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| Dr. Trattler, if you are truly concerned about the effect of pupil size
on refractive surgery outcome, why are you using a laser with an
optical zone of 6.5 mm?
Hint: What is the average scotopic (dark-adapted) pupil size in the
population?
Are you unaware that due to the cosine effect, correction for
astigmatism and the effects of healing, that the effective optical zone
(the fully corrected zone the patient actually ends up with) is usually
smaller than the programmed optical zone (typically termed 'optical
zone'... the INTENDED fully corrected zone exclusive of blend - which
is currently limited by FDA approval to ONLY 6.5 mm maximum in the
United States for the VISX and ALCON lasers)?
The Alcon and VISX lasers 'can be programmed' for larger optical zones,
but this represents an off-label use of these devices. This is not FDA
approved.
Do you routinley perform off-label procedures which increase the
programmed optical zone over the 6.5mm limit approved by the FDA for
the Alcon and VISX lasers (jeepers, hope you have a special informed
consent in every chart if you're doing THAT or every patient who didn't
provide written special permission for you to go 'off label' has
grounds to sue) or are you routinely performing surgeries on patients
which result in an effective optical zone smaller than their scotopic
pupil?
Golly, both of those options sound really unattractive.
Reminder hint: what is the average scotopic pupil size in the
population?
P.S. Does your practice meet the WAVEFRONT CHALLENGE, or are you
inducing distortions that cannot be corrected with glasses in people's
corneas without obtaining their fully informed consent to do so?
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