Lasik Eyes Surgery - Musings of a LASIK surgeon

Author

Musings of a LASIK surgeon

Casey

2005-04-14, 8:42 am

Here it is. You have the author's permission to post it.

There goes the alarm! Long day ahead, so I'll just grab a bagel on my way
out the door. What do I have this morning? At least 8 post-ops. Thank
goodness for co-management, or it would be 40 and I wouldn't have time to
make any money blasting corneas. Oh,I need to have Cindy call the keratome
rep and tell him it's sticking! Cut a short flap yesterday, dammit. I'll
probably get sued. Why oh why do I still do lasik on attorneys????

Well, lemme call Mike. "Hey Mike, my stocks are down again, thanks to that
stinkin' newspaper article on lasik complications. I never hated the
syndication of articles like I do these days. I'm getting calls from all
over the country about this one. Yeah, just sell it all
before they drop even further. I don't see any good news ahead for this
industry. Thanks, buddy. Later."

Hmmm, gotta find out how many eyeballs I'm burning today. "Cindy, how many
surgeries today? 24? Okay, I'll be there shortly." Hmmm, 24 x $5000. Okay,
so $120,000 grosstoday.....that leaves me with only $90,000 for the entire
day's work. Man, I need to talk to a marketing pro. Sales are down, and I am
so close to being able to buy that yacht. I can't wait to surprise the wife
with it. When she sees it, she'll stop giving me such a hard time about
missing dinner every night. Oh well, gotta make my millions now, before more
of
those damned stories about complications come out and dry up the market even
further. What's a little fuzzy vision, anyway? Most of them see far better
unaided than they did before I lasered them. I can't believe the kind of
money all of those ingrates are getting out of lawsuits against us.
Millions!!! What kind of baloney is that???? I'm a great surgeon though. My
patients don't have complications.
Well, a short or buttonhole flap once in a while, DLK rarely now, a little
irregular astigmatism here and there? I have so many grateful patients. They
hug me and kiss me and tell me that I'm a miracle worker. Well, not quite if
you wanna know the TRUTH, but it sure
feels good! Yeah, once in a while I have someone who's pissed off about
their vision. I warned them though--told them there were risks.
Not everyone can expect to have a perfect result. We'll fix up the bad ones
with custom ablation, if and when it ever comes. Guess I'll
call John and see how it's going with his FDA trial.

"John, how's the custom going? Done any mangled ones yet?
Okay.....well.....let me know when you do. I'm anxious to start too. Got a
lot of problems here with irregular astigmatism. See you at ISRS."

"Hello? Hey Cindy, what's up? Who? Oh, Mrs. Wesley. Uh huh. Uh huh. Yeah,
tell her she needs to be seen this morning." Ah, great!
Haze..... Well, it's probably just some edema or dry eye. Could even be
another DLK. Crap. I hate those. Daily followups until it clears. Just more
of my time down the drain. I hope she hasn't been on the internet again.
That damned Surgically Altered Eyes group. What a bunch of idiots, trying to
diagnose each other via a bulletin board! God help the man who damaged Don
Ringleader's eyes and started this whole mess. Refractive surgery used to be
no worries, mate. Now those self-appointed consumer activists are making our
lives miserable! The lengths they will go to: websites, crashing seminars,
whining to the media?. What do they want to do? Kill LASIK? Over mydead
body! There aren't enough serious complications for that.
LASIK is a great procedure. Sure, we don?t know the long-term, but heck,
there's no guarantee that I'll be here in five minutes. Life is full of
risks.

Later...

Yeah, it's shoot my laser time! Two more eyeballs staring at the lights.
Stay on the lights, geek, while I burn, baby, burn. Okay,
please God, let this one go well. He seems nice enough, but you never know
who will turn around and sue you. The blade slices right on through...nice
cut...snap snap snapsnap...vaporize this cornea...plumes of
burnt tissue rising up...fold the flap back over and rinse out as much
debris as I can...a little smoothing....okay, all done! Phew! No problems. I
don't need any more problems.

Next victim! Ah ha. My celebrity patient of the week. I have lasered the
eyes of so many Hollywood stars. I am pretty damn good at
this! Gotta double-check and triple-check my numbers here. If it goes well,
this one might be willing to autograph her photo and let me
hang it on the wall. Heck, maybe she'll even do an infommercial with me if I
pay her enough!

Oops, my pager. Hang on a minute....."George, thanks for calling. I'm really
concerned. We were so hoping that the new website would
get the public away from SurgicallyRuinedEyes.org, LASIKNightmare,
AskLaserJockeys and HornyToad's boards, and convince them that LASIK is
safe. The first thing it did was increase their traffic tenfold!
We should have seen that coming. Just mention the words "complication" or
"risk" and you know people will be typing them into search engines. Well, do
what you can. Emphasize that LASIK is safe and effective, and light-years
ahead of what we were doing even six months ago. Nooooo, George, my
complication rate is about the same as it was three years ago. I'm the best
though, remember? This is about as safe as it gets. It's close enough?

Here we go again! Another pre-op who wants to ask me another bunch of lousy
questions. "Do you sterilize your equipment? Of course. Do
you use a new blade for each patient? Of course. How many cases have you
done? Thousands upon thousands! What is your complication rate? LASIK is
safer than driving your car!? I think it's time that I videotape myself
answering all of this crap and just park these people in front of the
monitor for a few hours so they can watch it after they watch the informed
consent video. I am so sick of answering the same blasted 50 tough questions
over and over and over again! I don't make any money by answering questions
they've found on
the stinkin' internet! I try so hard to hold my tongue and be patient with
these people, but it's really getting old. Do they really think that if they
ask the questions, they are preventing complications? Oh well, I guess if it
makes them feel better and sells the procedure, it is another $5000 in my
pocket.

What's this? Ms. Jones wants me to recheck her microstriae AGAIN??? Aww,
she's not happy with her new 20/20 vision? Guess I'll have to
explain to her that she is a very active focuser and that she needs to relax
and enjoy her new natural vision. I wonder how many times I'll have to tell
people that before I get to retire and move to Tahiti. That will be the
life! No more whiners moaning about their starbursts and glare. No more
worries about wrinkled flaps or ingrowth, or the long-term stuff like
ectasia, regression or anything else these goons will present with in the
future. It will be someone else's problem. Ha ha ha. I'm just about there.
Buy the yacht, buy some more stocks and bonds (of course, none having
anything to do with laser vision correction!), and I'm outta this game. The
great thing about refractive surgery is that I'm guaranteeing my young
colleagues future income. In a few years, regression will make enhancements
so popular
that the second wave of laser vision correction will hit. After all, after
being given a taste of 20/20 without aid for a few years, no one
will be happy going back to contacts or glasses!

I'm still amazed that we managed to get this far. Really, how many
government-regulated industries can pull off having individuals with
financial interests in approval be the ones to vote the approval??? Cracks
me up that we get away with this stuff. We sure have beat the system on this
one. Gotta love the FDA. A few bucks put in the right hands and you get what
you want. It's so true that everything is for
sale if the price is right.

Oh, my favorite cohort on line 2. "Hey, Jay!!! I sent that letter out
yesterday. We've got to stop these guys from doing expert witness
stuff. They are spoiling everything. Not only are they badmouthing our work
as surgeons, but then they take the stand against us in
court! Our own brothers! In fact, I fear that one of them is criticizing my
own work today. Huh? Yeah, really. I did a minus 10 and his flaps crinkled
up--too thin, you know the routine. I've tried relifting, suturing,
everything and can't get the vision decent
again. The patient told me he's making the rounds for second opinions and
he's seeing one of the traitors this afternoon. I guess I'll
offer to pay for repair with the surgeon of his choice and see if that
prevents litigation. It will probably boil down to transplants, but then the
patient should be fine. Nothing I should be sued over!?

Next victim?.I mean, patient! Hmmm, I think the lens on this laser is dirty.
My ablations aren't as smooth as they should be. When was the
last time it was cleaned? Oops, we're overdue. What happened here? "Cindy!!!
Will ya take care of this please? Get this thing cleaned--set it up for next
week." By that time, after another hundred or so surgeries, it will
definitely be responsible for some poorer
outcomes. Nothing too noticeable, I'm sure, but for those active focusers it
could cause some complaints about their acuity. I don't like complaints. I'm
tired of complaints!

I wish I'd bought the Tokiyaki laser. I would not have near the troubles I
have had with this XLIS hunk of junk. I hear that the Tokiyaki jockeys are
using them to clean up the central islands the XLIS makes. Boy, am I glad
that I didn't have my laser used on my own eyes!
Okay...got a couple of complications here from other laser jockeys. Both
with irregular astigmatism and decentered ablations. I never miss. What?s
with these clowns that they can't aim their lasers properly? Well, I'll just
go with the flow. "Your surgeon did a fantastic job. Your flaps look
beautiful and you are healing nicely, but you must have moved during your
surgery or you weren't looking at the lights..the ablations are slightly
off-center. All in all, you really should be seeing better than you say you
are. Let's try the chart again. Please do your best to read each
letter...guess! Is it a P or an F? Come on---you have to be able to read
something. Okay, if this is your best, we'll stop here. I think your eyes
are a little dry. You need to use drops every hour. Custom ablation is
almost ready. We are already doing FDA trials, and soon we'll be treating
patients just like you! In the meantime, you can wear contact lenses and
you'll be just fine. Give my office a call in about six months and I'll be
able to fix you up. You can pay at the front desk and I'm sorry, but we
don't accept any insurance."

Last patient! I'm gonna have to string this one along. I can tell that she
is really getting annoyed with the ghost images and is
thinking legal. "Hello, Ms. Smith! You don't think there's any improvement
yet? Well, at eight months, you're still early in the healing process.
Ghosting is normal this early on. Oh, you don't remember that from the
informed consent form? Well, we cannot list everything imaginable on that
form. There are thousands of lasik patients with a little bit of ghosting in
an eye or two. It's perfectly normal after this procedure and will resolve
on its own with
time. You know, corneas heal very slowly and time is our friend here."

"Hmmm...your eye is looking much better from this side of the slit lamp. Are
you sure your vision has not improved?? Well, let's give it some time...how
about four more months? Then we'll know you're stable and we can evaluate
enhancement surgery. I'm already doing custom ablation and I'm sure it will
take care of all of your problems. Okay? See you then!" (He he, we'll be
past the statute of limitations when I
break the bad news to her that I cannot fix her.)

My buddies are starting to do quite a few PKs after LASIK. Good thing that
corneal transplants are the most successful of all transplant ops. Only a
20% risk of rejection. Heck, they're almost as safe as LASIK and with more
practice , they'll be even safer. Within a year or two, these people have
correctable vision again and can just go back to wearing contacts lenses
like they did before. No big deal.
If they have to take time off work, they can relax and even travel if they
want to. Even some of the worst damage from LASIK is easily
fixed with a transplant! Makes me wonder why so many of these people with
minor fixable complications claim to be depressed and flock to
psychiatrists. Probably very unstable before they had surgery. I really
should start doing some pre-op psychological screening to weed out the
sue-happies.

What a great procedure. There have been a few cases of blindness, but we've
done millions and the majority of our patients are very happy. We are the
heroes of modern medicine!

Well, Porsche baby, let's hit the highway!! 24 zap-a-roosies today. Woohoo!!
In these lean times for lasik surgeons, gotta love a $120,000 day. I'm so
good!

serebel

2005-04-14, 8:42 am

Nice story there Casey. Now can you read us a bedtime story ?
For those who don't know, Casey is a LME loonie who thinks RS is a
crime. Of course Casey had RS but it's not good enough for the little
people.

SErebel

Sandy - LASIKdisaster.com - LASIKmemorial.com

2005-04-19, 10:50 am

It sure sounds like a laser center employee wrote it.

serebel

2005-04-19, 10:50 am

Or something a Keller would dream up. Gotta admit, the loonies do have
great imaginations.

SErebel

Glenn - USAEyes.org

2005-04-19, 10:51 am

Those imaginations are evidenced in just about every post.

Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance

Email to glenn dot hagele at usaeyes dot org

http://www.USAEyes.org
http://www.ComplicatedEyes.org

I am not a doctor.

gospa68@aol.com

2005-04-19, 10:51 am

Real leaders - real heros - find fulfillment, meaning, and, yes, even
success by shifting their gaze beyond self-interest and serving others.
And they become greater - enhanced as persons -by focusing on something
greater than self-interest alone.

Refractive surgery and patients would be better off if surgeons would
adopt this as their mantra.
WK

serebel

2005-04-19, 10:51 am

HIS TRUTH IS MARCHIN' ON!!!

SErebel