Lasik Eyes Surgery - More On The LASIK Charade

Author

More On The LASIK Charade

gospa68@aol.com

2005-04-08, 10:25 pm

2005 March American Journal of Ophthalmology

39% difficulty driving at night after Lasik

S13.6-0950-1005 functional outcome and patient satisfaction after
LASIK for correction of myopia

N=2E Tahzib, F. Eggink, V. Nabar, R. Nuijts

Department of Ophthalmology, Academic Hospital Maastricht, Netherlands

Purpose: To determine patient satisfaction and self-perceived quality
of vision after LASIK to correct myopia.

Methods: A validated questionnaire was used. Seven scales of quality of
vision were formulated including global satisfaction, quality of
uncorrected and corrected vision, quality of night vision, glare,
day-and night driving. Main outcome measures: Responses by patients to
individual questions and scale scores and correlations with clinical
parameters including refractive outcome, UCVA, BCVA, ablation depth,
and scotopic pupil-ablation zone disparity were obtained for 142
consecutive patients.

Results: The mean score for the overall satisfaction was 4.1=B1 0.71
(scale 0-5). 92.2% of patients were satisfied with surgery, 93.6%
considered their main goal of surgery achieved and 92.3% would undergo
LASIK again. Satisfaction with uncorrected vision was 3.03=B1 0.71. The
mean glare score was 3.0=B1 0.9. Glare at night was believed to be more
important than before surgery by 47.2%. Glare from oncoming headlights
after surgery was reported by 58.4%, and was believed to be more
bothersome for night driving than before surgery by 52.8%. Night
driving was rated more difficult than before surgery by 39.4%, while
59.3% had less difficulty driving at night. There was a significant
correlation between the global satisfaction and postoperative spherical
equivalent (p=3D0.003) and between uncorrected vision score and
postoperative astigmatism (p=3D0.001). No correlation was found between
glare or night vision and ablation depth or scotopic pupil-ablation
zone disparity.

Conclusion: The overall satisfaction after LASIK for correction of
myopia is excellent. Glare and night vision disturbances influencing
the quality of night driving constitute significant secondary effects.

CatmanX

2005-04-08, 10:25 pm

Where is the charade?

94% are happy and would do it again, even though 30-40% have more night
vision disturbances, and 24-30% have worse dry eye problems. THe end
result is that these problems are insufficient to detract from the
benefits of RS, hence the high satisfaction rating.

The important thing is to at least be aware that these are issues and
ensure RS candidates are aware of the potential problems, trying to
weed out those who may not be willing to put up with these problems or
have underlying issues that may be exacerbated.

grant

serebel

2005-04-08, 10:25 pm

I doubt that 30-40% have night vision problems. I think you pulled that
one out of a hat. I do think that probably 100% have drier eyes. That
doesn't mean it becomes a problem though. As opposed to lasik's
infancy, people are way more informed now. The people on the ledges
should come back inside and close the window.

SErebel

CatmanX

2005-04-08, 10:25 pm

OK, SE, try: http://www.fda.gov/cdrh/pdf/P990027S002b.pdf page 17
table 12, 36.6% worse night driving vision at 6 months post surgery,
37.1% worse vision in dim lighting. Report is B&L Tecnnolas 217A
Exciner Laser system.

http://www.fda.gov/cdrh/pdf/P970043S010b.pdf Alcon Ladarvision 4000
Excimer Laser System table 18, page 20, 18.4% night driving vision
worse than preRS, 16.9% Fluctuation of vision, 16.2% dryness worse than
preRS 6 months after RS.

The companies that produce the lasers acknowledge that there are
problems. I can't see the table here, but I can remember reading one
report that showed similar results, and had an added table with patient
satisfaction, which showed that 94% were happy, extremely happy or
neutral about their surgery. So While 40% had driving issues, 30% had
worse dryness after 6 months, only 6% were unhappy with the process.

My point is that this is still not the perfect treatment, problems do
exist at levels that surgeons do not acknowledge.Patients should be
preinformed of complications (as happens at most clinics now) and
proper and complete preevaluation is performed.

Ragnar

2005-04-08, 10:25 pm

Thanks for posting that link.
That study was on 154 patients that had LASIK 6 years ago on the
Technolas laser system. In other words, that study is irrelevant to
anybody currently having surgery done. I'm not aware of anybody in my
region using the Technolas system and I check just about all of them
out.

What is your problem with LASIK? You are making a fool of yourself
trying to dig up anything negative you can on it to scare people.

On 8 Apr 2005 04:03:23 -0700, "CatmanX" <grantm@connexus.net.au>
wrote:

>OK, SE, try: http://www.fda.gov/cdrh/pdf/P990027S002b.pdf page 17
>table 12, 36.6% worse night driving vision at 6 months post surgery,
>37.1% worse vision in dim lighting. Report is B&L Tecnnolas 217A
>Exciner Laser system.
>
>http://www.fda.gov/cdrh/pdf/P970043S010b.pdf Alcon Ladarvision 4000
>Excimer Laser System table 18, page 20, 18.4% night driving vision
>worse than preRS, 16.9% Fluctuation of vision, 16.2% dryness worse than
>preRS 6 months after RS.
>
>The companies that produce the lasers acknowledge that there are
>problems. I can't see the table here, but I can remember reading one
>report that showed similar results, and had an added table with patient
>satisfaction, which showed that 94% were happy, extremely happy or
>neutral about their surgery. So While 40% had driving issues, 30% had
>worse dryness after 6 months, only 6% were unhappy with the process.
>
>My point is that this is still not the perfect treatment, problems do
>exist at levels that surgeons do not acknowledge.Patients should be
>preinformed of complications (as happens at most clinics now) and
>proper and complete preevaluation is performed.

serebel

2005-04-08, 10:25 pm

He can't quite get that SE spin out of his system.

SErebel

CatmanX

2005-04-11, 6:14 pm

I am sorry. You asked why I quote 30-40% and I give you 2 studies by
laser manufacturers. THis has nothing to do with SE spin, it has a lot
to do with a bunch of ignorant tossers who refuse to acknowledge
anything put in front of them, even when they ask for it.

Can you show me some proof that 3% is the complication rate that has
not come from a refractive surgeon?

serebel

2005-04-11, 6:14 pm

How on Earth would 154 patients out of millions comprise a scientific
study?

SErebel

CatmanX

2005-04-11, 6:14 pm

How does any report in journals by an ophthalmologist represent a
scientific study when it is inherently biased?????

154 patients does represent an accurate study as long as the
statistical components are correctly monitored. Given this was for an
FDA submission, the sample was set by the FDA as to what they
determined to be a sufficient size. Blame your government agencies if
you are not satisfied with this, I had no part in it.

The first thing you want to look at is what an ophthal determines to be
a complication. Dry eye? No they don't consider that a complication.
Poor vision? No not a complication either. The only thing ophthals
classify as a complication are surgical and post surgical problems such
as flap tear, epithelial debridemaent, dlk and so on.

Ophthalmology does not see any patient issues as complications.
Unfortunately, bunnies like me get to see these after the ophthal has
dismissed the problem as irrelevant.

You still don't get my point on all of this SErebel. It is that other
things are going on and these are not addressed fully. While most (yes,
I said most) people adapt to the dryness, glare, flaring etc. some
don't and it is the RS industry's responsibility to work out fixes for
these problems. Improved treatments have certainly fixed some of the
optical issues, but the treatments are not perfect yet. There is the
dry eye problem still to contend with, and I have about 40 patients I
am currently dealing with who are fine in every other way except for
chronic dry eye problems, 2, 3 and up to 7 years post RS. I simply want
the industry to acknowledge this does in fact occur and look at ways of
resolving the problems.

serebel

2005-04-11, 6:14 pm

I will agree that the RS industry should be cleaner. But the affected
bears the responsibility to help themselves also. How does someone
whining on say, the SE BB for years help anyone, let alone themselves?
Those long term whiners just do it to hear themselves. At least your
patients are proactive and doing something. Years of moaning on an
internet BB should tell you something.

SErebel

CatmanX

2005-04-11, 6:14 pm

Yes, you can argue that bleating on the BB and not seeking solutions is
not the right way to go. A BB such as SE is a way people can find
beginnings, doctors, help, solace, but yes, it can be pretty annoying
dealing with the same problem for months on end. Sometimes, you have to
bite your tongue and continue to try. There is also the killfile which
works well.

grant

Ragnar

2005-04-11, 6:14 pm

The study you posted was of lasik procedures done 7 years ago on the
technolas laser system which is not used by anyone I can think of.

That 3% complication rate number is also old and obsolete. Glenn came
up with that one. The complication rate is actually much lower than
that and he needs to re-evaluate it.

On 9 Apr 2005 05:20:19 -0700, "CatmanX" <grantm@connexus.net.au>
wrote:

>I am sorry. You asked why I quote 30-40% and I give you 2 studies by
>laser manufacturers. THis has nothing to do with SE spin, it has a lot
>to do with a bunch of ignorant tossers who refuse to acknowledge
>anything put in front of them, even when they ask for it.
>
>Can you show me some proof that 3% is the complication rate that has
>not come from a refractive surgeon?

Ragnar

2005-04-11, 6:14 pm

yeah.. and 154 patiens... 7 years ago.. on a laser system that nobody
uses anymore.

On 9 Apr 2005 21:42:57 -0700, "serebel" <serebel@aol.com> wrote:

>How on Earth would 154 patients out of millions comprise a scientific
>study?
>
>SErebel

Ragnar

2005-04-11, 6:14 pm

There you go with your Dry Eye claim again. Dryness does not equal
dry eye Grant. Write that down.

On 9 Apr 2005 23:01:42 -0700, "CatmanX" <grantm@connexus.net.au>
wrote:

>How does any report in journals by an ophthalmologist represent a
>scientific study when it is inherently biased?????
>
>154 patients does represent an accurate study as long as the
>statistical components are correctly monitored. Given this was for an
>FDA submission, the sample was set by the FDA as to what they
>determined to be a sufficient size. Blame your government agencies if
>you are not satisfied with this, I had no part in it.
>
>The first thing you want to look at is what an ophthal determines to be
>a complication. Dry eye? No they don't consider that a complication.
>Poor vision? No not a complication either. The only thing ophthals
>classify as a complication are surgical and post surgical problems such
>as flap tear, epithelial debridemaent, dlk and so on.
>
>Ophthalmology does not see any patient issues as complications.
>Unfortunately, bunnies like me get to see these after the ophthal has
>dismissed the problem as irrelevant.
>
>You still don't get my point on all of this SErebel. It is that other
>things are going on and these are not addressed fully. While most (yes,
>I said most) people adapt to the dryness, glare, flaring etc. some
>don't and it is the RS industry's responsibility to work out fixes for
>these problems. Improved treatments have certainly fixed some of the
>optical issues, but the treatments are not perfect yet. There is the
>dry eye problem still to contend with, and I have about 40 patients I
>am currently dealing with who are fine in every other way except for
>chronic dry eye problems, 2, 3 and up to 7 years post RS. I simply want
>the industry to acknowledge this does in fact occur and look at ways of
>resolving the problems.