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Home > Archive > Lasik Eyes Surgery > December 2004 > Refractive success but extreme pain - what's the solution?
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Refractive success but extreme pain - what's the solution?
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| Brent Hanson - LASIKFRAUD.COM 2004-12-16, 9:26 am |
| by Matt Young EyeWorld Staff Writer
One patient who is an apparent refractive success story " he achieved 20/20
vision after LASIK " has had extreme pain since the surgery. Bright
sunlight, cold air, and slight air current cause continuous bilateral pain.
Treatments sought include recommendations by 10 corneal specialists, a
multitude of Food and Drug Administration and non-FDA approved drugs,
bandage lenses, and more.
Some ophthalmologists that heard of this case said it is one of the most
perplexing they have reviewed and has prompted them to discuss the fine line
between psychiatric and ophthalmic treatment.
Ophthalmologists weigh in
Keith Kellum, M.D., clinical assistant professor, Louisiana State
University, New Orleans, said the patient, "had no obvious pathology, yet
he's having severe enough pain that he was willing to enucleate two
perfectly good eyes or kill himself, so I think psychiatric would be very
high" on the treatment list.
A possibility is that the patient has Munchausen's syndrome, a psychiatric
disorder in which the patient seeks out medical care for things that aren't
real, said Kellum, who participated in the Internet discussion on the
patient.
Tory Prestera, M.D., Ph.D., in practice, Prestera Eye Medical Group, San
Diego, said it is "a very unusual case for someone to ask for their eyes to
be removed." The problem partly appears to be psychosomatic, he said.
But Prestera, who also has discussed this case with colleagues, warned
against dismissing the case as psychological. "It's always arrogant for
physicians to assume the patient doesn't have a problem if we can't figure
it out," he said.
Kevin Hinshaw, M.D., Eye Specialists of West County P.C., St. Louis, said
the patient needs a multidisciplinary approach to his problem, which would
include pain treatment and both psychiatric and ophthalmic care.
Solutions for real pain
Hinshaw, who has also discussed the case with colleagues, said a low dose of
anti-depressants could make the patient's pain less severe. Hinshaw draws
his experience in pain relief from his experience as a staff ophthalmologist
at a hospital burn unit.
Selective sympathetic denervation also might be an option, as the patient's
sympathetic nerves could be transmitting erroneous pain signals to his
central nervous system, Hinshaw said.
If the patient was intent on having a surgical procedure, Kellum said he
might consider a corneal transplant to get rid of the portion of the cornea
causing so much pain. The patient might not get perfect vision back, but it
would be "a heck of a lot better than blindness," he said.
Prestera recommended using proparacaine hydrochloride, an anesthetic, to
numb the eye. "It's kind of like walking around with numb feet," Prestera
said of what the eye's sensation would feel like after experiencing
proparacaine.
A retrobulbar injection also could be used to numb the eye and paralyze its
muscles, Prestera said.
Enucleation: If not now, when?
"It would be a hard thing to do, to enucleate two perfectly good seeing
eyes," Kellum said. "I could if I was absolutely convinced that this patient
was going to kill himself if he didn't get the enucleation."
But the usual reasons for enucleation include large malignant tumors and
blind painful eyes, Kellum said.
Prestera added that enucleation could be an option for a blind eye that is
cosmetically displeasing, because it could then be replaced with a glass
eye.
"The problem with this patient is, you always have that doubt in the back of
your mind: Is this just a pure psychological thing going on and you're going
to enucleate two perfectly good eyes that have nothing wrong with them?"
Kellum said.
In other patients that have some type of pathology that is causing pain, an
ophthalmologist may feel more comfortable enucleating.
Hinshaw added that the patient's desire for enucleation "seems a bit
extreme," but if all else failed, might try a penetrating keratoplasty one
eye at a time for a chance of improvement.
Contact Information
Hinshaw: 314-743-0400, fax 314-743-0403, khinshaw@eswcpc.net
Kellum: 800-974-6784, fax 985-868-4190, dr2dk2@kellum-eye-center.com
Prestera: 760-598-0400, fax 760-598-5270, prestera@yahoo.com
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| This reminds me of another patient. She was an award-winning employee
one day, had lasik the next, and disabling severe pain and photophobia
two days later. Do these people just go from normal to crazy in
three days, or could it be that the pain really is extreme and
unbearable? Does it make the doctors feel better to blame it on the
patient's psyche so they don't have to accept responsibility for what
they have done to the patient with their "safe and effective" procedure?
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| markovzorro@doctor.com 2004-12-16, 11:10 am |
| I agree wholeheartedly with my esteemed colleague Dr. Keith Kellum.
Obviously this patient has Munchausen's syndrome, and is seeking out
medical care for things that aren't real. In my practice, I encounter
patients like this almost every day. I've learned to accept this as the
price I have to pay for making large sums of money in the refractive
surgery industry.
Dr. Mark OvZorro
Medical Director, Blinded By The Light Laser Vision Center
"The needs of the many outweigh the needs of the few" -- Spock, Star
Trek
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| serebel 2004-12-16, 10:08 pm |
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Sandy wrote:
> This reminds me of another patient. She was an award-winning
employee
> one day, had lasik the next, and disabling severe pain and
photophobia
> two days later. Do these people just go from normal to crazy in
> three days, or could it be that the pain really is extreme and
> unbearable? Does it make the doctors feel better to blame it on the
> patient's psyche so they don't have to accept responsibility for what
> they have done to the patient with their "safe and effective"
procedure?
Leave it to Sandy to take this guy seriously.
SErebel
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| The Standards suck 2004-12-22, 7:11 pm |
| Ya. I was told it could be psychosomatic by the lieing optometrist.
He had published an article about monocular diplopia and numerous other
studies about lasik complications, but he didn't mention that. Why not?
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| You know, it may be worthwhile using in vivo confocal microscopy for
patients with nerve pain to actually view the corneal nerves, checking
if any abnormalities during surgery or regrowth can be detected. Many
patients report persistent pain after LASIK. I have it. Before medical
professionals start labeling patients as mentally ill, some serious
investigation into the legitimacy of their complaints should be made!
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