But according to Keller, rare is 100%.

SErebel

Report this post to a moderator

[  Post Follow-up to this message ]

Glenn - USAEyes.org wrote:
> Our article was written by a knowledgeable PhD who did the research,
> then the article was evaluated by an ophthalmologist who specializes
> in corneal surgery and again by an ophthalmologist who is a
refractive
> surgeon.
>
> If you disagree with any issue of fact in the article, please point
> out where you believe it is wrong.  I'd be glad to correct anything
on
> our website that may be inaccurate.  If you simply don't like the
fact
> that it is on our website, then pound salt, Keller.
>
> 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.

Basically, I believe that what is presented on your site about flap
healing is wishful thinking.  Your PhD is not trained in the
biomechanics of the cornea, nor any other field of ophthalmology.  Do
the two surgeons have access to a confocal microscope and have they
analyzed actual sliced corneas, so that they can truthfully agree with
what your "PhD" has written?  Corneal and refractive surgeon Tay
Weinman MD could have evaluated the article, yet we all know how little
he knows about LASIK, or corneas for that matter.

Report this post to a moderator

[  Post Follow-up to this message ]

> Basically, I believe that what is presented on your site about flap
> healing is wishful thinking.  Your PhD is not trained in the
> biomechanics of the cornea, nor any other field of ophthalmology.  Do
> the two surgeons have access to a confocal microscope and have they
> analyzed actual sliced corneas, so that they can truthfully agree with
> what your "PhD" has written?  Corneal and refractive surgeon Tay
> Weinman MD could have evaluated the article, yet we all know how little
> he knows about LASIK, or corneas for that matter.
>

Does anyone know the actual statistics of flaps lifting?? I'd love to know
the truth on how common it is. I have never heard of anyone having one lift.
I know it must have happened but surely the odds are extremely low. I know
for sure that Sandy will surely know hundreds that its happened too - eh
Sandy??

When I was 1 week post op one morning I woke up rubbing the hell out of my
eyes. It freaked me out and I was sure I'd have dislodged the flaps but they
were ok luckily even after only 1 week. You read stories of people having
enhancements after 6 months and it sounds like the flaps lift but not easily
even using the appropriate surgical tools. Surely after several years you
must have to have a very large poke in the eye to dislodge it ??

Glen do you have any stats on how common this is. I know you often suggest
that people should consider PKR instead of lasik because of the possible
flap problems. Surely though after a sucessful lasik the chances of flaps
lifting later in life is extremely small??

Regards
Wal

Report this post to a moderator

[  Post Follow-up to this message ]

> Does anyone know the actual statistics of flaps lifting?? I'd love to
know
> the truth on how common it is. I have never heard of anyone having
one lift.
> I know it must have happened but surely the odds are extremely low. I
know
> for sure that Sandy will surely know hundreds that its happened too -
eh
> Sandy??

You mean dislodged flaps?

Certainly, the odds are probably very low. The point made is simply
that if you don't have a flap it can't happen, and if you do have a
flap it can.

No one can give definitive answers about incidence of this sort of
thing, for the simple reason that there are no centrally tracked
statistics. I would guess, personally, that it's among the rarest of
complications. Having said that two patients I've been in touch with
recently had it happen.

Report this post to a moderator

[  Post Follow-up to this message ]

Hi Rebecca

<rebeccaNO_SPAM@lasermyeye.org> wrote in message
news:1104548400.287726.312660@c13g2000cwb.googlegroups.com..

> You mean dislodged flaps?

Yes

> Certainly, the odds are probably very low. The point made is simply
> that if you don't have a flap it can't happen, and if you do have a
> flap it can.

Yes agree with that. If the odds of it happening are SO slim though and if
Lasik has other benifits over  PRK then it may out weigh the risks of having
the flap do you think?

When they dislodge do they break off or just move requiring re positioning?
If they do break off whats the chance of seeing any good again out of that
eye?

Doesn't sound very nice either way.

Wal

Report this post to a moderator

[  Post Follow-up to this message ]

That's a risk that has to be assessed to a certain extent in the
context of one's activities. Some people are more likely than others to
get hit in the face. But you never really know. Example - a patient I
was working with in Manchester. Minor accident and his flap got
dislodged. Extremely painful, but it was replaced and his vision is
fine though he still has extreme dry eye. - As to comparing the risks
of LASIK to PRK or other surface ablation, well, flap dislodgement  or
rotation is only one of the issues there. You've also got vision
quality reductions associated with the flap interface, and the
possibility of ectasia. There have been many advances in surface
ablation which make it - in my opinion - a much better option in many
cases.

A completely severed flap (free cap) can work out OK - that is, it
doesn't need a hinge to stay on the eye, there's something about
surface pressure or something that can keep it in place. The big
problem with a free cap though is positioning it correctly.

And if the flap is lost altogether - well, in all probability you're
talking corneal transplant to regain reasonable BCVA.

Report this post to a moderator

[  Post Follow-up to this message ]

In article <1104583834.551540.66840@c13g2000cwb.googlegroups.com>,
rebeccaNO_SPAM@lasermyeye.org wrote:

> Example - a patient I
> was working with in Manchester. Minor accident and his flap got
> dislodged. Extremely painful, but it was replaced and his vision is
> fine though he still has extreme dry eye.

Just curious, did he have dry eye before his flap was dislodged?  Is
there any correlation between people who suffer from post-LASIK dry eye
and an increased possibility of flap complications?  Or was his dry eye
caused by the flap dislodging?

--
~RT

Report this post to a moderator

[  Post Follow-up to this message ]

I don't have my notes handy and I'm afraid I don't recall all of the
details of timing, however, to the best of my recollection he had dry
eye before the flap was dislodged though it may have been worsened
afterwards. Actually if you don't mind my digressing for a moment, it
was an interesting case. He tried just about everything there is
including completely changing his lifestyle and diet, but it wasn't
until he started using Dakrina that he really was able to get the
symptoms under control.

As to an overall correlation between postop dry eye and postop flap
complications - probably only a doctor who has seen a large number of
flap complications could answer that with any accuracy. But from my
limited perspective I would hazard the guess that there is not a
significant correlation. Here's why:

Presumably a majority of flap complications (in terms of incidence, I
mean, not type) happen during rather than after surgery. Those that
happen after surgery include: epithelial ingrowth; DLK; flap melt; flap
dislodgement; flap rotation; and ectasia. (That's defining "flap
complication" in very simple terms as something that can't happen if
you don't have a flap. Well, I suppose ectasia could happen without a
flap, if you did PRK on a -22 or something, but if you did something
that insane, ectasia would be the least of the patient's worries.) And
I can't think offhand of any particular reason that would make a dry
eye patient more likely to get any of those specific complications. -
Except at a practical level, perhaps, that if a patient is using
eyedrops frequently and isn't careful, they could possibly dislodge or
injure the flap while applying drops if they were awfully careless, got
bumped roughly with the dropper very near their eye, etc.

Report this post to a moderator

[  Post Follow-up to this message ]

Not necessarily. It's exactly what happened to the guy I have mentioned
earlier in this thread. I completely agree with Glenn's post above.

Report this post to a moderator

[  Post Follow-up to this message ]

>Basically, I believe that what is presented on your site about flap
>healing is wishful thinking.

Show precisely where it is wrong, back that up with substantiated
facts, and I'll be glad to change it.

>Your PhD is not trained in the
>biomechanics of the cornea, nor any other field of ophthalmology.  Do
>the two surgeons have access to a confocal microscope and have they
>analyzed actual sliced corneas, so that they can truthfully agree with
>what your "PhD" has written?

Yes, on both parts.  And since you mentioned it, the article was
reviewed by a PhD renown for the biomechanics of the cornea.

>Corneal and refractive surgeon Tay
>Weinman MD could have evaluated the article, yet we all know how little
>he knows about LASIK, or corneas for that matter.

To my knowledge, your refractive surgeon has not evaluated our article
on flap healing, and I'm sure you don't have any information to the
contrary.

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.

Report this post to a moderator

[  Post Follow-up to this message ]