Lasik Eyes Surgery - What's wrong with lasers today...what would be ideal

Author

What's wrong with lasers today...what would be ideal

gospa68@aol.com

2005-08-09, 9:05 am

TOP STORIES 8/5/2005
Surgeons conceptualize the ideal excimer laser

SEATTLE - It may be a little early to start thinking of holiday gift
ideas, but a few surgeons at the ASCRS Summer Refractive Congress were
sharing their wish lists.

Ronald R. Krueger, MD, Roger F. Steinert, MD, and Karl G. Stonecipher,
MD, were each asked to speak about their "ideal excimer laser" in
their presentations here.

Dr. Krueger said he would optimize the excimer laser spot, eye tracking
system, excimer ablation pattern and delivery, and the ergonomics and
external efficiency.

"The pulse frequency with some of the lasers are increasing, and I
think it would be nice to see most of the lasers coming out to about
400 pulses per second, if possible, in order to decrease the time,"
Dr. Krueger said.

Dr. Krueger cited a study that showed the relationship between spot
size and ablation efficiency.

"As we start going with smaller spots, in order to get a very ideal
shape being ablated, you are going to have to have a very fast tracker
with low latency, and that is still somewhat of a challenge," he
said.

To optimize the eye tracking system, Dr. Krueger said he would prefer a
tracker frequency of greater than 1,000 Hz and a latency of less than 1
millisecond.

A reproducible and accurate wavefront pattern, corneal wavefront
overlap and Q-factor adjustment would also be ideal.

Dr. Krueger said he would incorporate a smart software algorithm or
nomogram with the laser to compensate for biomechanics, wound healing
and environmental factors. He would top it off with a moveable laser
bed, patient auto-alignment and identification, infrared illumination
and foot switch controls in a sequential menu of steps.

Dr. Steinert began his presentation by asking meeting attendees to
mentally perform a rank order evaluation, which is used by marketers to
prioritize needs.

"There really is a thing called Disney university in Orlando, and
they teach this well-known marketing technique, and in Disney they
teach people the magic of how they market," he said.

Dr. Steinert asked the attendees to think about what order Disney would
rank the elements - waiting times, safety in the park, environment
and the shows - and revealed that safety comes first, followed by a
clean environment, the shows and waiting times.

He continued by applying a rank order evaluation to lasers.

"Basic attributes include accuracy, reliability, ease of use,
versatility and cost," he said. "I think that is the order,
actually."

Dr. Steinert said he would like to see a machine that can perform a
wavefront analysis as well as perform the laser treatment.

"Wouldn't you really like get your wavefront done with all of your
patients laying under the same laser instead of measuring in one place
and doing it in another?" he asked.

He said he would also like to see an increase in user-friendly items
that minimize the potential for error as well as an integrated
femtosecond laser.

"Cheap was listed at the bottom of the list, but you can't do
everything I said and make it cheap," he said. However, patient
throughput can be increased, enhancements are decreased, and patients
are happier.

"The ideal system is never going to be achieved, but it is certainly
a worthy goal to pursue," he said. "The properties that increase
accuracy are going to be the most critical. Everything else evolves
from that - reliability, ease of use and versatility. Cheap will take
care of itself."

Dr. Stonecipher said he would like to see real-time outcome analysis
and more speed.

"It's easy to have a wireless integration or link on our analyzers
or topographers," he said. "It would be wonderful if you could do
that in real time under the laser."

"Innovation is the key to success," he said in a presentation
handout. "However, technology can be our best ally in some instances
or, on the other hand, our worst enemy, creating albatrosses around our
neck from which we wish to be detached."

Glenn - USAEyes.org

2005-08-09, 10:59 pm

An important point that may be lost is that the speakers who were
putting up their wish-list are advisors to the laser manufacturers.
These comments did not just fall on the ears of the physician
audience, but are also requested of the R&D people who develop the
technology.

Considering the success rate of refractive surgery with the current
technology, just think what it would be if all these additional
discussed technologies were ultimately integrated.

Glenn Hagele
Executive Director
USAEyes.org

"Consider and Choose With Confidence"

Email to glenn dot hagele at usaeyes dot org

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

I am not a doctor.

serebel

2005-08-10, 10:55 pm

As the technology evolves and outcomes become better and more
predictable, the zealots seem to become even more nutty by the minute.

SErebel

Cathy

2005-08-12, 10:54 pm

I feel like I may vomit. Current lasers are woefully inadequate and these
guys know it.
But they still trash people's vision with their inferior machines. Ever
heard of the Stiles-Crawford
or 'cosine' effect? This phenomenon is a result of lasers not being designed
to treat something round like an
eye. You get maximum ablation near the center where the eye is the highest,
and the treatment falls off rapidly
as the eye curves and is farther and farther away from the laser. This
causes the effective optical zone to almost
always be smaller than the doctor intended, and increases spherical
aberration, which is essentially unfocused
light that enters the eye from the untreated periphery.

LASIK is garbage, the lasers used are garbage... especially VISX which is
one of the worst offenders for undersized optical
zone (that blend zone they promise is not worth a damn). Alcon has had many
published and public problems with their
lasers and they have been sued.

LASIK is a bad surgery performed by greedy individuals on an underinformed
public.
<gospa68@aol.com> wrote in message
news:1123562646.259487.283700@z14g2000cwz.googlegroups.com...
> TOP STORIES 8/5/2005
> Surgeons conceptualize the ideal excimer laser
>
> SEATTLE - It may be a little early to start thinking of holiday gift
> ideas, but a few surgeons at the ASCRS Summer Refractive Congress were
> sharing their wish lists.
>
> Ronald R. Krueger, MD, Roger F. Steinert, MD, and Karl G. Stonecipher,
> MD, were each asked to speak about their "ideal excimer laser" in
> their presentations here.
>
> Dr. Krueger said he would optimize the excimer laser spot, eye tracking
> system, excimer ablation pattern and delivery, and the ergonomics and
> external efficiency.
>
> "The pulse frequency with some of the lasers are increasing, and I
> think it would be nice to see most of the lasers coming out to about
> 400 pulses per second, if possible, in order to decrease the time,"
> Dr. Krueger said.
>
> Dr. Krueger cited a study that showed the relationship between spot
> size and ablation efficiency.
>
> "As we start going with smaller spots, in order to get a very ideal
> shape being ablated, you are going to have to have a very fast tracker
> with low latency, and that is still somewhat of a challenge," he
> said.
>
> To optimize the eye tracking system, Dr. Krueger said he would prefer a
> tracker frequency of greater than 1,000 Hz and a latency of less than 1
> millisecond.
>
> A reproducible and accurate wavefront pattern, corneal wavefront
> overlap and Q-factor adjustment would also be ideal.
>
> Dr. Krueger said he would incorporate a smart software algorithm or
> nomogram with the laser to compensate for biomechanics, wound healing
> and environmental factors. He would top it off with a moveable laser
> bed, patient auto-alignment and identification, infrared illumination
> and foot switch controls in a sequential menu of steps.
>
> Dr. Steinert began his presentation by asking meeting attendees to
> mentally perform a rank order evaluation, which is used by marketers to
> prioritize needs.
>
> "There really is a thing called Disney university in Orlando, and
> they teach this well-known marketing technique, and in Disney they
> teach people the magic of how they market," he said.
>
> Dr. Steinert asked the attendees to think about what order Disney would
> rank the elements - waiting times, safety in the park, environment
> and the shows - and revealed that safety comes first, followed by a
> clean environment, the shows and waiting times.
>
> He continued by applying a rank order evaluation to lasers.
>
> "Basic attributes include accuracy, reliability, ease of use,
> versatility and cost," he said. "I think that is the order,
> actually."
>
> Dr. Steinert said he would like to see a machine that can perform a
> wavefront analysis as well as perform the laser treatment.
>
> "Wouldn't you really like get your wavefront done with all of your
> patients laying under the same laser instead of measuring in one place
> and doing it in another?" he asked.
>
> He said he would also like to see an increase in user-friendly items
> that minimize the potential for error as well as an integrated
> femtosecond laser.
>
> "Cheap was listed at the bottom of the list, but you can't do
> everything I said and make it cheap," he said. However, patient
> throughput can be increased, enhancements are decreased, and patients
> are happier.
>
> "The ideal system is never going to be achieved, but it is certainly
> a worthy goal to pursue," he said. "The properties that increase
> accuracy are going to be the most critical. Everything else evolves
> from that - reliability, ease of use and versatility. Cheap will take
> care of itself."
>
> Dr. Stonecipher said he would like to see real-time outcome analysis
> and more speed.
>
> "It's easy to have a wireless integration or link on our analyzers
> or topographers," he said. "It would be wonderful if you could do
> that in real time under the laser."
>
> "Innovation is the key to success," he said in a presentation
> handout. "However, technology can be our best ally in some instances
> or, on the other hand, our worst enemy, creating albatrosses around our
> neck from which we wish to be detached."
>

serebel

2005-08-12, 10:54 pm

I rest my case!!!

SErebel

Glenn - USAEyes.org

2005-08-13, 11:54 am

The Stiles-Crawford has nothing to do with laser fluence.

The Stiles–Crawford effect is based upon the observation that the
luminous efficiency of light is greater when entering the center of
the eye than when entering the edge of the pupil. It is an optical
property of the cone receptor cells of the retina, which "point"
toward the luminance as a method of compensation.

It is opined, but I don't think it is yet proven, that one of the
reasons some vision problems induced in problematic refractive surgery
or trauma resolve over time is that through the Stiles-Crawford effect
the receptor cells adjust to the fluency that has been altered through
manipulation of the cornea.

Glenn Hagele
Executive Director
USAEyes.org

"Consider and Choose With Confidence"

Email to glenn dot hagele at usaeyes dot org

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

I am not a doctor.