Lasik Eyes Surgery - Ectasia rate at 9% says ASCRS

Author

Ectasia rate at 9% says ASCRS

LASIKtruth

2005-04-25, 10:51 pm

--------------------------------------------------------------------------------

LASIK volume up more than 25%, ASCRS survey finds

--------------------------------------------------------------------------------

Well, I guess ectasia is something that doesn't resolve in 6 months, Glenn.
And ectasia is the most serious complication of LASIK. 9%. LASIK needs to be
stopped. Now.

WASHINGTON - The volume of LASIK procedures grew 26% from 2003 to 2004,
according to an annual survey of practice preferences presented here at the
American Society of Cataract and Refractive Surgery meeting.

Other notable findings of the survey of U.S. members of ASCRS included an
overwhelming preference for acrylic IOLs, a unanimous interest in
accommodating IOLs and a near-doubling of the use of clear corneal incisions
from 5 years ago.

David V. Leaming, MD, sent his annual survey on general ophthalmic trends to
6,296 physicians; 773 returned the questionnaire. He reported the results of
the survey here in a presentation and a poster.

According to Dr. Leaming, in 2004, 62% of survey respondents used topical
plus intracameral anesthesia in cataract surgery.

Over a 5-year period, from 1999 to 2004, the use of clear corneal incisions
almost doubled, from 40% to 72%, according to survey responses. Surgeons
said they prefer a metal blade to a diamond blade by a two-to-one ratio, Dr.
Leaming reported.

As in recent years, acrylic IOLs remained the preferred IOL material among
respondents, followed by silicone, PMMA and hydrogel. More than half the
respondents - 57% - said they prefer a single-piece foldable IOL

For use with ultrasmall-incision cataract surgery in the future, 38% of
respondents said an acrylic lens is the most promising IOL, and 29% of
respondents said an injectable lens material holds the most promise.

In a change from last year, 61% of respondents said they prefer implanting a
clear IOL rather than a blue-light-filtering IOL. In 2003 47% reported
preferring clear lenses.

The survey also addressed refractive surgery topics. As noted above,
respondents reported an increase in LASIK volume by 26% in the year since
the 2003 survey.

Seventy-five percent of respondents said 250 µm is the threshold for the
residual stromal bed below which they would not perform LASIK.

Asked about what refractive procedures they were interested in adopting, 84%
of respondents said they were not interested in scleral expansion, 49% were
not interested in conductive keratoplasty, 54% were not interested in LASEK
and 50% were interested in phakic IOL implantation.

Respondents said they charge an average $500 additional to perform
customized LASIK over their fee for conventional LASIK.

Dr. Leaming noted that in 2003 respondents said only 9% of patients were
offered wavefront LASIK. In 2004, every patient was offered the option of
wavefront, he said.

The survey respondents reported an overall post-LASIK ectasia rate of 9%.

Regarding glaucoma, the survey posed a series of scenarios and asked what
drug the respondents would prescribe. For first-line therapy in a
45-year-old patient, 60% said they would prescribe prostaglandins if the
patient was blue-eyed with no cardiopulmonary complications, and 77% would
prescribe prostaglandins if the patient had brown eyes and no
cardiopulmonary complications. For a blue-eyed patient with a history of
cardiopulmonary complications 83% would prescribe prostaglandins, and for a
brown-eyed patient, 94%.

Regarding medical liability, 17% of respondents said they pay a malpractice
insurance premium of $10,000 per year; 14% each said they pay $7,500,
$12,500 or $15,000.

Ragnar

2005-04-25, 10:51 pm

This is garbage...9% ectasia rate? That is absurd. Someone made a
mistake in that number.
The ecstasia rates are:
40 to 200 in a hundred thousand for the general population
35 in a hundred thousand for myopic lasik patients
This article below implies
9000 in a hundred thousand for lasik
A slight exaggeration I would say...off by a factor of 257 times!

The actual rate would make it seem like LASIK actually PREVENTS
ecstasia because the rate of post lasik ectasia is lower than even the
lowest estimate of the general population (35 versus 40 per 100,000)
This is because LASIK patients are screened before surgery. LASIK
neither prevents nor causes ecstasia.

Anyone who even would consider the 9000 per hundred thousand figure to
be accurate is too out of touch with reality to be bothered arguing
with.

Anybody with an understanding of the eye and the strength of the
cornea, etc. would know better.

Perhaps the 9% figure represents some temporary swelling in the days
following surgery.

On Mon, 25 Apr 2005 19:50:41 -0400, "LASIKtruth"
<LASIKtruth@Yahoo_nospam.com> wrote:

>--------------------------------------------------------------------------------
>
>LASIK volume up more than 25%, ASCRS survey finds
>
>--------------------------------------------------------------------------------
>
>Well, I guess ectasia is something that doesn't resolve in 6 months, Glenn.
>And ectasia is the most serious complication of LASIK. 9%. LASIK needs to be
>stopped. Now.
>
>WASHINGTON - The volume of LASIK procedures grew 26% from 2003 to 2004,
>according to an annual survey of practice preferences presented here at the
>American Society of Cataract and Refractive Surgery meeting.
>
>Other notable findings of the survey of U.S. members of ASCRS included an
>overwhelming preference for acrylic IOLs, a unanimous interest in
>accommodating IOLs and a near-doubling of the use of clear corneal incisions
>from 5 years ago.
>
>David V. Leaming, MD, sent his annual survey on general ophthalmic trends to
>6,296 physicians; 773 returned the questionnaire. He reported the results of
>the survey here in a presentation and a poster.
>
>According to Dr. Leaming, in 2004, 62% of survey respondents used topical
>plus intracameral anesthesia in cataract surgery.
>
>Over a 5-year period, from 1999 to 2004, the use of clear corneal incisions
>almost doubled, from 40% to 72%, according to survey responses. Surgeons
>said they prefer a metal blade to a diamond blade by a two-to-one ratio, Dr.
>Leaming reported.
>
>As in recent years, acrylic IOLs remained the preferred IOL material among
>respondents, followed by silicone, PMMA and hydrogel. More than half the
>respondents - 57% - said they prefer a single-piece foldable IOL
>
>For use with ultrasmall-incision cataract surgery in the future, 38% of
>respondents said an acrylic lens is the most promising IOL, and 29% of
>respondents said an injectable lens material holds the most promise.
>
>In a change from last year, 61% of respondents said they prefer implanting a
>clear IOL rather than a blue-light-filtering IOL. In 2003 47% reported
>preferring clear lenses.
>
>The survey also addressed refractive surgery topics. As noted above,
>respondents reported an increase in LASIK volume by 26% in the year since
>the 2003 survey.
>
>Seventy-five percent of respondents said 250 µm is the threshold for the
>residual stromal bed below which they would not perform LASIK.
>
>Asked about what refractive procedures they were interested in adopting, 84%
>of respondents said they were not interested in scleral expansion, 49% were
>not interested in conductive keratoplasty, 54% were not interested in LASEK
>and 50% were interested in phakic IOL implantation.
>
>Respondents said they charge an average $500 additional to perform
>customized LASIK over their fee for conventional LASIK.
>
>Dr. Leaming noted that in 2003 respondents said only 9% of patients were
>offered wavefront LASIK. In 2004, every patient was offered the option of
>wavefront, he said.
>
>The survey respondents reported an overall post-LASIK ectasia rate of 9%.
>
>Regarding glaucoma, the survey posed a series of scenarios and asked what
>drug the respondents would prescribe. For first-line therapy in a
>45-year-old patient, 60% said they would prescribe prostaglandins if the
>patient was blue-eyed with no cardiopulmonary complications, and 77% would
>prescribe prostaglandins if the patient had brown eyes and no
>cardiopulmonary complications. For a blue-eyed patient with a history of
>cardiopulmonary complications 83% would prescribe prostaglandins, and for a
>brown-eyed patient, 94%.
>
>Regarding medical liability, 17% of respondents said they pay a malpractice
>insurance premium of $10,000 per year; 14% each said they pay $7,500,
>$12,500 or $15,000.
>

Glenn - USAEyes.org

2005-04-26, 11:49 am

I contacted Dr. Leaming who provided this response:

~~~~~~~~~~~
Dear Mr. Hagele,

There was no question on the 2004 Survey of US ASCRS members where the
post LASIK ectasia rate could be derived. The only question dealing
with ectasia was "How many cases of post LASIK ectasia have occurred
to date (not just last year) where you were the primary surgeon?"
This has nothing to do with rate but with what percent of surgeon have
even seen a case in the years they have been doing refractive surgery.

There was a typo in the answer section of the question in that there
was no "zero" choice. For the most part the data was not even posted
because of that typo.

An estimate of the percent of ASCRS members who have seen ectasia 9%
over the last 8-9 years LASIK has been around was derived but it is
pretty meaningless since we don't know what the time frame was (1-8)
years and we don't know how many skipped the question because there
was no Zero choice in the responses.

The 9% of members who have seen ectasia must have been misinterpreted
from the poster display as a post LASIK ectasia rate which it is not.

In retrospect nothing should have been said about the question since
the answer choices were flawed.

I hope this clears up the miscommunication. I have sent a copy of
this to David Karcher at ASCRS.

Sincerely,
David Leaming MD
~~~~~~~~~~~~~~~~~~~~~

What absolutely amazes me about some people who profess to want to
discover and disclose the "truth" about LASIK and other refractive
surgery procedures is that when something that is so obviously amiss
comes out, rather than investigate the situation to determine
accuracy, they run to publish it on the Internet and point to it as
some sort of justification for their anti-LASIK zealotry.

Take a look at every person who jumped on this bandwagon, from Raj who
posted the article in its entirety at LaserMyEye (bolding the
erroneous 9% statement), to Rebecca who allows it to remain without
rebuke, to WizKid who posted it here, to LASIKTruth who obviously
cares little about the truth about LASIK. As has been shown time and
time again, these people don't care about the truth, they only care
about their own anti-LASIK agenda.

Now all the anti-LASIK zealots need to scurry back into the darkness
because the lights have been turned on.

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.

Ragnar

2005-04-26, 11:49 am

In other words... that 9% figure means nothing at all.

On Tue, 26 Apr 2005 14:11:32 GMT, Glenn - USAEyes.org
<glenn.hageleSTOPSPAM@USAEyes.org> wrote:

>I contacted Dr. Leaming who provided this response:
>
>~~~~~~~~~~~
>Dear Mr. Hagele,
>
>There was no question on the 2004 Survey of US ASCRS members where the
>post LASIK ectasia rate could be derived. The only question dealing
>with ectasia was "How many cases of post LASIK ectasia have occurred
>to date (not just last year) where you were the primary surgeon?"
>This has nothing to do with rate but with what percent of surgeon have
>even seen a case in the years they have been doing refractive surgery.
>
>There was a typo in the answer section of the question in that there
>was no "zero" choice. For the most part the data was not even posted
>because of that typo.
>
>An estimate of the percent of ASCRS members who have seen ectasia 9%
>over the last 8-9 years LASIK has been around was derived but it is
>pretty meaningless since we don't know what the time frame was (1-8)
>years and we don't know how many skipped the question because there
>was no Zero choice in the responses.
>
>The 9% of members who have seen ectasia must have been misinterpreted
>from the poster display as a post LASIK ectasia rate which it is not.
>
>In retrospect nothing should have been said about the question since
>the answer choices were flawed.
>
>I hope this clears up the miscommunication. I have sent a copy of
>this to David Karcher at ASCRS.
>
>Sincerely,
>David Leaming MD
>~~~~~~~~~~~~~~~~~~~~~
>
>What absolutely amazes me about some people who profess to want to
>discover and disclose the "truth" about LASIK and other refractive
>surgery procedures is that when something that is so obviously amiss
>comes out, rather than investigate the situation to determine
>accuracy, they run to publish it on the Internet and point to it as
>some sort of justification for their anti-LASIK zealotry.
>
>Take a look at every person who jumped on this bandwagon, from Raj who
>posted the article in its entirety at LaserMyEye (bolding the
>erroneous 9% statement), to Rebecca who allows it to remain without
>rebuke, to WizKid who posted it here, to LASIKTruth who obviously
>cares little about the truth about LASIK. As has been shown time and
>time again, these people don't care about the truth, they only care
>about their own anti-LASIK agenda.
>
>Now all the anti-LASIK zealots need to scurry back into the darkness
>because the lights have been turned on.
>
>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.

Glenn - USAEyes.org

2005-04-26, 11:49 am

The 9% figure means nothing at all, but who responded and how they
responded does.

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.

Glenn - USAEyes.org

2005-04-26, 5:53 pm

Since I've been doing research on this issue thanks to the erroneous
9% ectasia rate statement, I received this from Jack Holladay, MD:

"The actual computed and actual values are about 1/10,000 (or 0.01%).
These data come from Dan Reinstein presentations and are based on the
1/100 rate of a patients being near the 250 microns limit and the
1/100 chance that the patient is at the high end of the flap thickness
that is 2 SD higher than the average. The actual documents
prevalence is ~ 0.01 % or 1/10,000 cases with a keratome. It should
be even less with the predictability of the Intralase."

Ocular Surgery News, the publisher of the article with the incorrect
LASIK ectasia rate, has corrected the online version of the article
and will publish a clarification next issue.

Perhaps Rebecca at LaserMyEye could correct the copy of the article
with the incorrect ectasia statement she has published on her website
(can you say copyright violation?), rather than just saying she hadn't
noticed the posting on her own website and it must be some sort of
typo.

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.

Ragnar

2005-04-26, 10:59 pm

I see one tiny problem with the post below...
The ectasia rate following LASIK is actually LOWER than the ectasia
rate for the general population. This isn't because lasik prevents
ectasia - its because patients are screened.
Therefore, the rate of intralase isn't likely to be any better nor
worse than the standard lasik patients assuming they are screened with
the same criteria.

The general conclusion is that refractive surgery doesn't cause nor
prevent ecstasia.

On Tue, 26 Apr 2005 19:10:35 GMT, Glenn - USAEyes.org
<glenn.hageleSTOPSPAM@USAEyes.org> wrote:

>Since I've been doing research on this issue thanks to the erroneous
>9% ectasia rate statement, I received this from Jack Holladay, MD:
>
>"The actual computed and actual values are about 1/10,000 (or 0.01%).
>These data come from Dan Reinstein presentations and are based on the
>1/100 rate of a patients being near the 250 microns limit and the
>1/100 chance that the patient is at the high end of the flap thickness
>that is 2 SD higher than the average. The actual documents
>prevalence is ~ 0.01 % or 1/10,000 cases with a keratome. It should
>be even less with the predictability of the Intralase."
>
>Ocular Surgery News, the publisher of the article with the incorrect
>LASIK ectasia rate, has corrected the online version of the article
>and will publish a clarification next issue.
>
>Perhaps Rebecca at LaserMyEye could correct the copy of the article
>with the incorrect ectasia statement she has published on her website
>(can you say copyright violation?), rather than just saying she hadn't
>noticed the posting on her own website and it must be some sort of
>typo.
>
>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.