| Ragnar 2005-11-29, 12:58 pm |
| You almost sound like you know what you are talking about below. You
don't, but it sure sounds impressive.
On 29 Nov 2005 04:56:44 -0800, "Eye" <eyetooamdamaged@yahoo.com>
wrote:
>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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