>Hi Ace! I have noticed you are
>beginning to 'see through' all the
>marketing claims and are really getting
>a grasp on the problems inherent
>in refractive surgery.
There is alot of marketing and politics surrounding lasik. We have the
freedom of speech to give our opinions of lasik as long as we dont
flame anyone. I can see there are still shortcommings in lasik. However
we are working on them. lasik in the past was much worse than its
today. Lasik in the future very well may further address some
shortcommings.
>Believe it or not, there was an
>FDA hearing discussing the increase in
>HOAs by custom wavefront LASIK and
>how this information should be disclosed
>in the patient labeling to the
>public.
That information was never mentioned to me. I just heard it reduces
HOAs and makes your cornea more perfect and you see better without
glasses. I guess that is true for highly abberated eyes but ive seen
lots of people with high BCVA(better than 20/20) complain about
decrease in quality and even accuracy in vision. To put it short, the
better your BCVA is before lasik, the more you have to lose. The worse
your BCVA is before lasik, the less you lose and you may even gain!
>DR. GRIMMETT: Dr. Bradley stated wavefront-guided LASIK
>does not reduce the level of
>higher-order aberrations of the preoperative eye,
>and he also wrote there's no
>way wavefront-guided LASIK can correct higher-order
>aberrations and render super-normal vision.
I am hearing conflicting reports. Some make the claim you can improve
one or more lines of BCVA. Do you think it was because of glasses
minification? Improper glasses pescription? Improperly made or fitted
glasses/contacts?
If it always increases HOA's then your visual quality and accuracy will
always go down from your true BCVA. My true BCVA is probably 20/25 but
I am not gonna achieve this with -5 glasses. with RGP probably because
they dont minify and also they provide a smooth, percise fit over the
cornea. Unless wavefront lasik can really remove my HOAs and I end up
with less than what I had before lasik, I will see no better than I do
with glasses.
>DR. GRIMMETT: Sure. Wavefront-guided LASIK does not
>reduce the level of higher-order aberrations
>of the preoperative eye.
>DR. WEISS: Would that not be confusing
>to someone? Wouldn't that be confusing?
its very confusing, especially to me.
>DR. GRIMMETT: Michael Grimmett.It may suggest somehow
>wording in that wasn't it that
>the higher-order aberrations were 20 percent
>higher than the preop eye in
>the wavefront-guided versus what, 80 percent
>was the number?
>PARTICIPANT: Seventy-seven percent.
question for eye, what was your glasses pescription before and what was
your BCVA? You mentioned in another post you were seeing a blurry 20/15
for a while but not anymore. Were you able to see 20/15 better with
glasses?
>DR. WEISS: In here, is there any
>place saying that LASIK itself increases
>aberrations and that customized corneal ablation
>increases them less than conventional treatment?
>DR. GRIMMETT: I think that's the idea.
this makes sense. However the word "reduced" is used too liberally. Its
reduced compared to conventional lasik but NOT reduced compared to no
lasik. I think they should start telling everyone that wavefront lasik
will create a reduced amount of extra HOAs vs. conventional instead of
just saying "reduced" they need to explain the meaning of "reduced"
>DR. WEISS: So maybe we could put
>that wavefront-guided ablation ??
>DR. GRIMMETT: Conventional LADARVision LASIK increases higher-order
>aberrations by that figure 77 percent
>while wavefront-guided LASIK increases them by
>whatever, 20 percent, whatever the number
>is, or you can say reduces
>them to a 20-percent level, if
>you want to use the word
>"reduces."
>DR. BULLIMORE: I would avoid the term
>"reducing."
Its just so confusing! It reduces HOA's but not in the way many people
believe. We should say "increases less"
>DR. WEISS: I would say each of
>them increases it because basically whether
>or not you're treating the preexistent
>or what's induced, the bottom line
>is you still have more aberrations
>than you did when you started
>off.
>DR. GRIMMETT: Well, the intent is telling
>the traffic cop that you're speeding
>less than the other speeders.------------------------------------------------
>Go to FDA.gov and look up the
>approvals for wavefront guided treatements. You
>will see that the FDA states
>that HOAs are NOT reduced.
>You quoted Jack Holliday - here is
>something he said in the current
>issue of the Journal of Refractive
>Surgery:
>" Ablations based on refractive wavefront aberrometry
>alone, without detailed knoweledge of the
>patient's current corneal topography WILL NEVER
>attain the best visual results and
>is the reason wavefront-guided ablations have
>lost much of their luster".
>Unless you have an EXTREMELY aberrated cornea
>it is unlikely that your HOAs
>will be decreased by wavefront treatment.
>We are still searching for ONE
>patient who had normal virgin eyes...
>who experienced a decrease in HOAs
>after wavefront treatment.
There are topographies of people before and after lasik. Some of them
are obviously worse but others appear to be better but then I am not an
expert at interpreting topographies.
>Ace - you've hit the nail on
>the head! What is really upsettig
>to me is that doctors will
>perform LASIK on patients like you,
>who do not have 'visual quality
>reserve' to play around with.
He just said "we can get you to 20/25"
When he gave me a manual refraction I was kinda just guessing the 20/25
line. I had said "too small, cant see those" then he said try your best
so I did. I guess I can partially blame my -5 glasses for minification
and making the 20/25 line too small. If I end up plano with lasik then
his 20/25 claims are reasonable.
The fact
>that you are not correctable to
>20/20 now may or may not
>be due to HOA's (you should
>go for a thorough exam and
>find out).
I can show you my topographies here:
http://www.asklasikdocs.com/forum/main/3371.html
Feel free to interpret them. I have been told I have irregular
astigmastim which cant really be corrected by glasses. Notice the
orange colors, this is the steeper, uneven part.
Refractive surgery is riskier
>for you because refractive surgery does
>reduce visual quality and your baseline
>of visual quality is nothigh.
If I have highly abberated eyes, I may not end up worse but it still
wont guarantee overcorrection, dry eyes, regression, GASH, etc or still
needing glasses anyway.
>My hope is that getting the word
>out will protect the 'visual reserves'
>of patients like you.
What do you think of intacs then? Perhaps I am better suited for those?
Are you the same Eye who used to post at asklasikdocs? I have some
questions for you to answer.