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Home > Archive > Lasik Eyes Surgery > April 2005 > LASIK Dry Eye Set at 25%, Ectasia Incidence Low at Present
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LASIK Dry Eye Set at 25%, Ectasia Incidence Low at Present
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| gospa68@aol.com 2005-04-19, 10:51 am |
| LONDON - If a patient is going to develop keratectasia after LASIK,
it will usually present within 6 to 20 months after surgery, said one
ophthalmologist speaking here.
David Gartry, MD, FRCS, FRCOphth, noted the rates of ectasia range
from one in 500 up to one in 2,500, and surgeons should be able to
identify those at highest risk of its development. He spoke here on the
complications of refractive surgery and the likelihood of ectasia
development at the Moorfields Bicentenary scientific meeting.
"Risk factors include patients with greater than -8 D, an abnormal
cornea preoperatively, a residual stromal bed of less than 250 =B5m and
low preop pachymetry," he said.
A meta-analysis of 21 published papers dealing with the incidence of
keratectasia showed a majority of patients had a best corrected visual
acuity of 6/7.5 or worse, 1.25 D of astigmatism or more and a residual
myopia of more than 2 D. The residual corneal bed for these patients
was less than 400 =B5m, he said. In addition, he recommended surgeons
keep ablation depths to no more than 80 =B5m.
He said in his own practice he has had three cases of ectasia in more
than 8,500 refractive surgeries. All three patients were asymmetric
although each had undergone bilateral surgery. In one case, a
39-year-old woman underwent bilateral LASIK in 2001. Her initial error
was -8 D/-0.75 x 175, he said. Her pachymetry preoperatively showed
520 =B5m. The ablation depth was 84 =B5m. Her residual stromal bed was
276 =B5m. "So why, 3 years later, did she develop ectasia in one eye
but not in the
fellow eye?" he asked. While he cannot answer his own question, he
advised surgeons presented with patients who do not fall into
his "safe" range to be offered the option of undergoing epi-LASIK
or LASEK instead.
To manage the complication, Dr. Gartry said he uses spectacles,
contact lenses or Intacs (although he said the results for Intacs
are "unreliable"), reduces IOP or sutures the flap edge. In some
cases, corneal grafting may be necessary. He estimated about 10% to 30%
of patients who develop ectasia will require grafting.
"LASIK is still an excellent procedure for low myopes," he said.
"An epidemic of ectasia is unlikely."
The European Society of Cataract and Refractive Surgeons has created a
Web site to collect information about the rates and incidence of
ectasia. It can be found athttp://www.escrs.org/Corneal_Ectasia.asp,
Dr. Gartry said.
He further advised surgeons to avoid advertising complication rates, as
some are now doing in the United States and elsewhere. "Quoting a
complication rate of 0.1% is useless," Dr. Gartry said. "You have
to break it down for the patient." For instance, an overall dry eye
complication rate of 25% is not uncommon, but errors that are
mechanical in nature, such as buttonholes, occur in one in 1,000, and
infection may occur in "one in 7,000 or 8,000," he said.
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| Glenn - USAEyes.org 2005-04-19, 10:51 am |
| According to this doctor, he had 3 cases of ectasia out of 8,500 LASIK
surgeries. That is .035% ectasia complication rate. That's right,
35/100ths of 1 percent complication rate. This is what WizKid has his
knickers in a bunch about.
I would disagree on one issue with the doctor. He stated that LASIK
induced dry eye is about 25%. I believe that is much too low. The
occurrence of LASIK induced dry eye is probably closer to 40-60%,
however it is usually resolved through treatment and/or healing during
the normal six month recovery period. Fewer than 3% of refractive
surgery patients have ANY kind of unresolved complication at six
months postop.
BTW, WizKid. There is only one phakic intraocular lens (P-IOL)
approved in the US. You RAVE about P-IOLs. What is the size of the
incision necessary to implant the Artisan/Verisyse P-IOL approved for
US patients? Do you know or care? How many stitches are required?
Is this important to you? What is the incidence of induced
astigmatism greater than 1.00 diopter by this incision and suturing?
Have you even given this a thought? While we are talking about what
you are thinking about, have you ever thought about the fact that when
the P-IOL is removed - and ALL must be removed if you live long enough
- that another large multiple stitch incision will be required to get
the Artisan/Verisyse out?
P-IOLs are appropriate in some cases, but your fanaticism with a
technique and technology that carries some significant downsides (and
I didn't even mention endothelium cell loss) really seems misplaced.
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.
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| gospa68@aol.com 2005-04-19, 10:51 am |
| I hope that you are going to the same ASCRS sessions that I am. I am
sure that we will bump into each other.
I do not know where you get the idea that I am a fanatic about p-IOLs.
I am not fanatical about any of the existing procedures. P-IOLs are
another alternative with its own set of problems. I find it
interesting, though, that when you address alternatives, you are very
clear about the problems and their extent. This cannot be said about
how you address LASIK. It makes a big difference, as I have seen in
this field, on the source of your income. You can ALWAYS understand a
person's (or an organization's, like CRSQA's) position by following the
money.
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| Ragnar 2005-04-19, 10:51 am |
| That is very very low.. however, I wonder what the ectasia rate of
myopic people who don't have lasik done is. I wouldn't be surprised
if it's the same rate.
On Sun, 17 Apr 2005 00:33:25 GMT, Glenn - USAEyes.org
<glenn.hageleSTOPSPAM@USAEyes.org> wrote:
>According to this doctor, he had 3 cases of ectasia out of 8,500 LASIK
>surgeries. That is .035% ectasia complication rate. That's right,
>35/100ths of 1 percent complication rate. This is what WizKid has his
>knickers in a bunch about.
>
>I would disagree on one issue with the doctor. He stated that LASIK
>induced dry eye is about 25%. I believe that is much too low. The
>occurrence of LASIK induced dry eye is probably closer to 40-60%,
>however it is usually resolved through treatment and/or healing during
>the normal six month recovery period. Fewer than 3% of refractive
>surgery patients have ANY kind of unresolved complication at six
>months postop.
>
>BTW, WizKid. There is only one phakic intraocular lens (P-IOL)
>approved in the US. You RAVE about P-IOLs. What is the size of the
>incision necessary to implant the Artisan/Verisyse P-IOL approved for
>US patients? Do you know or care? How many stitches are required?
>Is this important to you? What is the incidence of induced
>astigmatism greater than 1.00 diopter by this incision and suturing?
>Have you even given this a thought? While we are talking about what
>you are thinking about, have you ever thought about the fact that when
>the P-IOL is removed - and ALL must be removed if you live long enough
>- that another large multiple stitch incision will be required to get
>the Artisan/Verisyse out?
>
>P-IOLs are appropriate in some cases, but your fanaticism with a
>technique and technology that carries some significant downsides (and
>I didn't even mention endothelium cell loss) really seems misplaced.
>
>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.
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| gospa68@aol.com 2005-04-19, 10:51 am |
| Your ignorance of physiology, and eye surgery never ceases to amaze me.
WK
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| Glenn - USAEyes.org 2005-04-19, 10:51 am |
| Since you refuse to identify yourself, WizKid, I'm not sure how I
would know if I bumped into you. Of course, you could bump into me. I
let everyone know who I am, what I do, and even how to contact me.
That allows people who read the information I provide to consider its
validity by its source.
I get the idea that you are a fanatic about P-IOLs by your postings
here, where you decry CRSQA because we brought our concerns regarding
P-IOLs to the attention of the FDA, because you have consistently
remarked that P-IOLs are going to provide a better outcome with every
scenario discussed, and because you have absolutely refused to
acknowledge any of the limitations that I have raised, including those
just mentioned.
I cannot believe that you could say with a straight face that I do not
address the limitations of LASIK or other excimer laser related
refractive surgery procedures. Look at my postings here. Look at the
content of our websites. Such statements are simply foolishness,
WizKid.
CRSQA Certified Refractive Surgeons do ALL kinds of refractive surgery
procedures. In fact, several developed some of the alternatives to
LASIK and/or brought them through the FDA approval process. Get a
grip, WizKid. Do you even know which doctors are affiliated with us?
Your remarks really are a joke, WizKid. You had better hope your
colleagues are never able to tie you to the statements you have made
in this forum, as your credibility would be lower than a snake's
bellybutton.
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.
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| Glenn - USAEyes.org 2005-04-19, 10:51 am |
| Naturally occurring ectasia is almost always associated with
keratoconus, which is a disease of the cornea.
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.
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| gospa68@aol.com 2005-04-19, 10:51 am |
| That is a misleading statement. But then, what more could we expect
from you...WK
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| gospa68@aol.com 2005-04-19, 10:51 am |
| As usual, your short term memory is failing you. While I took you task
for your testimony against the p-IOLs, it was not because I was a
fanatic about them. I was merely pointing out your bias to LASIK as you
did not do the same (and there was plenty to grouse about when it went
to panel) when it went to panel. Your behavior and on-goint commentary
continue to highlight the bias you have. It is remarkable that you can
say you are a patient advocate without breaking into laughter...as we
are.
With regard to your websites and postings, do not worry as they are
being archived. My bet is that there will be a day of judgement when
these will be of great value.
If you feel a thump here, it is me bumping into you.
WK
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| serebel 2005-04-19, 10:51 am |
| Wizzer is a gatherin' , time to circle the wagons.
SErebel
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| Glenn - USAEyes.org 2005-04-19, 10:51 am |
| Well WizKid, if you see anything in our website that is factually
inaccurate and you are willing to substantiate this, please let me
know. I've maintained an open invitation for anyone who thinks we've
got something wrong to show it so we can correct it.
Thus far, I've seen no takers. Lots of opinions, but nobody showing
we are factually inaccurate in anything we present.
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.
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| Glenn - USAEyes.org 2005-04-19, 10:51 am |
| Factually accurate statements are "misleading"? If I'm wrong, please
substantiate where I am wrong so I can correct myself.
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.
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