Lasik Eyes Surgery - Setting the record straight for RT(warning:long)

Author

Setting the record straight for RT(warning:long)

Dr. Leukoma

2004-12-16, 9:25 am

Uh, huh. Can't even muster up the courage of an apology. Of course,
taking the high ground might make you dizzy. I am beginning to question
your credentials. Ph.D. from where, and in what?

Let's review the facts of the case. Here is the original post from Glenn:

> Subject: Re: UK National Health Service Says LASIK is Too Risky
> From: Glenn - USAEyes.org <glenn.hageleSTOPSPAM@USAEyes.org>
> Newsgroups: alt.lasik-eyes
> Reply-To: glenn.hageleSTOPSPAM@USAEyes.org
>
> Okay, it's Singapore, but I suspect there will be many articles like
> this in the near future.
>
> ~~~~~~~~~~~~~~~~~
> Tuesday December 7, 2:17 AM
> Doctors say LASIK is proven safe, only 1% of patients get
> complications
>
> SINGAPORE : Eye doctors say laser eye surgery is safe and effective,
> with less than 1 percent of patients developing complications.
> So the two main public LASIK centres will continue to offer the
> surgery to correct short-sightedness.
>
> The reassurance comes after London newspapers had raised concerns over
> the long-term safety of laser eye surgery.
>
> In the last 12 months alone, nearly 6,000 Singaporeans had gone to
> public hospitals for laser eye surgery to correct myopia and
> astigmatism.
>
> Given the rising popularity of LASIK, many were concerned over reports
> that UK is putting a 'block on laser eye surgery in Britain'.
>
> But The Eye Institute says no one has called to cancel any surgery,
> and that the report is misleading.
>
> Dr Lee Hung Ming, Head of Refractive Surgery at The Eye Institute
> (National Healthcare Group), said: "A little bit misleading because it
> gives people the impression that the British government is banning
> LASIK procedure all over the country.
>
> "If you read into the report, they are trying to block the move to
> prevent LASIK from becoming a subsidised item under the healthcare
> system."
>
> The report also quoted American Journal of Ophthalmology saying the
> failure rate for eye surgery was one in 10, when it is widely known to
> be one in a 1,000.
>
> That figure puzzled doctors too.
>
> Associate Professor Donald Tan, Deputy Director of Singapore National
> Eye Centre, said: "We have done 18,288 LASIKs since 1998 and that is a
> lot of cases.
>
> "We have at present a 100 percent safety record which means no patient
> has developed a bad complication and who has gone blind. LASIK is
> probably the safest operation that we have."
>
> Dr Lee said: "The long-term safety concern that they mentioned include
> the corneal ectesia, which is the progressive thinning of the cornea
> that can result in progressive loss of vision for the patients."
>
> Doctors say long-term complications from LASIK, where the cornea gets
> progressively thinner, are rare.
>
> But to make sure they do not happen, doctors carry out very stringent
> pre-operation screening.
>
> Those with pre-existing corneal problems or thin cornea will not be
> operated on.
>
> The centre says it enjoys a success rate of over 98 percent.
>
> And in the four years since it opened, it has carried out more than
> 5,500 cases, and only one patient so far, has developed complications
> such as corneal infection.
>
> Both the Singapore National Eye Centre and the Eye Institute say they
> will continue to offer laser eye surgery.
>
> Dr Lee added: "I do not know what is their definition of a failure
> rate. But as in all surgical procedures, LASIK does have some side
> effects.
>
> "The mild side effects are dry eyes, glare halos at night. But these
> are usually short-term and usually persist for three to six months.
> But this is mild compared to the new found freedom from the surgery."
> - CNA
>
>
>
>
> 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.

Then, my response to Glenn's post:

> On reading this, I see that the Singapore surgeons "carry out very
> stringent pre-operation screening." It would be safe to say that
> stringent pre-operative screening is not always observed.
>
> The other point is that Dr. Lee considers all side-effects of LASIK to be
> mild and mostly short-term. There are bound to be some disagreements
> with this rather benign assessment.
>
> DrG

Then, in apparent agreement with me, Glenn said:

> IMO, this is a huge problem with unsupportable, misrepresentative, and
> outlandish claims on both sides of the issue. What inevitably happens
> if someone says everything about LASIK is bad, is that someone else
> will say everything about LASIK is good. Neither side is correct and
> the public just gets confused. Confusion is seldom a good thing when
> it comes to medicine.
>
> Glenn Hagele
> Executive Director
> Council for Refractive Surgery Quality Assurance

But, then I caught another report of the same story, and emphasized the
fact that the authors totally underplay dryness and halos as complications,
considering only sight-threatening, or potentially blinding events as
complications. This totally flies in the face of what I have seen in my
own practice, where dry eye and visual disturbances can be quite unsettling
and debilitating:

> Well, it looks like there are pro-LASIK zealots just as there are
> anti- LASIK zealots. Read this:
>
> =======================================================================
>
> "We perform 100 per cent audit checks on all cases and the safety data
> showed that there has been no vision loss, blindness or severe
> complications leading to blindness," said Prof Tan.
> .
> At the TEI, the Lasik success rate for myopia of up to 600 degrees is
> 98.3 per cent, as the institute takes stringent precautions to prevent
> long-term complications.
> .
> But even with the good track record, both Dr Lee and Prof Tan
> cautioned, there is always a risk, as with any other surgical
> procedure. .
> At the SNEC, the complication rate is about 0.4 per cent. These are
> primarily minor complications like dryness of the eyes and seeing
> halos at night.
> .
> The SNEC, like the TEI, screens patients prior to Lasik surgery. This
> year, the SNEC turned away 10 per cent of up to 5,000 cases who were
> not suitable, while the TEI turned away five per cent of some 300
> cases each month.
> .
> "Some of our own Lasik surgeons have had Lasik; we have also performed
> Lasik on our children and relatives, so I think that's proof of the
> pudding that we believe in it," said Prof Tan.
> Report that Britain will prohibit the procedure due to long-term
> safety concerns was 'misleading'
> =======================================================================
>
>
> "...minor complications like dryness of the eyes and seeing halos at
> night....we have also performed LASIK on our children."
>
> DrG

Here, RT agrees with the authors and downplays dryness and night vision
disturbances as minor and temporary. RT also thinks it is alright to do
LASIK on children if the children are really adults:

> Subject: Re: UK National Health Service Says LASIK is Too Risky
> From: RT <RTMD24@NOSPAMyahoo.com>
> Newsgroups: alt.lasik-eyes
>
> In article <Xns95B7CCFB53E2Cdrgleukomacom@204.127.204.17>,
> "Dr. Leukoma" <drgNOSPAM@leukoma.com> wrote:
>
>
> Please explain what is so terrible about these statements? Most dry eye
> resolves within a few months, as do halos. I think most people would
> consider these minor complications, a temporary nuisance with a payoff
> of great vision after a few months. Yes, there are a few cases of
> severe dry eye post-LASIK, but from all that I can tell, this usually
> occurs in patients who are pre-disposed due to a medical condition and
> who are not caught b/c of poor prescreening.
>
> I'm glad they perform LASIK on their children and relatives (and
> themselves). I think it shows they do trust the technology.
>
> Oh, you probably thought "children" meant while they are young.
> Unlikely, their children are probably adults.
>
> Nice try.
>
> RT,

Oh, but then he tap dances out of this by denying the customary use of the
word "children" is in reference to minors, to which I replied:

> Even to an objective person, the article seems to show a bias. It is
> clear that the authors consider as a complicaton only those that would
> lead to blindness. Everything else -- such as dry eye and halos --
> are but minor nuisances to them. I know quite a few people who do not
> consider those symptoms minor nuisances, even years after surgery.
>
> Sorry, but I infer the meaning of words as they are commonly used, and
> the dictionary defines "child" as somewhere between infancy and youth.
>
> Nice try, Ragnar, but I don't think we'll be reading the results of
> their study in the Lancet any time soon.
>
> DrG

To which RT responds by trying to redefine the word "blindness" to include
moderate myopia and accuses me of putting "spin" on an article that is
itself - and even Glenn admits - is "spin:"

> Subject: Re: UK National Health Service Says LASIK is Too Risky
> From: RT <RTMD24@NOSPAMyahoo.com>
> Newsgroups: alt.lasik-eyes
>
> In article <Xns95B848E663AFEdrgleukomacom@216.148.227.77>,
> "Dr. Leukoma" <drgNOSPAM@leukoma.com> wrote:
>
>
> What is the definition of blindness? Apparently I was functionally
> blind before LASIK as -4.50. If that's the case, then I suppose one
> could consider debilitating starbursts as "blindness." That would be a
> complication of "blindness."
>
> If it resolves with healing, like most dry eyes and halos, is that a
> complication? or a side effect of healing? Could it be that the
> definition of "complication" is the issue? Are side effects and
> complications different things? What do you think?
>
>
> I just find the "spin" everyone puts on things so very interesting and
> illuminating. I was responding to the quote you highlighted from the
> article, which showed *your* particular bias. I didn't read that
> their children are "youths" but rather to show that they are willing
> to perform LASIK on their nearest and dearest.
>
>
> Please! I'm not Ragnar. I'm sorry he came up with the RM name. That
> seems to be causing some confusion.
>
> ~RT
>
> PS: Everything has a bias. "Studies" have a bias. Remember, for
> everything that is included, something has been left out. Even
> "objective" Glenn has a bias 8^)

Taking this discussion to a new level of absurdity, RT claims that all
studies are biased, to which I responded by providing a few hypothetical
propositions to see what RT considers spin:

> Which of the following statements make sense? Which ones reflect a clear
> bias of the author?
>
> "In Dallas today, the high temperature was 60 degrees under sunny skies."
>
> "Ten percent of LASIK patients require a re-operation."
>
> "XX percent of LASIK patients experience dry eyes following their
> surgery."
>
> "In Singapore, LASIK surgeons have performed LASIK on their own
> children."
>
> "RT thinks that every statement is biased if it is not exhaustive."
>
>
> DrG

To which RT replies:

> Subject: Re: UK National Health Service Says LASIK is Too Risky
> From: RT <RTMD24@NOSPAMyahoo.com>
> Newsgroups: alt.lasik-eyes
>
> In article <Xns95B897EB55E50DrLeukoma@207.217.125.201>,
> "Dr. Leukoma" <drg@leukoma.com> wrote:
>
>
> this statement makes sense, as long as you know what/where Dallas is.
> The bias of this author is that he/she makes an assumption that the
> reader will know that degrees are in Fahrenheit, otherwise 60 degrees
> is absurdly hot. Why not mention the low? Or the fact there were no
> clouds?
>
> This statement makes sense, but the author shows a certain bias by not
> stating: 80% of LASIK patients do not require a re-operation. Same
> "fact;" different way of stating it.

According to RT, bias also means incomplete information, and on, and on,
and on. RT's main objective then, is not to debate the issue, but to make
me the issue by creating a tempest in a teapot, taking lessons from Ragnar,
preferring instead to walk across the street to tell a fib than to shoot
straight.

I'm sorry about the name-calling, RT, when I called you Ragnar's twin.
That was indeed harsh. Can we agree that you are a disciple of Ragnar,
then?

DrG

Glenn - USAEyes.org

2004-12-16, 9:25 am

No matter how you look at it, the three news reports do not provide a
balanced view nor do they seem to stick to established facts regarding
complications. They may do this by ignoring information that does not
support their apparent bias, by misrepresenting facts that do not
support their apparent bias, outright lying, or a combination of the
three.

Our press release is supposed to present the facts as we know them,
but there is undoubtedly some bias in there, simply because even when
you endeavor to be objective, it is nearly an impossible task.

BTW, I hope you don't leave Dr.G. It would be very lonely around here
for me. Perhaps you could just leave this particular thread.

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.

Dr. Leukoma

2004-12-16, 9:25 am

Glenn - USAEyes.org <glenn.hageleSTOPSPAM@USAEyes.org> wrote in
news:7k7ir05fvc7gcm8lq60ursppjplm7njd6n@4ax.com:

> No matter how you look at it, the three news reports do not provide a
> balanced view nor do they seem to stick to established facts regarding
> complications. They may do this by ignoring information that does not
> support their apparent bias, by misrepresenting facts that do not
> support their apparent bias, outright lying, or a combination of the
> three.
>
> Our press release is supposed to present the facts as we know them,
> but there is undoubtedly some bias in there, simply because even when
> you endeavor to be objective, it is nearly an impossible task.
>
> BTW, I hope you don't leave Dr.G. It would be very lonely around here
> for me. Perhaps you could just leave this particular thread.
>
> 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.
>

I think objectivity is a worthy goal, and the proper goal of all science.
Objectivity is in short supply here and on other BBs. My enthusiasm for
this NG has waned, as has my enthusiasm for other discussion groups. I
need to be spending more time on an upcoming presentation and on some other
projects I am working on.

However, when I see this NG in need of a reasonable and rational RS critic,
or at least an RS non-advocate, then you can count on me.

DrG

Glenn - USAEyes.org

2004-12-16, 9:25 am

Which reminds me, I need to make my reservations. San Diego, right?

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.

2004-12-16, 9:25 am

In article <Xns95BADFC934799drgleukomacom@204.127.204.17>,
"Dr. Leukoma" <drgNOSPAM@leukoma.com> wrote:

> Let's review the facts of the case.

Good idea. After rereading it I realize what went wrong here.

You misread my questions and comments as if I were Ragnar. I am not
Ragnar. Not his twin, not his disciple, not even vaguely related in the
most obscure way. I don't know how to make this any clearer. Maybe ask
him, or Glenn since you seem to respect his opinion. Glenn can tell
you.

Please reread your long post as if I'm asking questions as if I really
want to know the answers, because I do.

First of all, you seem to be the only one on this board arguing that you
are above reading articles, studies and essays without imposing your own
bias upon them, which thus colors your interpretation of them.

Secondly, These were legitimate questions I was asking. Again, my work,
education, training etc. has nothing to do with the optics of the eye.
I am a complete layman in these areas. My questions are because I'm
trying to understand. Isn't true that most dry eye and halos resolve
during the healing period? What is the definition of blindness? I'm
not discounting that some people suffer from long term complications.
But as I read this board, I see more and more evidence that it's due to
poor pre-screening and the individual's healing response. It could be
that Singapore's pre-screening process is superior to the US.

Thirdly, I see that you took this all very personally. In fact you have
made it into a "case." For that I'll offer an apology. I'm sorry that
you felt you had to take it personally, reply with insults and take it
to a level where it was never meant to go. I'm sorry that I've engaged
you in a debate because you haven't been able to understand that this
wasn't originally about you, but about how "objectivity" cannot take
place in a forum such as this. After 3 times, I concede that you will
not see this, so I won't bring it up again in relation to your posts.
But hopefully you and others will read things more carefully and think
about how you phrase things can change, obscure or emphasize meanings in
a way the original author didn't intend.

But I will still read this NG and post when I feel like asking questions
to understand an issue more deeply, and comment where I think issues are
being obscured or slanted by pro- or anti- rhetoric or bias.

--
~RT

Dr. Leukoma

2004-12-16, 9:25 am

RT <RTMD24@NOSPAMyahoo.com> wrote in
news:RTMD24-E48F83.08213710122004@newssvr14-ext.news.prodigy.com:

> In article <Xns95BADFC934799drgleukomacom@204.127.204.17>,
> "Dr. Leukoma" <drgNOSPAM@leukoma.com> wrote:
>
>
> Good idea. After rereading it I realize what went wrong here.
>
> You misread my questions and comments as if I were Ragnar. I am not
> Ragnar. Not his twin, not his disciple, not even vaguely related in
> the most obscure way. I don't know how to make this any clearer.
> Maybe ask him, or Glenn since you seem to respect his opinion. Glenn
> can tell you.
>
> Please reread your long post as if I'm asking questions as if I really
> want to know the answers, because I do.
>
> First of all, you seem to be the only one on this board arguing that
> you are above reading articles, studies and essays without imposing
> your own bias upon them, which thus colors your interpretation of
> them.

I "seem"? Said what, when? Never said that. Did you ever take a course
in literary criticism, or recieve any formal training in analysis, logic,
or similar? As a Ph.D., I should think so. The other thing is that I am
not here to either inject bias or read it into statements. Glenn took
issue with the Times report on the NICE report, and deemed it inaccurate.
He then posted another article from Singapore as an example of the
pendulum swung too far in the other direction, to which I agreed. Then,
I found a statement that struck me as curious, and which I interpreted as
showing the bias of the authors -- which was decidedly "pro-LASIK."
Could you not see the bias in that article? Apparently not, because you
then charged me with bias on my own part for thinking that the word
"children" could possibly mean, well, children, i.e. non-adults.

I see that you have this idea that bias colors our world, but my world
punishes me for being less than objective. If I blow a diagnosis because
I believe everything the patient tells me rather than my own eyes and my
common sense, I stand to get sued.
>
> Secondly, These were legitimate questions I was asking. Again, my
> work, education, training etc. has nothing to do with the optics of
> the eye. I am a complete layman in these areas. My questions are
> because I'm trying to understand. Isn't true that most dry eye and
> halos resolve during the healing period? What is the definition of
> blindness? I'm not discounting that some people suffer from long term
> complications. But as I read this board, I see more and more evidence
> that it's due to poor pre-screening and the individual's healing
> response. It could be that Singapore's pre-screening process is
> superior to the US.

Agreed. But, my opinion is that a 10% or less reject rate is probably
too low.
>
> Thirdly, I see that you took this all very personally. In fact you
> have made it into a "case." For that I'll offer an apology. I'm
> sorry that you felt you had to take it personally, reply with insults
> and take it to a level where it was never meant to go. I'm sorry that
> I've engaged you in a debate because you haven't been able to
> understand that this wasn't originally about you, but about how
> "objectivity" cannot take place in a forum such as this. After 3
> times, I concede that you will not see this, so I won't bring it up
> again in relation to your posts. But hopefully you and others will
> read things more carefully and think about how you phrase things can
> change, obscure or emphasize meanings in a way the original author
> didn't intend.

Now, why would I take anything personally, like I have ever been the
subject of ad hominem attacks on this NG? Naw, couldn't be me. You've
got me confused with Dr. Leukoma.
>
> But I will still read this NG and post when I feel like asking
> questions to understand an issue more deeply, and comment where I
> think issues are being obscured or slanted by pro- or anti- rhetoric
> or bias.
>

If you have a legitimate question, don't hesitate to ask. By the way, I
don't think that LASIK causes pterygiums. I merely posed the only two
logical possibilities: either that LASIK precipitated it, or that it was
present before, given the slow growth of pterygiums. However, either way
it was rather damning evidence.

DrG

2004-12-16, 9:25 am

In article <Xns95BB5E2FBC7E6DrLeukoma@207.217.125.201>,
"Dr. Leukoma" <drg@leukoma.com> wrote:
>
> I see that you have this idea that bias colors our world, but my world
> punishes me for being less than objective. If I blow a diagnosis because
> I believe everything the patient tells me rather than my own eyes and my
> common sense, I stand to get sued.

That's fascinating because as a patient, I've experienced it the other
way. going for years to the doctor complaining of different symptoms
and because the doctor's eyes and "common sense" overruled my personal
experience, my MS went years undiagnosed. Told it was all in my head.

I would think that because some visual disturbances aren't measurable,
that to be a good doctor, you'd have to put a good deal of weight
towards what the patient says. In fact, I bet there are many extremely
frustrated post-LASIK people who have long term or lingering visual
disturbances because their eye doctors have chosen not to believe them
because they are not measurable.

Furthermore, I would also expect my doctor to "believe" everything I
tell him. Why would I lie? Why start a relationship with a patient in
such an antagonistic way by questioning the veracity of their
description of their own symptoms they want cured??????

> If you have a legitimate question, don't hesitate to ask.

So very kind of you to extend this invitation. I happen to think every
question I've posted is legitimate.

>By the way, I
> don't think that LASIK causes pterygiums. I merely posed the only two
> logical possibilities: either that LASIK precipitated it, or that it was
> present before, given the slow growth of pterygiums.

No, actually you said (and this is the confirmation sentence quoted from
you in a post yesterday): "What I said was either the pterygium was
present before LASIK, or LASIK caused it."

Why do you keep changing your story? It is important what you post,
because as a "doctor" people are going to give some weight to what you
say. Which is it? Is it something people should make sure they are
screened for prior to LASIK?

--
~RT

Dr. Leukoma

2004-12-16, 9:25 am

I guess it's true that you can never win an argument with a child.

DrG

2004-12-16, 9:25 am

In article <Xns95BBB5C0A7493DrLeukoma@207.217.125.201>,
"Dr. Leukoma" <drg@leukoma.com> wrote:

> I guess it's true that you can never win an argument with a child.
>
> DrG

How disappointing to have that be the response to my legitimate
questions that I spent so long composing, but *Dr.* G's certainly
consistently evasive of personal responsibility, if nothing else. Oh
well.

--
~RT

2004-12-16, 9:26 am

On Sat, 11 Dec 2004 06:45:13 GMT, RT <RTMD24@NOSPAMyahoo.com> wrote:

>In article <Xns95BBB5C0A7493DrLeukoma@207.217.125.201>,
> "Dr. Leukoma" <drg@leukoma.com> wrote:
>
>
>How disappointing to have that be the response to my legitimate
>questions that I spent so long composing, but *Dr.* G's certainly
>consistently evasive of personal responsibility, if nothing else. Oh
>well.

Here's another example of how RT and I are very different. RT wastes
his time composing long replies and reading through the diatribes of
Dr. Gemoules doing his tap-dance routine to evade reality.
My primary method of dealing with such useless babble is to click my
mouse button down to the next message.