompt many of the industry's pioneers and leaders to return to
surface ablation, it is more than enough to make me sit up, take
notice and take great care how I talk about it. It is my opinion that
informed, conscientious individuals cannot, in their advice to
patients, in any way seem to lump ectasia in the random-remote-risk
category without doing them a disservice.

Rebecca Petris
www.lasermyeye.org

Rebecca

2004-11-02, 11:14 am

Glenn - USAEyes.org <glenn.hageleSTOPSPAM@USAEyes.org> wrote in message news:<pquco091bmrnlffvcvvrll5pl77uvjjldn@4ax.com>...

> Lamellar surgery started in the 1950s. ALK was popular in the 1980s.
> Epikeratophakia around the same time. LASIK has been around the US
> for nearly 10 years and the world much longer.

Glenn,

As we all know, LASIK has been FDA-approved on certain lasers for no
more than FIVE years and therefore the vast majority of LASIK
procedures which have been performed (which in turn comprise the vast
majority of refractive procedures performed) have been performed in
the last five years. Ectasia onset is typically identified when? From
two to five years after surgery. The peer-review cycle itself lasts
years. It is therefore in my opinion not by any means reasonable to
expect the peer-reviewed medical literature to show any evidence much
less conclusive evidence of the presence or absence of a current trend
in ectasia or suggest the probable long-term incidence in an average
clinical setting.

I am not saying that there is or will be an explosion of ectasia cases
in the next five years. I am saying that your peer-reviewed lit
argument is not strong.

Sandy

2004-11-02, 11:14 am

Glenn - USAEyes.org <glenn.hageleSTOPSPAM@USAEyes.org> wrote in message news:<t0lao0tdem5kg7qa2n4vggb06bphr83vl5@4ax.com>...
>
> Com'on WizKid. Show us the peer reviewed studies. Show us the
> studies that have determined that a healthy cornea with at least 250
> microns of untouched tissue is going to develop ectasia every time.
> You know, all that "underlying science" you've been talking about.
> That reproducible cause and effect.
>
> Lamellar surgery has been around for the better part of 50 years. It
> doesn't seem likely that you would be the only one to know this
> apparently unknowable "fact".
>
> Considering the millions worldwide who have had lamellar transplants,
> ALK, epikeratophakia, and LASIK, you should be able to produce
> something more substantial than your often repeated gloom and doom.
>
> Glenn Hagele
> Executive Director
> Council for Refractive Surgery Quality Assurance
>
> Email to glenn dot hagele at usaeyes dot org
>
> http://www.USAEyes.org
> http://www.ComplicatedEyes.org
>
> I am not a doctor.

It doesn't happen "every time" Glenn, and that is the scary unknown.

Sandy

2004-11-02, 11:14 am

Glenn - USAEyes.org <glenn.hageleSTOPSPAM@USAEyes.org> wrote in message news:<k4qbo0lb0qcrrsdu9sdnhmkrpv4kn83ia1@4ax.com>...
> On 31 Oct 2004 23:11:15 -0800, gospa68@aol.com (Wizkid) wrote:
>
>
> In other words, there is not substantiation to support such claims.
> Just your often repeated nebulous "just wait until someday" scare
> tactics.
>
> Look at Dr. Trattler's post in this thread. He is reporting a 0.06%
> rate in his first 3,000 patients. Is this the sky that is falling?
>
> Glenn Hagele
> Executive Director
> Council for Refractive Surgery Quality Assurance
>
> Email to glenn dot hagele at usaeyes dot org
>
> http://www.USAEyes.org
> http://www.ComplicatedEyes.org
>
> I am not a doctor.

The sky has certainly fallen on those patients who have developed ectasia.

Glenn - USAEyes.org

2004-11-02, 7:12 pm

>The sky has certainly fallen on those patients who have developed ectasia.

There is no doubt that ectasia is not desired and is problematic, but
ectasia tends to be a stable malady that can be treated or
accommodated with glasses, contacts, collagen crosslinking, or just
being a bit myopic.

Considering that ectasia occurs in about 3/50ths of one percent of
LASIK cases (reported here by Dr. Trattler), it is fortunate that the
sky does not fall on many and does not fall hard.

Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance

Email to glenn dot hagele at usaeyes dot org

http://www.USAEyes.org
http://www.ComplicatedEyes.org

I am not a doctor.

Glenn - USAEyes.org

2004-11-02, 7:12 pm

Ectasia is not a new concern. Your argument falls short on several
levels.

LASIK was performed outside the US prior to the FDA's approval. That
takes us back about 15 years. There are no international studies that
support WizKid's claims.

LASIK was performed in the US as an off-label use of the excimer laser
immediately upon approval of the excimer lasers for PRK. That takes
us back about 10 years. There are no US studies that support WizKid's
claims.

LASIK is not the only lamellar surgery and in fact is a combination of
PRK and a previous lamellar surgery called Automated Lamellar
Keratoplasty (ALK). ALK takes us back to about 30-35 years. There
are no ALK studies that support WizKid's claims.

Lamellar surgery was invented by Dr. Barraquer in 1954. That takes us
back 50 years.

Lamellar surgery, whether it be LASIK, ALK, epikeratophakia, or any
other flavors, is by medical standards well understood and
predictable. Nearly half a century's experience with lamellar surgery
does not support WizKid's claims.

The truth is that there are many, many studies that relate to the
potential problem or ectasia, but they simply do not support WizKid's
claims. When challenged, he has not been able to provide one study -
out of 50 years worth of knowledge - that substantiates his claims.

Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance

Email to glenn dot hagele at usaeyes dot org

http://www.USAEyes.org
http://www.ComplicatedEyes.org

I am not a doctor.

Glenn - USAEyes.org

2004-11-02, 7:12 pm

Exactly how scared should one be about something that is well
understood, well documented, very avoidable, and occurs 3/50ths of one
percent of the time?

Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance

Email to glenn dot hagele at usaeyes dot org

http://www.USAEyes.org
http://www.ComplicatedEyes.org

I am not a doctor.

serebel

2004-11-02, 10:08 pm

sandy@savvysneaks.com (Sandy) wrote in message news
>
> It doesn't happen "every time" Glenn, and that is the scary unknown.

It does according too you and the Wizzer. Oh yeah, the sky is falling, heads up!!!

SErebel

Wizkid

2004-11-03, 2:08 am

You are "not a doctor" nor are you a patient advocate. Who do you represent? WK

Glenn - USAEyes.org <glenn.hageleSTOPSPAM@USAEyes.org> wrote in message news:<p8hfo01v6t86kkv7stg8501bn0c02k98q5@4ax.com>...
> Exactly how scared should one be about something that is well
> understood, well documented, very avoidable, and occurs 3/50ths of one
> percent of the time?
>
> Glenn Hagele
> Executive Director
> Council for Refractive Surgery Quality Assurance
>
> Email to glenn dot hagele at usaeyes dot org
>
> http://www.USAEyes.org
> http://www.ComplicatedEyes.org
>
> I am not a doctor.

Sandy

2004-11-03, 4:07 am

Rebecca

2004-11-03, 11:10 am

Glenn - USAEyes.org <glenn.hageleSTOPSPAM@USAEyes.org> wrote in message news:<p8hfo01v6t86kkv7stg8501bn0c02k98q5@4ax.com>...

> Exactly how scared should one be about something that is well
> understood, well documented, very avoidable, and occurs 3/50ths of one
> percent of the time?

Early activists spent a lot of time raising red flags about issues
that were not acknowledged by the medical community - such as the life
impact of severe vision quality degradation secondary to aberrations
induced by laser surgery. Such activists had a hard time getting a
hearing, but they were clearly justified, and now vision quality and
how to preserve it is now hot topic of the medical conferences.

With ectasia, the situation is different and much more advanced: the
medical community are talking about it, and many of them are acting on
it, today. That is understandable even with a far lower incidence of
ectasia than vision quality defects because of the far more serious
implications to the long-term health of the cornea that the former
poses.

How "scared" should one be?

I find it imperative to be "scared" enough on behalf of future
patients to do my part to ensure they have a thorough understanding of
the facts, particularly as relate to microkeratome inaccuracies, the
uncertainties of the outcome with RST below 300um, and the
difficulties of determining RST prior to a retreatment. I don't want
to see potentially borderline patients subjected to elevated risks
without their knowledge during the years-long processes of developing
better keratomes, determining the finer points of topographical
analysis and disseminating knowledge to other surgeons.

Rebecca Petris
www.lasermyeye.org

Glenn - USAEyes.org

2004-11-03, 11:10 am

Hmmm. I don't agree with your unsubstantiated sky is falling routine.
I present solid facts that show you are wrong. You cannot provide a
single study to affirm your claims.

Obviously the only thing left for you to do is to cast aspersions .

I view an important part of patient advocacy as providing accurate and
substantiated information in the most objective fashion possible.
What you have perpetrated lately, is the exact opposite.

Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance

Email to glenn dot hagele at usaeyes dot org

http://www.USAEyes.org
http://www.ComplicatedEyes.org

I am not a doctor.

Glenn - USAEyes.org

2004-11-03, 11:10 am

>
>
>Ask the patients who have it.

Nobody is suggesting that ectasia is something that somebody would
want, but you have completely ignored the question at hand.

How scared should someone be about something that happens so rarely?

Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance

Email to glenn dot hagele at usaeyes dot org

http://www.USAEyes.org
http://www.ComplicatedEyes.org

I am not a doctor.

serebel

2004-11-03, 10:09 pm

sandy@savvysneaks.com (Sandy) wrote in message news:<1f704412.0411030137.50c4c6e8@posting.google.com>...
> Glenn - USAEyes.org <glenn.hageleSTOPSPAM@USAEyes.org> wrote in message news:<p8hfo01v6t86kkv7stg8501bn0c02k98q5@4ax.com>...
>
>
> Ask the patients who have it.

Yeah, all three of 'em.

SErebel

Anastasia

2004-11-03, 10:09 pm

serebel wrote:

>sandy@savvysneaks.com (Sandy) wrote in message news:<1f704412.0411030137.50c4c6e8@posting.google.com>...
>
>
>
>Yeah, all three of 'em.
>
>
>SErebel
>
What would you do Bryce Carlson/serebel...if you were one of those
'three' with ectasia?

Wizkid

2004-11-05, 2:10 am

The issue is not one of frightening people, but rather one of
informing them. If they are not being informed, and if informing them
is being construed by you and "your group" as frightening them, then
you and "your group" need to be instrospective. This says alot about
you and "your group."

Do you feel that by informing them that you are frightening them? Then
the patient should be frightened, not by being informed, but rather,
by not being informed. What else is not being said?
WK

Glenn - USAEyes.org <glenn.hageleSTOPSPAM@USAEyes.org> wrote in message news:<hk0io096h92fkqqfnulpmupmq3gp4vukvo@4ax.com>...
>
> Nobody is suggesting that ectasia is something that somebody would
> want, but you have completely ignored the question at hand.
>
> How scared should someone be about something that happens so rarely?
>
> Glenn Hagele
> Executive Director
> Council for Refractive Surgery Quality Assurance
>
> Email to glenn dot hagele at usaeyes dot org
>
> http://www.USAEyes.org
> http://www.ComplicatedEyes.org
>
> I am not a doctor.

Glenn - USAEyes.org

2004-11-05, 2:10 am

Jeeze WizKid, get a grip on reality. Our organization was the first
to publicize the national norms on patient outcomes in a user friendly
and plain-language format...including the incidence of complications.
See http://www.usaeyes.org/faq/expectations.htm

No, we do not break down which complications are how much of the 3%
norm. Discussion of something as arcane as 3/50ths of one percent
will develop ectasia we leave up to the surgeon who actually sees the
patient and evaluates the situation. ANY rate of ectasia is
irrelevant for a patient with a very cornea or one who is receiving
PRK, LASEK, Epi-LASIK, RLE, or P-IOL.

Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance

Email to glenn dot hagele at usaeyes dot org

http://www.USAEyes.org
http://www.ComplicatedEyes.org

I am not a doctor.

serebel

2004-11-06, 2:08 am

Anastasia <Anasta@aol.com> wrote in message news:<> >>
> What would you do Bryce Carlson/serebel...if you were one of those
> 'three' with ectasia?
>
> --

Have it treated,of course.

SErebel