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Home > Archive > Lasik Eyes Surgery > November 2005 > Dr. William Trattler - lowering the standard of medical care for large pupil patients?
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Dr. William Trattler - lowering the standard of medical care for large pupil patients?
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| Dr. William Trattler - lowering the standard of medical care for large
pupil patients?
Dr. William Trattler said:
http://www.asklasikdocs.com/forum/main/3700.html
"First..all lasers can now have an ablation zone larger than
6.5mm."
And here is some important clarification:
There is a big difference between the optical zone (also known as the
effective optical zone, EOZ, or full treatment zone) and the ablation
zone, which can include the optical zone plus a blend zone. It is true
that all lasers can have an ablation zone larger than 6.5mm, but the
VISX and ALCON lasers are NOT APPROVED FOR AN OPTICAL ZONE LARGER THAN
6.5mm IN THE UNITED STATES.
If anyone disagrees, please provide a link to the approval order. Just
checked the FDA website, so good luck with that.
If your pupils are 7mm or larger, your effective optical zone will be
smaller than your maximum pupil size if your doctor is US surgeon
following FDA regulations. The B&L laser claims an optical zone
'BETWEEN 6 and 7' - this is the largest approved optical zone in the US
- and they do not claim a full 7mm. Please be aware that optical zones
for multiple reasons.. have a tendency to turn out smaller than the
surgeon planned. Therefore, if you have refractive surgery, you will
likely have unfocused rays of light entering your pupil from the area
that is not fully corrected when ambient light is low. This causes some
nasty visual side-effects that you don't want.
Dr. William Trattler said:
"So all of the lasers can be used for patients with large pupils."
Here is some important clarification:
There is a difference between 'can' and 'should'.
Well, yes.. they CAN be used but large pupil patients may not be happy
with their visual outcome - in fact such surgeries have ruined lives of
large pupil patients. See the Lone Dog's Pupil Primer for Casualty
Prevention:
http://www.lasermyeye.org/keratosco..g31may2003.html
Why have starbursts at all? They are caused by distortions that are
created in the cornea by refractive surgery. All forms of refractive
surgery induce these distortions. The least aberrated corneas you'll
ever have are your virgin (pre-surgery) corneas. Keep your
starburst-free vision, it's truly a gift.
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| I have nothing against Trattler or any other surgeons. The only request
is those with large pupils be informed of the risks of decreased night
vision. If they still go ahead, it was the decision of the patient. I
have huge pupils and have been informed and I realize lasik isnt for
me. Eye, how large are your pupils and hows your night vision?
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| serebel 2005-11-27, 12:59 am |
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Ace wrote:
> I have nothing against Trattler or any other surgeons. The only request
> is those with large pupils be informed of the risks of decreased night
> vision. If they still go ahead, it was the decision of the patient. I
> have huge pupils and have been informed and I realize lasik isnt for
> me.
People are informed of this. Eye is just pissed off of being kicked
off Trattler's site.
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| Ragnar 2005-11-27, 10:59 am |
| It is possible that Trattler has wised up. Some people are able to
learn from mistakes.
On 26 Nov 2005 21:53:28 -0800, "serebel" <serebel@aol.com> wrote:
>
>Ace wrote:
>
>
>
> People are informed of this. Eye is just pissed off of being kicked
>off Trattler's site.
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| By the way, I will stand up for Trattler. He is aware of the importance
of pupil sizes and encourages other surgeons to measure the size of
patients pupils before surgury. I am sure he informs the patients the
risks, especially more so if their pupils happen to be large. The
patients will be aware and informed of ablation zones, off label
treatments and their pupil sizes. Off label doesnt make something
unsafe just because FDA didnt approve it yet. Its much better to get an
8mm zone thats "off label" than a 6mm zone thats "approved" your
results will be much better with the "off label" 8mm zone! As long as
the patient is informed of the risks, there was no wrongdoing. Your
risks of decreased night vision is reduced if you can get an ablation
zone equal or larger than your dilated pupils. I am aware that even
those with smaller pupils arent guaranteed of perfect night vision,
only that their risks are lower. Patients with huge pupils will want to
think long and hard before making their decision. How important is your
ability to see? Is the risks acceptable or not? Again I got nothing
against Trattler
I dont know how large my pupils are, but im gonna estimate 9mm which
would mean ill lose some night vision. How much I lose ill never know
but its not something im going to find out surgically. I am looking
into ortho-k and the doctor said big pupils may complicate results of
ortho-k but since things will revert to the way they were upon stopping
ortho-k for a few days, theres no harm. If im happy with ortho-k, good.
If not, just stop and go back to glasses, simple as that.
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