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Read The LASIK Report BEFORE you decide to have surgery
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| southeasteyecare@hotmail.com 2006-10-14, 4:28 pm |
| The LASIK Report
Exposes the LASIK industry for hiding complications from the public.
Demonstrates that the FDA puts industry interests ahead of protecting
public health. Discusses new LASIK technologies, how they fail to live
up to the hype. Calls for the discontinuation of an unnecessary surgery
that causes permanent damage to the eyes of every patient, and provides
references to scientific studies that prove LASIK's harmful effects.
Many of the studies cited were conducted by the most well-known, highly
regarded LASIK surgeons in the industry.
THE LASIK REPORT
A Call for the Discontinuation of a Harmful Procedure
August, 2006
LASIK is one of the most commonly performed elective surgeries in the
United States today. The public perception of LASIK is based largely on
advertising, which is intended to entice patients to have surgery
without disclosing risks, side effects and contraindications.
The perceived benefits of LASIK surgery are obvious, whereas risks and
adverse effects are not. It is unwise to assume that a surgeon who has
a financial interest in a patient's decision to have LASIK will
provide adequate informed consent.
LASIK is irreversible and may result in long-term, debilitating
complications. There are permanent adverse effects of LASIK in 100% of
cases, even in the absence of clinically significant complications.
This is unacceptable in the context of an elective surgery when safer
alternatives such as glasses or contact lenses exist.
I. BACKGROUND
In 1998, when the first laser received FDA approval for LASIK, little
was known about complications and long-term safety of the procedure.
Early clinical trials did not thoroughly examine adverse effects of
LASIK.
Since that time, numerous medical studies have examined the risks of
LASIK. It is now widely reported in ophthalmic medical journals that
complications such as dry eye and visual disturbances in low light are
common, and that creation of the corneal flap permanently compromises
tensile strength and biomechanical integrity of the cornea.
In 1999 during the initial boom in popularity of LASIK, Marguerite B.
McDonald, noted refractive surgeon and then-Chief Medical Editor of
EyeWorld magazine, stated in an editorial:
"We are only starting to ride the enormous growth curve of LASIK in
this country. There will be more than enough surgeries for everyone to
benefit if we keep our heads by sharing information openly and honestly
and by resisting the temptation to criticize the work of our colleagues
when we are offering a second opinion to a patient with a suboptimal
result. Who was it who said, 'When the tide comes in, all the boats
in the harbor go up?' "
Today some prominent refractive surgeons are finding superior outcomes
and better safety profiles with surface ablations such as PRK and
LASEK, which avoid creation of a corneal flap. Yet LASIK continues to
be the most common refractive surgical procedure performed.
II. DRY EYE
A report by the American Academy of Ophthalmology published in 2002
stated that dry eye is the most common complication of LASIK surgery.1
Refractive surgeons are aware that LASIK induces dry eye, yet patients
are not receiving full informed consent as to the etiology, chronic
nature and severity of this condition.
"My LASIK dry eye is not a minor problem, as downplayed by some
ophthalmologists. It's a disability. I estimate that I am blind
approximately 10 percent of the time due to my eyes being closed
because of the pain. At the time of my surgery, I was told only a small
number of patients experience a complication from this procedure. There
is substantial evidence that shows this crippling side effect to be
relatively common." LASIK patient, David Shell, testifying before the
FDA Ophthalmic Devices Panel in August, 2002.
Persistent Dry Eye and Quality of Life after LASIK
Patients elect to undergo LASIK surgery with the expectation of
improved quality of life. Instead, many are living with chronic pain
from LASIK-induced dry eye. The FDA website states that dry eyes after
LASIK may be permanent (http://www.fda.gov/cdrh/LASIK/risks.htm).
Patients should be informed that LASIK surgery severs corneal nerves
that play a crucial role in tear production, and that these nerves do
not return to normal. Inability to sense and respond to dryness may
lead to ocular surface damage.
Medical Research on the Duration and Severity of Dry Eye
Dry eye disease is a painful, chronic condition for some patients after
LASIK surgery. In 2001, Hovanesian, Shah, and Maloney found that 48% of
LASIK patients reported symptoms of dryness at least 6 months after
surgery, including soreness, sharp pain and eyelid sticking to the
eyeball.2
A Mayo Clinic study published in 2004 demonstrates that 3 years after
LASIK corneal nerves are less than 60% of preoperative densities.3
In 2006, researchers at Baylor college of Medicine reported the
incidence of dry eyes six months after LASIK at 36% overall and 41% in
eyes with superior-hinges.4 These findings were based on objective
medical tests rather than patient questionnaires, which is significant
as patients with nerve damage may not be capable of sensing dryness.
The scientific literature is replete with case reports and studies of
LASIK-induced dry eye. This complication is widely recognized in the
industry as the most common complaint of LASIK patients, yet the
problem is downplayed in the informed consent process. Most dry eye
therapies provide only marginally effective symptomatic relief. There
is no cure for LASIK-induced dry eye. Internet bulletin boards with
forums devoted to post-LASIK dry eye are a testament to this
widespread, debilitating condition.
III. NIGHT VISION IMPAIRMENT
Millions of LASIK surgeries have been performed in the United States
since its approval in 1998. Many patients now suffer from visual
impairment at night. Some of these patients, especially those with
large pupils, are unsafe to drive at night and can no longer live
normal, independent lives.
"When I drive to work every day, fighting the DC traffic I hear lots
of great advertisements including the advertisements from the center
that did my surgery talking about 95, 98 percent, whatever the
percentage is of their patients who achieve 20/20 or 20/40 or better
vision, and they consider that a success. I am considered a success by
that criteria as well. However, in anything but extremely bright
daylight I am visually impaired by starbursts, halos, multiple ghost
images because of LASIK done on my 8-millimeter pupils... FDA approval
of devices should include not only approval within a certain range of
myopia or astigmatism or hyperopia but within a range of pupil sizes
such that any use of that device outside of that pupil size should be
considered against the FDA approval of that device...". LASIK
patient, Mitch Ferro, testifying before the FDA Ophthalmic Devices
Panel in July, 1999.
Unfortunately the FDA turned a deaf ear on this recommendation and did
not place a pupil size limit on the approval, nor did it include large
pupils in the list of LASIK contraindications. Instead, the FDA
approved lasers for LASIK with watered-down cautionary language in the
labeling regarding large pupils. Dissemination of this labeling to
patients was mandated by the FDA but not enforced, which violated the
right to full informed consent for many patients with large pupils.
Reduced visual quality in dim light is frequently reported by LASIK
patients.1 Patients with pupils that dilate larger than the effective
optical zone of the LASIK treatment are at increased risk for
debilitating visual aberrations and loss of contrast sensitivity.5 Even
patients with normal pupil sizes are at risk, as the laser loses
efficiency on the slope of the cornea resulting in an effective optical
zone that is smaller than intended.6 Newer laser technologies attempt
to compensate by applying more laser energy in the periphery of the
ablation, but this technique removes more corneal tissue, increasing
the risk of surgically-induced keratectasia.7
In a study published in 2004, dark-adapted pupil sizes of candidates
for refractive surgery were found to range from 4.3 to 8.9 mm with a
mean diameter of 6.5 mm.8 This finding explains why many patients had
severe nighttime visual aberrations in the early days of
photorefractive keratectomy when optical zones as small as 4 mm were
used. In an attempt to overcome pupil size/optical zone mismatch, the
standard treatment zone was increased incrementally over several years.
However, even the 6.5 mm optical zone commonly used today does not
prevent aberrations in many patients with large pupils, or high
corrections and associated small effective optical zones.
Image degradation and visual aberrations in low light after LASIK were
predictable. These problems had been widely recognized and reported
with previous refractive surgeries such as radial keratotomy (RK) and
photorefractive keratectomy (PRK), and were related to pupil size.9 If
refractive power is not consistent across the entire diameter of the
pupil, visual aberrations and loss of contrast sensitivity result.
After cataract surgery or refractive lens exchange, patients also
report poor vision at night when the pupil dilates. As phakic IOLs
begin to replace LASIK for high myopia due to safety concerns, the
pattern of patients with large pupils experiencing night vision
disturbances is consistent.
Public Health Concerns following LASIK Surgery
Dr. Leo Maguire forewarned of the threat to public health posed by
impaired vision following refractive surgery.10 The following is an
excerpt from an editorial published in the March, 1994 edition of
American Journal of Ophthalmology:
"I hope the reader will now understand how a patient may have
clinically acceptable 20/20 visual acuity in the daytime and still
suffer from clinically dangerous visual aberration at night if that
patient's visual system must cope with an altered refractive error,
increased glare, poorer contrast discrimination, and preferentially
degraded peripheral vision. People die at night in motor vehicle
accidents four times as frequently as they do during the day, and these
figures are adjusted for miles driven. Night driving presents a
hazardous visual experience to adults without aberrations. When we
discuss aberration at night we are considering a possible morbid effect
of refractive surgery."
A Brief Chronology of Scientific Literature on Night Vision Impairment
after Corneal Refractive Surgery
Factors responsible for visual impairment in low light following
refractive surgery have been discussed in articles and reported in
peer-reviewed studies for nearly two decades.
1987 "For a patient to have a zone of glare-free vision centered on
the point of fixation, the optical zone of the cornea must be larger
than the entrance pupil. The larger the optical zone, the larger the
field of glare-free vision."11
1993 "Optical zone diameters must be at least as large as the
entrance pupil diameter to preclude glare at the fovea, and larger than
the entrance pupil to preclude parafoveal glare."12
1996 "At nighttime, when the pupil dilates, rays from treated and
untreated areas of the cornea reach the retina at different foci and
produce haloes."13
1997 "Corneal modulation transfer function calculations suggest that
a significant loss of visual performance should be anticipated
following photorefractive keratectomy, the effect being the greatest
for large pupil diameters."14
1998 "...after PRK, the diameter of the entrance pupil greatly
affects the amount and character of the aberrations..."15
1999 "Changes in functional vision worsen as the target contrast
diminishes and the pupil size increases."16
2000 "The increase in ocular aberrations was significantly related
with the virtual pupil size."17
"Thus, an optical system may have no refractive error in the center
of the pupil and an increasing error in the annular zones surrounding
the pupil center. The resultant image may be sharp for small pupil
diameters but degrade as the pupil expands."18
2002 "The relation between pupil size and the optical clear zone are
most important in minimizing these disturbances in RK. In PRK and
LASIK, pupil size and the ablation diameter size and location are the
major factors involved." 19
The LASIK industry failed to take corrective action in response to
scientific evidence regarding the importance of matching the effective
optical zone to a patient's pupil size. As a result, many LASIK
patients are now permanently visually impaired in dim light.
IV. IATROGENIC KERATECTASIA
The cornea is under constant stress from normal intraocular pressure
pushing outward. The collagen bands of the cornea provide its form and
biomechanical strength. LASIK thins the cornea and severs collagen
bands, permanently weakening the cornea. This results in forward
bulging of the cornea, which may progress to a condition known as
keratectasia, characterized by loss of best corrected vision and
possible corneal failure requiring corneal transplant.
The FDA, laser manufacturers, and refractive surgeons are aware of
limits on flap thickness, ablation depth, and diameter of the optical
zone imposed by corneal biomechanics. When the FDA initially approved
lasers for LASIK, it established a minimum of 250 microns of corneal
tissue under the flap after LASIK surgery to prevent corneal
instability and progressive forward bulging. Subsequent reports in
medical literature indicate that 250 microns is not sufficient to
ensure corneal biomechanical stability.20,21 In response, some surgeons
stopped performing LASIK or raised the residual stromal thickness limit
in their practices. However, the majority of surgeons continue to
observe the 250 micron rule initially established by the FDA, even
though this limit has been shown to be insufficient.
The 250 micron rule is often violated inadvertently during surgery, as
microkeratomes that cut the LASIK flap are unpredictable and produce
flaps of varying thickness.22 For this reason, flap thickness should be
measured intraoperatively. Most surgeons have not incorporated this
important measurement into the surgical procedure prior to ablation,
which places patients with thicker flaps at increased risk.
Keratectasia may develop months or years following LASIK.23 Since most
cases are never reported, the true rate of this devastating
complication may never be known. The safest solution for patients would
be to abandon LASIK altogether. It is important to remember that LASIK
is elective surgery. There is no sound medical reason to place patients
at risk of vision loss from unnecessary surgery.
V. LIMITED HEALING OF THE CORNEA FOLLOWING LASIK
The human cornea is incapable of complete wound healing after LASIK
surgery. In 2005, researchers at Emory university found permanent
pathologic changes in all post-LASIK corneas examined, including
undulation of Bowman's layer, spatial separation of the LASIK flap from
the stromal bed, epithelial thickening over the wound margin, interface
debris, and severed and severely disordered collagen fibrils.24 The
study reveals that the healing response never completely regenerates
normal corneal stroma.
Another recent study demonstrates that the LASIK flap produces a scar
at the margin that is only 28.1% of the tensile strength of normal
corneal stroma, and the flap itself heals to only 2.4% of normal
tensile strength.25 The article reports that one author has lifted
LASIK flaps out to 11 years after initial surgery, further attesting to
long-term weakness of the LASIK interface wound. Reports of late flap
dislocations suggest that LASIK patients are vulnerable to traumatic
flap injury for life. 26
VI. OTHER COMPLICATIONS AND CONCERNS
Potential Complications
Other vision-threatening complications are seen following LASIK surgery
such as infection, retinal breaks and detachment, macular holes and
hemorrhage, optic nerve damage, diffuse lamellar keratitis, irregular
flaps, flap folds and striae, slipped flaps, epithelial defects, and
epithelial ingrowth. These and other complications may have severe,
lasting adverse effects.
Inaccurate IOP Measurement after LASIK
The changes in corneal thickness and curvature following LASIK affect
intraocular pressure measurements, resulting in falsely low readings.
LASIK patients face lifetime risk of undiagnosed high intraocular
pressure (glaucoma), a leading cause of blindness.
Cataract Surgery after LASIK
Like the general population, LASIK patients will develop cataracts
later in life. The altered corneal surface following LASIK prevents
accurate measurement of intraocular lens power for cataract surgery.
This may result in a "refractive surprise" for LASIK patients
following cataract surgery and exposes them to increased risk of repeat
surgeries.
LASIK Results in Loss of Near Vision
Patients are routinely misinformed that they will require reading
glasses after the age of 40 whether they have LASIK or not. Nearsighted
patients who do not have refractive surgery actually retain the ability
to see up close naturally after the age of 40 simply by removing their
glasses. LASIK increases the need for reading glasses by changing the
eye's focus from near to distance. The loss of near vision after
myopic-LASIK affects many daily activities, not just reading. LASIK
patients over the age of 40 may discover they have simply traded one
pair of glasses for another.
| |
|
| achooo... sorry... I am allergic to bullshit
<southeasteyecare@hotmail.com> wrote in message
news:1160843789.914924.203440@m7g2000cwm.googlegroups.com...
> The LASIK Report
>
> Exposes the LASIK industry for hiding complications from the public.
> Demonstrates that the FDA puts industry interests ahead of protecting
> public health. Discusses new LASIK technologies, how they fail to live
> up to the hype. Calls for the discontinuation of an unnecessary surgery
> that causes permanent damage to the eyes of every patient, and provides
> references to scientific studies that prove LASIK's harmful effects.
> Many of the studies cited were conducted by the most well-known, highly
> regarded LASIK surgeons in the industry.
>
> THE LASIK REPORT
>
> A Call for the Discontinuation of a Harmful Procedure
> August, 2006
>
> LASIK is one of the most commonly performed elective surgeries in the
> United States today. The public perception of LASIK is based largely on
> advertising, which is intended to entice patients to have surgery
> without disclosing risks, side effects and contraindications.
>
> The perceived benefits of LASIK surgery are obvious, whereas risks and
> adverse effects are not. It is unwise to assume that a surgeon who has
> a financial interest in a patient's decision to have LASIK will
> provide adequate informed consent.
>
> LASIK is irreversible and may result in long-term, debilitating
> complications. There are permanent adverse effects of LASIK in 100% of
> cases, even in the absence of clinically significant complications.
> This is unacceptable in the context of an elective surgery when safer
> alternatives such as glasses or contact lenses exist.
>
> I. BACKGROUND
>
> In 1998, when the first laser received FDA approval for LASIK, little
> was known about complications and long-term safety of the procedure.
> Early clinical trials did not thoroughly examine adverse effects of
> LASIK.
>
> Since that time, numerous medical studies have examined the risks of
> LASIK. It is now widely reported in ophthalmic medical journals that
> complications such as dry eye and visual disturbances in low light are
> common, and that creation of the corneal flap permanently compromises
> tensile strength and biomechanical integrity of the cornea.
>
> In 1999 during the initial boom in popularity of LASIK, Marguerite B.
> McDonald, noted refractive surgeon and then-Chief Medical Editor of
> EyeWorld magazine, stated in an editorial:
> "We are only starting to ride the enormous growth curve of LASIK in
> this country. There will be more than enough surgeries for everyone to
> benefit if we keep our heads by sharing information openly and honestly
> and by resisting the temptation to criticize the work of our colleagues
> when we are offering a second opinion to a patient with a suboptimal
> result. Who was it who said, 'When the tide comes in, all the boats
> in the harbor go up?' "
>
> Today some prominent refractive surgeons are finding superior outcomes
> and better safety profiles with surface ablations such as PRK and
> LASEK, which avoid creation of a corneal flap. Yet LASIK continues to
> be the most common refractive surgical procedure performed.
>
>
> II. DRY EYE
>
> A report by the American Academy of Ophthalmology published in 2002
> stated that dry eye is the most common complication of LASIK surgery.1
> Refractive surgeons are aware that LASIK induces dry eye, yet patients
> are not receiving full informed consent as to the etiology, chronic
> nature and severity of this condition.
>
> "My LASIK dry eye is not a minor problem, as downplayed by some
> ophthalmologists. It's a disability. I estimate that I am blind
> approximately 10 percent of the time due to my eyes being closed
> because of the pain. At the time of my surgery, I was told only a small
> number of patients experience a complication from this procedure. There
> is substantial evidence that shows this crippling side effect to be
> relatively common." LASIK patient, David Shell, testifying before the
> FDA Ophthalmic Devices Panel in August, 2002.
>
> Persistent Dry Eye and Quality of Life after LASIK
>
> Patients elect to undergo LASIK surgery with the expectation of
> improved quality of life. Instead, many are living with chronic pain
> from LASIK-induced dry eye. The FDA website states that dry eyes after
> LASIK may be permanent (http://www.fda.gov/cdrh/LASIK/risks.htm).
> Patients should be informed that LASIK surgery severs corneal nerves
> that play a crucial role in tear production, and that these nerves do
> not return to normal. Inability to sense and respond to dryness may
> lead to ocular surface damage.
>
> Medical Research on the Duration and Severity of Dry Eye
>
> Dry eye disease is a painful, chronic condition for some patients after
> LASIK surgery. In 2001, Hovanesian, Shah, and Maloney found that 48% of
> LASIK patients reported symptoms of dryness at least 6 months after
> surgery, including soreness, sharp pain and eyelid sticking to the
> eyeball.2
> A Mayo Clinic study published in 2004 demonstrates that 3 years after
> LASIK corneal nerves are less than 60% of preoperative densities.3
>
> In 2006, researchers at Baylor college of Medicine reported the
> incidence of dry eyes six months after LASIK at 36% overall and 41% in
> eyes with superior-hinges.4 These findings were based on objective
> medical tests rather than patient questionnaires, which is significant
> as patients with nerve damage may not be capable of sensing dryness.
>
> The scientific literature is replete with case reports and studies of
> LASIK-induced dry eye. This complication is widely recognized in the
> industry as the most common complaint of LASIK patients, yet the
> problem is downplayed in the informed consent process. Most dry eye
> therapies provide only marginally effective symptomatic relief. There
> is no cure for LASIK-induced dry eye. Internet bulletin boards with
> forums devoted to post-LASIK dry eye are a testament to this
> widespread, debilitating condition.
>
>
> III. NIGHT VISION IMPAIRMENT
>
> Millions of LASIK surgeries have been performed in the United States
> since its approval in 1998. Many patients now suffer from visual
> impairment at night. Some of these patients, especially those with
> large pupils, are unsafe to drive at night and can no longer live
> normal, independent lives.
>
> "When I drive to work every day, fighting the DC traffic I hear lots
> of great advertisements including the advertisements from the center
> that did my surgery talking about 95, 98 percent, whatever the
> percentage is of their patients who achieve 20/20 or 20/40 or better
> vision, and they consider that a success. I am considered a success by
> that criteria as well. However, in anything but extremely bright
> daylight I am visually impaired by starbursts, halos, multiple ghost
> images because of LASIK done on my 8-millimeter pupils... FDA approval
> of devices should include not only approval within a certain range of
> myopia or astigmatism or hyperopia but within a range of pupil sizes
> such that any use of that device outside of that pupil size should be
> considered against the FDA approval of that device...". LASIK
> patient, Mitch Ferro, testifying before the FDA Ophthalmic Devices
> Panel in July, 1999.
>
> Unfortunately the FDA turned a deaf ear on this recommendation and did
> not place a pupil size limit on the approval, nor did it include large
> pupils in the list of LASIK contraindications. Instead, the FDA
> approved lasers for LASIK with watered-down cautionary language in the
> labeling regarding large pupils. Dissemination of this labeling to
> patients was mandated by the FDA but not enforced, which violated the
> right to full informed consent for many patients with large pupils.
>
> Reduced visual quality in dim light is frequently reported by LASIK
> patients.1 Patients with pupils that dilate larger than the effective
> optical zone of the LASIK treatment are at increased risk for
> debilitating visual aberrations and loss of contrast sensitivity.5 Even
> patients with normal pupil sizes are at risk, as the laser loses
> efficiency on the slope of the cornea resulting in an effective optical
> zone that is smaller than intended.6 Newer laser technologies attempt
> to compensate by applying more laser energy in the periphery of the
> ablation, but this technique removes more corneal tissue, increasing
> the risk of surgically-induced keratectasia.7
>
> In a study published in 2004, dark-adapted pupil sizes of candidates
> for refractive surgery were found to range from 4.3 to 8.9 mm with a
> mean diameter of 6.5 mm.8 This finding explains why many patients had
> severe nighttime visual aberrations in the early days of
> photorefractive keratectomy when optical zones as small as 4 mm were
> used. In an attempt to overcome pupil size/optical zone mismatch, the
> standard treatment zone was increased incrementally over several years.
> However, even the 6.5 mm optical zone commonly used today does not
> prevent aberrations in many patients with large pupils, or high
> corrections and associated small effective optical zones.
>
> Image degradation and visual aberrations in low light after LASIK were
> predictable. These problems had been widely recognized and reported
> with previous refractive surgeries such as radial keratotomy (RK) and
> photorefractive keratectomy (PRK), and were related to pupil size.9 If
> refractive power is not consistent across the entire diameter of the
> pupil, visual aberrations and loss of contrast sensitivity result.
> After cataract surgery or refractive lens exchange, patients also
> report poor vision at night when the pupil dilates. As phakic IOLs
> begin to replace LASIK for high myopia due to safety concerns, the
> pattern of patients with large pupils experiencing night vision
> disturbances is consistent.
>
> Public Health Concerns following LASIK Surgery
>
> Dr. Leo Maguire forewarned of the threat to public health posed by
> impaired vision following refractive surgery.10 The following is an
> excerpt from an editorial published in the March, 1994 edition of
> American Journal of Ophthalmology:
>
> "I hope the reader will now understand how a patient may have
> clinically acceptable 20/20 visual acuity in the daytime and still
> suffer from clinically dangerous visual aberration at night if that
> patient's visual system must cope with an altered refractive error,
> increased glare, poorer contrast discrimination, and preferentially
> degraded peripheral vision. People die at night in motor vehicle
> accidents four times as frequently as they do during the day, and these
> figures are adjusted for miles driven. Night driving presents a
> hazardous visual experience to adults without aberrations. When we
> discuss aberration at night we are considering a possible morbid effect
> of refractive surgery."
>
> A Brief Chronology of Scientific Literature on Night Vision Impairment
> after Corneal Refractive Surgery
>
> Factors responsible for visual impairment in low light following
> refractive surgery have been discussed in articles and reported in
> peer-reviewed studies for nearly two decades.
>
> 1987 "For a patient to have a zone of glare-free vision centered on
> the point of fixation, the optical zone of the cornea must be larger
> than the entrance pupil. The larger the optical zone, the larger the
> field of glare-free vision."11
>
> 1993 "Optical zone diameters must be at least as large as the
> entrance pupil diameter to preclude glare at the fovea, and larger than
> the entrance pupil to preclude parafoveal glare."12
>
> 1996 "At nighttime, when the pupil dilates, rays from treated and
> untreated areas of the cornea reach the retina at different foci and
> produce haloes."13
>
> 1997 "Corneal modulation transfer function calculations suggest that
> a significant loss of visual performance should be anticipated
> following photorefractive keratectomy, the effect being the greatest
> for large pupil diameters."14
>
> 1998 "...after PRK, the diameter of the entrance pupil greatly
> affects the amount and character of the aberrations..."15
>
> 1999 "Changes in functional vision worsen as the target contrast
> diminishes and the pupil size increases."16
>
> 2000 "The increase in ocular aberrations was significantly related
> with the virtual pupil size."17
> "Thus, an optical system may have no refractive error in the center
> of the pupil and an increasing error in the annular zones surrounding
> the pupil center. The resultant image may be sharp for small pupil
> diameters but degrade as the pupil expands."18
>
> 2002 "The relation between pupil size and the optical clear zone are
> most important in minimizing these disturbances in RK. In PRK and
> LASIK, pupil size and the ablation diameter size and location are the
> major factors involved." 19
>
> The LASIK industry failed to take corrective action in response to
> scientific evidence regarding the importance of matching the effective
> optical zone to a patient's pupil size. As a result, many LASIK
> patients are now permanently visually impaired in dim light.
>
> IV. IATROGENIC KERATECTASIA
>
> The cornea is under constant stress from normal intraocular pressure
> pushing outward. The collagen bands of the cornea provide its form and
> biomechanical strength. LASIK thins the cornea and severs collagen
> bands, permanently weakening the cornea. This results in forward
> bulging of the cornea, which may progress to a condition known as
> keratectasia, characterized by loss of best corrected vision and
> possible corneal failure requiring corneal transplant.
>
> The FDA, laser manufacturers, and refractive surgeons are aware of
> limits on flap thickness, ablation depth, and diameter of the optical
> zone imposed by corneal biomechanics. When the FDA initially approved
> lasers for LASIK, it established a minimum of 250 microns of corneal
> tissue under the flap after LASIK surgery to prevent corneal
> instability and progressive forward bulging. Subsequent reports in
> medical literature indicate that 250 microns is not sufficient to
> ensure corneal biomechanical stability.20,21 In response, some surgeons
> stopped performing LASIK or raised the residual stromal thickness limit
> in their practices. However, the majority of surgeons continue to
> observe the 250 micron rule initially established by the FDA, even
> though this limit has been shown to be insufficient.
>
> The 250 micron rule is often violated inadvertently during surgery, as
> microkeratomes that cut the LASIK flap are unpredictable and produce
> flaps of varying thickness.22 For this reason, flap thickness should be
> measured intraoperatively. Most surgeons have not incorporated this
> important measurement into the surgical procedure prior to ablation,
> which places patients with thicker flaps at increased risk.
>
> Keratectasia may develop months or years following LASIK.23 Since most
> cases are never reported, the true rate of this devastating
> complication may never be known. The safest solution for patients would
> be to abandon LASIK altogether. It is important to remember that LASIK
> is elective surgery. There is no sound medical reason to place patients
> at risk of vision loss from unnecessary surgery.
>
> V. LIMITED HEALING OF THE CORNEA FOLLOWING LASIK
>
> The human cornea is incapable of complete wound healing after LASIK
> surgery. In 2005, researchers at Emory university found permanent
> pathologic changes in all post-LASIK corneas examined, including
> undulation of Bowman's layer, spatial separation of the LASIK flap from
> the stromal bed, epithelial thickening over the wound margin, interface
> debris, and severed and severely disordered collagen fibrils.24 The
> study reveals that the healing response never completely regenerates
> normal corneal stroma.
>
> Another recent study demonstrates that the LASIK flap produces a scar
> at the margin that is only 28.1% of the tensile strength of normal
> corneal stroma, and the flap itself heals to only 2.4% of normal
> tensile strength.25 The article reports that one author has lifted
> LASIK flaps out to 11 years after initial surgery, further attesting to
> long-term weakness of the LASIK interface wound. Reports of late flap
> dislocations suggest that LASIK patients are vulnerable to traumatic
> flap injury for life. 26
>
> VI. OTHER COMPLICATIONS AND CONCERNS
> Potential Complications
> Other vision-threatening complications are seen following LASIK surgery
> such as infection, retinal breaks and detachment, macular holes and
> hemorrhage, optic nerve damage, diffuse lamellar keratitis, irregular
> flaps, flap folds and striae, slipped flaps, epithelial defects, and
> epithelial ingrowth. These and other complications may have severe,
> lasting adverse effects.
>
> Inaccurate IOP Measurement after LASIK
>
> The changes in corneal thickness and curvature following LASIK affect
> intraocular pressure measurements, resulting in falsely low readings.
> LASIK patients face lifetime risk of undiagnosed high intraocular
> pressure (glaucoma), a leading cause of blindness.
>
> Cataract Surgery after LASIK
>
> Like the general population, LASIK patients will develop cataracts
> later in life. The altered corneal surface following LASIK prevents
> accurate measurement of intraocular lens power for cataract surgery.
> This may result in a "refractive surprise" for LASIK patients
> following cataract surgery and exposes them to increased risk of repeat
> surgeries.
>
> LASIK Results in Loss of Near Vision
>
> Patients are routinely misinformed that they will require reading
> glasses after the age of 40 whether they have LASIK or not. Nearsighted
> patients who do not have refractive surgery actually retain the ability
> to see up close naturally after the age of 40 simply by removing their
> glasses. LASIK increases the need for reading glasses by changing the
> eye's focus from near to distance. The loss of near vision after
> myopic-LASIK affects many daily activities, not just reading. LASIK
> patients over the age of 40 may discover they have simply traded one
> pair of glasses for another.
>
| |
| southeasteyecare@hotmail.com 2006-10-15, 8:26 am |
| Dear Scott,
Please find even a single statement in The LASIK Report that you feel
is 'bullshit' and support your assertion with some documentation.
Problems? Gosh, no one else has been able to document a problem with
The LASIK Report either.
| |
|
| why don't you answer this?
>where is the link that shows this flawed methodology?
<southeasteyecare@hotmail.com> wrote in message
news:1160841481.680269.324880@e3g2000cwe.googlegroups.com...
>
> The Mayo Clinic studies measuring corneal nerve densities after corneal
> refractive surgery used FLAWED methods to compare
> normal and post-refractive surgery corneal nerve density.
>
<southeasteyecare@hotmail.com> wrote in message
news:1160916684.223297.86680@m73g2000cwd.googlegroups.com...
> Dear Scott,
>
> Please find even a single statement in The LASIK Report that you feel
> is 'bullshit' and support your assertion with some documentation.
> Problems? Gosh, no one else has been able to document a problem with
> The LASIK Report either.
>
| |
| Ragnar 2006-10-15, 4:28 pm |
| That whole report is a manifesto of misinformation. Dissecting it
piece by piece would dilute the total stench of what a load of manure
it is.
On 15 Oct 2006 05:51:24 -0700, southeasteyecare@hotmail.com wrote:
>Dear Scott,
>
>Please find even a single statement in The LASIK Report that you feel
>is 'bullshit' and support your assertion with some documentation.
>Problems? Gosh, no one else has been able to document a problem with
>The LASIK Report either.
| |
|
| considering that it is anonymously written, non peer reviewed, full of anecdotal
statements and testimony, uses the word "may" "maybe" "some" and "many" without
any quantification, the whole thing is suspect.
as it's presenter, the onus is on you to prove it is true.
not just say it is true because that fits your agenda.
i.e.. In a section on Dry Eye this reference is used...
"A Mayo Clinic study published in 2004 demonstrates that 3 years after
LASIK corneal nerves are less than 60% of preoperative densities.3"
but... if you read the reference, nowhere in it does it ever mention dry eye or
make a correlation between nerve regeneration and dry eye.
a somewhat disingenuous use of a reference if I ever saw one.
considering that this was the first one I checked... I am going to assume that
there are more.
<southeasteyecare@hotmail.com> wrote in message
news:1160916684.223297.86680@m73g2000cwd.googlegroups.com...
> Dear Scott,
>
> Please find even a single statement in The LASIK Report that you feel
> is 'bullshit' and support your assertion with some documentation.
> Problems? Gosh, no one else has been able to document a problem with
> The LASIK Report either.
>
| |
|
|
Scott wrote:
> considering that it is anonymously written, non peer reviewed, full of anecdotal
> statements and testimony, uses the word "may" "maybe" "some" and "many" without
> any quantification, the whole thing is suspect.
> as it's presenter, the onus is on you to prove it is true.
> not just say it is true because that fits your agenda.
>
> i.e.. In a section on Dry Eye this reference is used...
> "A Mayo Clinic study published in 2004 demonstrates that 3 years after
> LASIK corneal nerves are less than 60% of preoperative densities.3"
> but... if you read the reference, nowhere in it does it ever mention dry eye or
> make a correlation between nerve regeneration and dry eye.
> a somewhat disingenuous use of a reference if I ever saw one.
> considering that this was the first one I checked... I am going to assume that
> there are more.
Theres no problems. This lady I know in person has dry eyes ever since
ruining her eyes with lasik and to this day 3 years post lasik they are
still dry! Nothing like knowing a case in person to support your belief
in the facts. She even admits lasik causes dry eyes.
| |
|
| Do you not read before you post? or do you just start jabbering?
I said that the reference makes no mention of dry eye, so it was dishonest (if
not fraudulent and misleading) to use it.
I had Lasik 9 years ago and don't have dry eye.
So clearly the facts support that Lasik doesn't cause dry eye.
"Ace" <acemanvx@yahoo.com> wrote in message
news:1161126954.143969.197970@m73g2000cwd.googlegroups.com...
>
> Scott wrote:
>
>
> Theres no problems. This lady I know in person has dry eyes ever since
> ruining her eyes with lasik and to this day 3 years post lasik they are
> still dry! Nothing like knowing a case in person to support your belief
> in the facts. She even admits lasik causes dry eyes.
>
| |
|
|
Scott wrote:
> Do you not read before you post? or do you just start jabbering?
> I said that the reference makes no mention of dry eye, so it was dishonest (if
> not fraudulent and misleading) to use it.
> I had Lasik 9 years ago and don't have dry eye.
> So clearly the facts support that Lasik doesn't cause dry eye.
Your the exception. My friend has dry eyes and so do many others I
know. One reason I wont touch lasik is the high risk of permanent dry
eyes!
| |
| Tom Lucas 2006-10-18, 8:33 am |
| "Ace" <acemanvx@yahoo.com> wrote in message
news:1161126954.143969.197970@m73g2000cwd.googlegroups.com...
>
> Scott wrote:
>
>
> Theres no problems. This lady I know in person has dry eyes ever since
> ruining her eyes with lasik and to this day 3 years post lasik they
> are
> still dry! Nothing like knowing a case in person to support your
> belief
> in the facts. She even admits lasik causes dry eyes.
You also said she is happy with her result and would recommend it to
others so I would hardly call that "ruined". And anyway, you don't need
a belief in facts - they stand by themselves. Faiths need belief
otherwise they cease to exist but facts are facts whether you agree or
not. I.e. Lasik causes dry eye in _some_ eyes is a fact but Lasik
ruining all eyes is a faith (actually a myth but that aside...). If you
stop believing Lasik ruins all eyes then it goes away whereas the fact
that it doesn't remains.
| |
| Ragnar 2006-10-18, 9:33 pm |
| Surely you don't expect people to believe you have friends.
You don't like lasik, you don't like rigid contacts, you don't even
like SOFT contacts. My suggestion for you is to squint a lot and get
a seeing eye dog.
On 17 Oct 2006 23:11:42 -0700, "Ace" <acemanvx@yahoo.com> wrote:
>
>Scott wrote:
>
>
>Your the exception. My friend has dry eyes and so do many others I
>know. One reason I wont touch lasik is the high risk of permanent dry
>eyes!
| |
|
|
Tom Lucas wrote:
> You also said she is happy with her result and would recommend it to
> others so I would hardly call that "ruined". And anyway, you don't need
> a belief in facts - they stand by themselves. Faiths need belief
> otherwise they cease to exist but facts are facts whether you agree or
> not. I.e. Lasik causes dry eye in _some_ eyes is a fact but Lasik
> ruining all eyes is a faith (actually a myth but that aside...). If you
> stop believing Lasik ruins all eyes then it goes away whereas the fact
> that it doesn't remains.
She is apperently happy, but still complains about dry eyes. She said
if anyone wants lasik, they can go ahead but know that lasik causes dry
eyes. Perhaps the inconvinences of glasses is worse than the
inconvinences of dry eyes and needing eyedrops everyday? Thats her
opinion.
| |
| Ragnar 2006-10-19, 2:30 am |
| Lasik does not cause dry eyes - other than the 3 months of the healing
response post-op. When is that going to get through your thick skull?
People's eyes tend to get drier as they age. A bit dry is actually
better than a bit wet. Besides.. one can always add moisture,you
can't take it away.
You are the type of person that would XXXXX if it was one tenth of a
degree above 74 degrees outside.. and you would also XXXXX if it were
one tenth of a degree below 74 degrees.
On 18 Oct 2006 20:38:51 -0700, "Ace" <acemanvx@yahoo.com> wrote:
>
>Tom Lucas wrote:
>
>
>
>She is apperently happy, but still complains about dry eyes. She said
>if anyone wants lasik, they can go ahead but know that lasik causes dry
>eyes. Perhaps the inconvinences of glasses is worse than the
>inconvinences of dry eyes and needing eyedrops everyday? Thats her
>opinion.
| |
|
|
Ragnar wrote:
> Lasik does not cause dry eyes - other than the 3 months of the healing
> response post-op. When is that going to get through your thick skull?
>
> People's eyes tend to get drier as they age. A bit dry is actually
> better than a bit wet. Besides.. one can always add moisture,you
> can't take it away.
>
> You are the type of person that would XXXXX if it was one tenth of a
> degree above 74 degrees outside.. and you would also XXXXX if it were
> one tenth of a degree below 74 degrees.
Im sorry but I dont believe you. I will go with the facts that lasik
causes dry eyes over what you say.
| |
|
| I had Lasik and don't have dry eye.
So clearly the facts support that Lasik doesn't cause dry eye.
"Ace" <acemanvx@yahoo.com> wrote in message
news:1161235469.734266.12650@h48g2000cwc.googlegroups.com...
>
> Ragnar wrote:
>
>
>
> Im sorry but I dont believe you. I will go with the facts that lasik
> causes dry eyes over what you say.
>
| |
| Tom Lucas 2006-10-19, 8:28 am |
| "Ragnar" <ragnarsuomi@yahoo.com> wrote in message
news:llfdj21epq7atv6056vf4i157rf6mp55k2@4ax.com...
> Surely you don't expect people to believe you have friends.
>
> You don't like lasik, you don't like rigid contacts, you don't even
> like SOFT contacts. My suggestion for you is to squint a lot and get
> a seeing eye dog.
That's a US term that always confuses me. We call them "Guide Dogs" in
the UK and it seems more logical. "Seeing Eye" is saying the same thing
twice. Do you get "Hearing Eye" dogs or "Smelling Eye" dogs?
[vbcol=seagreen]
> On 17 Oct 2006 23:11:42 -0700, "Ace" <acemanvx@yahoo.com> wrote:
>
| |
| Tom Lucas 2006-10-19, 8:28 am |
| "Ace" <acemanvx@yahoo.com> wrote in message
news:1161229131.456680.198730@f16g2000cwb.googlegroups.com...
>
> Tom Lucas wrote:
>
>
>
> She is apperently happy, but still complains about dry eyes. She said
> if anyone wants lasik, they can go ahead but know that lasik causes
> dry
> eyes. Perhaps the inconvinences of glasses is worse than the
> inconvinences of dry eyes and needing eyedrops everyday? Thats her
> opinion.
That's a long way from "ruined" though isn't it. Please be more careful
when using emotive language where objectivity would be better.
| |
| Ragnar 2006-10-19, 4:27 pm |
| On 18 Oct 2006 22:24:29 -0700, "Ace" <acemanvx@yahoo.com> wrote:
>
>Ragnar wrote:
>
>
>
>Im sorry but I dont believe you. I will go with the facts that lasik
>causes dry eyes over what you say.
Good.. stick with your glasses and believe Burch then. There is no
law against stupidity in this country. If there were, the president
would be impeached.
Don't feel bad when people call you a retard and an idiot on a daily
basis though.
You pick the strangest people to believe.
| |
| Ragnar 2006-10-19, 4:27 pm |
| I don't know either... but then we drive on parkways.. we park in
driveways.. and freeways often have pay tolls... and Hawaii has
interstate highways.
I would like to hear the nuts explain just what it is about lasik that
they think results in dry eyes since the nerves are back to
preoperative levels after 2 or 3 years. Lasik results in 33% of the
nerves never being touched.. in some cases, 66% are never touched, and
the nerves that are touched regenerate to preoperative levels over
time.
On Thu, 19 Oct 2006 09:31:17 +0100, "Tom Lucas"
<news@REMOVE_auto_THIS_flame_TO_REPLY.clara.co.uk> wrote:
>"Ragnar" <ragnarsuomi@yahoo.com> wrote in message
>news:llfdj21epq7atv6056vf4i157rf6mp55k2@4ax.com...
>
>That's a US term that always confuses me. We call them "Guide Dogs" in
>the UK and it seems more logical. "Seeing Eye" is saying the same thing
>twice. Do you get "Hearing Eye" dogs or "Smelling Eye" dogs?
>
>
| |
| serebel 2006-10-19, 9:36 pm |
|
Tom Lucas wrote:
>
> Do you get "Hearing Eye" dogs or "Smelling Eye" dogs?
>
Not yet, but we're working on dogs who can think for retards.
| |
|
|
Ragnar wrote:
> Good.. stick with your glasses and believe Burch then. There is no
> law against stupidity in this country. If there were, the president
> would be impeached.
>
> Don't feel bad when people call you a retard and an idiot on a daily
> basis though.
>
> You pick the strangest people to believe.
Its not so much as belief or faith as its about the hard facts. I
choose to believe the facts, you choose not to.
| |
| Ragnar 2006-10-20, 2:30 am |
| On 19 Oct 2006 19:36:40 -0700, "Ace" <acemanvx@yahoo.com> wrote:
>
>Ragnar wrote:
>
>
>
>Its not so much as belief or faith as its about the hard facts. I
>choose to believe the facts, you choose not to.
You are out of your mind and stupid to believe Burch and the sunflower
oil lady. When are you going to pull your head out of your XXX?
|
| |
|
|