Glenn, who gave you the $250,000?
LASIKdisaster
or part of initial certification fees and quarterly recertification
fees. In some cases, all fees will be paid by the grant funds.
Contact CRSQA's Executive Director at glenn....@usaeyes.org to
verify if you are eligible to receive grant money."
Was it an investment made by a dying industry?
I assume that it is only meant to be used to certify more docs, and
not to help patients who need surgical or contact lens remediation to
regain their vision after refractive surgery.
$250,000 would go a long way in helping those patients and might
generate some goodwill toward the doctors and manufacturers who have
done damage. That would be the best PR your industry could buy.
Glenn Hagele - Council for Refractive Surgery Quality Assurance
The purpose of these private internal grants are to help us achieve
our goal of a CRSQA Certified Refractive Surgeon in each of the major
US cities and to provide additional public awareness of refractive
surgery issues in coordination with our affiliated surgeons.
>
>Was it an investment made by a dying industry?
To paraphrase Mark Twain; the rumor of refractive surgery's death is
greatly exaggerated.
>I assume that it is only meant to be used to certify more docs, and
>not to help patients who need surgical or contact lens remediation to
>regain their vision after refractive surgery.
CRSQA is not - and cannot be - all things to all people. Our
resources are limited and we are by law limited in the scope of the
services we provide.
CRSQA was created to provide objective information about refractive
surgery and assist patients in the process of selecting a qualified
surgeon. In essence, we focused our services to help people who are
considering LASIK, LASEK, PRK, CK, LTK or other refractive surgery
procedures get objective information, consider if this is something
they really want, then provide them the tools necessary to find the
better doctor if they decide to move forward. We have always made our
Ask An Expert service available for anyone who had postoperative
concerns, but we had left long-term complication rehabilitation
resource assistance to the doctors and other organizations established
specifically for that purpose.
We recently instituted our Second Response Team (SRT) to coordinate
second opinion examinations for those few patients who are worried
about their immediate postop situation. If a patient has a concern
with their outcome or care they are receiving from their primary
surgeon, we will research to find the most appropriate expert on the
area of concern and facilitate a referral to that doctor.
Other organizations exist and new ones are forming to assist those
postoperative patients who need help beyond what SRT can provide. We
are supporting the new programs and will be delighted to coordinate
our efforts with theirs. We will go full tilt into the rehabilitation
of patients with refractive surgery induced problems only when we see
that the other organizations are not able to provide the help
required. That is why we started the SRT. It fills a niche that was
not being served, but we see no reason to duplicate efforts when other
resources exist.
Although these grants are not for the SRT program, they do free up
other funds to bolster our SRT efforts.
>$250,000 would go a long way in helping those patients and might
>generate some goodwill toward the doctors and manufacturers who have
>done damage. That would be the best PR your industry could buy.
Good PR for CRSQA comes from helping patients make an informed
decision about whether or not to have refractive surgery then
providing the tools to help them find the better doctors. With SRT,
we also help those few who have concerns after surgery.
Good PR for the refractive surgery industry will only come from
satisfying their patients. CRSQA can educate the patient, but it is
up to the doctors to deliver the goods.
Sandy, something that will probably always trouble me is that we got
started so late. I don't know if our information would have made any
difference in your situation, but if we were a stronger presence when
you had surgery in late 1999, you might have had the information you
needed to better understand refractive surgery. If we had started a
year earlier, you may not be in the situation you are today. We
cannot change the past, but I'm hopeful we help others avoid the
dreadful situation that you endure.
I don't know if an apology that CRSQA was not there when you could
have used us makes any difference, but it is extended.
Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance
http://www.usaeyes.org
glenn....@usaeyes.org
I am not a doctor.
JK
On 22 Dec 2002 08:03:07 GMT, Glenn Hagele - Council for Refractive
JK
answer was a non answer evading the question
Part of being a non-profit is DISCLOSURE. You enjoy many tax
advantages but have to play by the rules, that is unless you feel a
letter to the state attorney general would be in order.
On 22 Dec 2002 08:03:07 GMT, Glenn Hagele - Council for Refractive
Roger
I believe the list below gives us some insight into Glenn Hagele's
definition of the word "Quality".
It appears that there are some persons in the refractive surgery
industry who feel that it's important to have a "Good Housekeeping
Seal of Approval" to award to "Doctors" who meet Glenn's "Quality
Assurance" critera.
Happy advertising, Glenn.
Roger
-------------------------------------------------------------------------------
==> Legal Complaints naming a "Glenn Kawesch, MD" as the Defendant.
==> a "Glenn Kawesch, MD" was recently listed on the CRSQA website as
being CRSQA certified.
Search Parameters:
* The documents listed here are the result of a search performed on
the computer in the "General Civil" (Not "Small Claims") Section of
the San Diego Courthouse at 330 West Broadway, San Diego, California
on Monday September 9, 2002.
* The one document with an "N" prefix is purportedly archived at the
North County courthouse on Melrose in San Marcos.
* "Category of Case" is as described on the San Diego Courthouse
computer.
* "Filing Date" is as described on the San Diego Courthouse computer.
* Case Numbers GIC764982 and GIC779106 name the same plaintiff, and
are listed here because the categories of case are different: the
former cites "Malpractice", the latter case cites "Fraud."
* The Plaintiff listed on Case Number 724772 has another case filed,
Number 718290. However, the Category of Case listed on the computer is
the same in each case (Malpractice). Therfore I left the case that
was filed earlier off the tabular listing.
CASE NUMBER CATEGORY OF CASE Filing Date
GIC774078 Medical Malpractice September 7, 2001
GIC787221 Malpractice April 24, 2002
GIC764982 Malpractice April 2, 2001
GIC779106 Fraud December 4, 2001
GIC793085 Medical Malpractice July 25, 2002
724772 Malpractice October 7, 1998
GIC753609 Medical Malpractice August 25, 2000
GIC764538 Medical Malpractice March 26, 2001
GIC748269 Malpractice May 16, 2000
GIC753043 Malpractice August 15, 2000
GIC782738 Medical Malpractice February 6, 2002
N79316 Malpractice September 30,
1998
727331 Malpractice January 15, 1999
728995 Malpractice March 15, 1999
728997 Malpractice March 15, 1999
729568 Negligence April 2, 1999
GIC743137 Malpractice February 8, 2000
GIC757257 Medical Malpractice November 1, 2000
GIC760421 Medical Malpractice January 8, 2001
GIC775955 Medical Malpractice October 10, 2001
GIC787421 Medical Malpractice April 26, 2002
GIC788174 Medical Malpractice May 8, 2002
GIC789393 Medical Malpractice May 29, 2002
GIC794779 Medical Malpractice August 22, 2002
GIC768248 Medical Malpractice May 31, 2001
25 Separate Cases. 24 Distinct Plaintiff's.
Glenn Hagele, exactly how is it that you define "Quality Assurance",
again ?
LASIKdisaster
attempting to regain the trust of the American public, after so many
horror stories have been the subject of television and newspaper
reports. They are using wavefront to lure people back; making them
think that lasik will be safer, which is untrue.
Anyway, the fact that you offer grants to fund the certification of
multimillionaire refractive surgeons is quite disturbing. I guess not
enough of them were willing to pay for your services.
EyeSeeWell
his home in Sacramento. He is trying to prove to his investors, which
are doctors and coporations.
Visx, Nidek, Alcon, and a few others have been pressured by the
doctors to help set up a "self vigilant" group to "educate" the
consumers about the "great" benefits of LASIK.
Some of the doctors on Glenn's board helped pressure these companies
to give money. The misnomer is that these companies gladly gave the
money because they want to see business increase.
LASIK business has been dropping and will continue to drop because the
procedure is flawed. Many consumers don't have the results they
expected. Lawsuits will continue to rise and the amount of payout
will continue to rise as well.
Dry Eye is a huge problem post LASIK. If you are told you need
puntual plugs, then the surgey didn't go well. It is not natural to
have your eye plugged for a problem that didn't exist pre LASIK.
Night driving or loss of contrast will be a publich health issue.
CRSQA is a sham and only set up to self police itself. Although some
feel that CRSQA helps, I believe LASIK is being spun to sound great
eventhough consumers have problems.
Well Glenn congratulations on getting more funding and continuously
spending time on the internet to promote your job.
I am watching the LASIK industry and CRSQA. Get ethical Glenn.
JK <j...@aol.com> wrote in message news:<hf2b0vc2pvvu1fhkj...@4ax.com>...
Glenn Hagele - Council for Refractive Surgery Quality Assurance
>Glenn love(s) working out of his home in Sacramento.
Beyond this statement, you don't know what you are talking about.
Glenn Hagele - Council for Refractive Surgery Quality Assurance
they can go to the newsgroup archives.
Glenn Hagele - Council for Refractive Surgery Quality Assurance
wrote:
> The industry focus now is on
>attempting to regain the trust of the American public, after so many
>horror stories have been the subject of television and newspaper
>reports.
The refractive surgery industry has become a victim of its own hype.
You can't make promises then not deliver. A few bad practitioners
used the media to help create expectations way out of proportion to
the reality. Some have tried to sell LASIK as a mass-produced
commodity that was the same no matter where you got it, so you might
as well get it from them. Boy, are they wrong. LASIK, LASEK, PRK,
CK, et al is surgery and is very dependent upon the skill of the
surgeon. A big part of that skill is selecting only appropriate
candidates.
All the patient "victim" noise in the media did make some folks pay
attention. Unfortunately, we are again seeing similar unsupportable
claims in refractive surgery advertising. The big difference is now
there are people like you, who give personal accounts of how things
can go wrong, and orgs like CRSQA saying slow down and consider what
you are doing and who is going to do it to you. If people want good
information about LASIK, it is available.
The only way the refractive surgery industry is going to regain trust
is by satisfying patients. You can't have satisfied patients when you
make promises you cannot deliver.
> They are using wavefront to lure people back; making them
>think that lasik will be safer, which is untrue.
To me, safety is about complications. As a diagnostic tool, wavefront
can determine if someone has higher order aberration problems that are
likely to be greatly exacerbated by corneal surgery. That is
something that has not been available before and is a very clear
advantage. Some people who would only know they were poor candidates
after surgery can now be identified as poor candidates before surgery.
That is an improvement.
The idea that wavefront guided ablations will be hugely superior to
conventional refractive surgery is good in theory, but there is
nothing like reality to screw up a perfectly good theory. We will
need to see what happens when the technology "hits the streets" to
know if wavefront guided ablations make much difference.
IMO, wavefront is tremendously advantageous as a diagnostic tool, but
as yet unproven as an ablation tool.
>Anyway, the fact that you offer grants to fund the certification of
>multimillionaire refractive surgeons is quite disturbing. I guess not
>enough of them were willing to pay for your services.
We don't like the idea of millionaires in major markets receiving
grant money either. That is why the grants have restricted purposes.
The grants are designed primarily for areas that are underserved. An
example is in the Dakotas where there are only one or two doctors who
we would like certified, but the economics of their marketplace make
certification unaffordable. These grants will help patients in
underserved areas have an evaluated surgeon available.
We also have grants that will assist affiliated surgeons with public
education campaigns, but only those that meet the Federal Trade
Commission, Food and Drug Administration, and American Academy of
Ophthalmology ethical guidelines. We don't want to facilitate grant
money that would be contributing to unsubstantiated hype.
Brent Hanson
"donated" the money himself. Put yourself in his shoes. You only
have a 100(?) CRSQA surgeons, and you want to grow your organization.
Cancel the "auditing" fees, call it a "grant", and you just have grown
the size of CRSQA.
JK
http://www.isrs.org/ is the website of the international society of
refractive surgery.
Glenn, you stated in your prior post that ISRS recognizes CRQSA, yet I
am unable to find anything on their site to this effect.
Please Glenn, post the link to their statement of policy about their
so called recognition on CRQSA, stated by you.
As we are sure none of your statement are misleading, inacurate, or
false, and as you are a non-profit entity, you surely wish to share
the source of these so called grants
You surely would not jeopardize the credibility or very existance of
your non profit entity for something like misleading, forward or
fraudulent representations; would you?
On 22 Dec 2002 18:44:57 GMT, glenn....@usaeyes.org (Glenn Hagele -
LASIKdisaster
> To me, safety is about complications.
Yes. And visual aberrations are not considered "complications" by
this industry. They are explained away as "You are too picky about
your vision"; "You are an active focuser"; "Go out and enjoy your new
'natural' vision"; and "You signed the informed consent form".
Wavefront does not address the risks of infection and loss of the eye,
DLK, CTK, irregular healing, flap striae, epithelial ingrowth,
blade/microkeratome malfunctions, incorrect data imput into laser,
ptosis or the zillion other things that can happen to a lasik patient.
> As a diagnostic tool, wavefront
> can determine if someone has higher order aberration problems that are
> likely to be greatly exacerbated by corneal surgery. That is
> something that has not been available before and is a very clear
> advantage. Some people who would only know they were poor candidates
> after surgery can now be identified as poor candidates before surgery.
> That is an improvement.
I think it's more likely to be used by doctors as a marketing tool
rather than a screening tool. Look at all of the doctors still
measuring pupils with pupil cards and rulers?
Dr. Lee Nordan, the only doctor who seems to have been able to
surgically improve the vision of a number of post-refractives (and he
gets the worst of the worst), is using regular old PRK and has no
plans to integrate any wavefront technology into his procedures. He
doesn't believe that it's going to live up to the hype we've been
hearing for years now.
The one great thing about wavefront is that those of us who are
damaged can now demonstrate to a jury that there is actual,
measureable vision loss and they won't have to depend on our
subjective complaints, which we are frequently accused of faking or
exaggerating.
Glenn Hagele - Council for Refractive Surgery Quality Assurance
wrote:
>>
>> To me, safety is about complications.
>
>Yes. And visual aberrations are not considered "complications" by
>this industry.
They are by us!
> They are explained away as "You are too picky about
>your vision"; "You are an active focuser"; "Go out and enjoy your new
>'natural' vision"; and "You signed the informed consent form".
I'm familiar with these and too many more, but the "active focuser" is
a new one on me. What on earth do they think that is supposed to
mean?
This is why we are moving more toward patient feedback in our
evaluation process. Either the patient (patient, not doctor) is
satisfied with the result or they are not. Pardon my bluntness, but
screw the excuses and subterfuge.
>
>Wavefront does not address the risks of infection and loss of the eye,
>DLK, CTK, irregular healing, flap striae, epithelial ingrowth,
>blade/microkeratome malfunctions, incorrect data imput into laser,
>ptosis or the zillion other things that can happen to a lasik patient.
Absolutely correct, but I still say it is a good diagnostic tool. I
think what you are saying is that some surgeons or facilities will try
to make wavefront a panacea for any refractive surgery limitation.
I'm sure hoping potential patients are smarter than that and do their
homework first. I also hope the doctors understand that
over-promising is only going to get them in trouble.
>> As a diagnostic tool, wavefront
>> can determine if someone has higher order aberration problems that are
>> likely to be greatly exacerbated by corneal surgery. That is
>> something that has not been available before and is a very clear
>> advantage. Some people who would only know they were poor candidates
>> after surgery can now be identified as poor candidates before surgery.
>> That is an improvement.
>
>I think it's more likely to be used by doctors as a marketing tool
>rather than a screening tool.
Well, if they try, you and I have our job cut out for us. 8^)
Even if the motivation is not pure, using wavefront as a diagnostic
tool preoperatively will provide information that would be hard to
ignore. Even if the right thing happens for the wrong reason, at
least the right thing is happening.
> Look at all of the doctors still
>measuring pupils with pupil cards and rulers?
At least they are now measuring. A pupilometer is definitely
preferred.
>Dr. Lee Nordan, the only doctor who seems to have been able to
>surgically improve the vision of a number of post-refractives (and he
>gets the worst of the worst), is using regular old PRK and has no
>plans to integrate any wavefront technology into his procedures. He
>doesn't believe that it's going to live up to the hype we've been
>hearing for years now.
I had the infinite pleasure of attending a microkeratome training
course with Dr. Nordan. (No, I don't use them but I feel it is
important I see first-hand the tools used by this industry). He is
not alone in his view of wavefront. In the hallways of the meetings
you will hear doctors saying that wavefront guided ablations have not
quite shown all their worth yet and seem to be hesitating at the cost
and training of staff for adding wavefront. A few are seeing
wavefront as a patient driven demand. The tail wagging the dog, if
you ask me.
The doctors in the know seem to value wavefront for what it can
provide diagnostically, and are very positive about what the future
holds for wavefront guided ablations, but I honestly believe that
there are very few ophthalmologists who really understand what
wavefront and higher order aberrations is about. It is encouraging
that the more popular seminars and exhibitors at the most recent major
ophthalmic meetings are wavefront related.
>
>The one great thing about wavefront is that those of us who are
>damaged can now demonstrate to a jury that there is actual,
>measureable vision loss and they won't have to depend on our
>subjective complaints, which we are frequently accused of faking or
>exaggerating.
I've heard it has happened, but I've never understood why a doctor
would think a patient would have any desire to fake vision problems.
Wavefront diagnostic was a key factor in the Post vs. UPI case, the
one with the $4 million malpractice judgement that has been appealed
and is probably going to be retried. The jury saw a wavefront
diagnosis of the patient in daylight then a diagnosis in a low light
environment. You can clearly see the aberrations in a tiny ring at
the edge of the pupil.
I honestly don't know if wavefront had been performed preoperatively
it would have revealed anything that would have indicated the Mr. Post
was a poor candidate. It appears from the items I've read and a short
conversation with the defendant's attorney that the problem was wholly
one of pupil size vs. ablation size. Again, we get back to the
importance of a scotopic pupil measurement preoperatively and an
ablation larger than the naturally dilated pupil. Something that can
be easily done and can potentially save a lot of grief.
Glenn Hagele - Council for Refractive Surgery Quality Assurance
>Until we see who cut the check, I am suspicious that Glenn has
>"donated" the money himself.
LOL! Oh Brent, how you overestimate my financial resources! Your
comments about me usually are just irritating, but this time I
honestly enjoyed the really hearty laugh your assumption gave me!
Glenn Hagele - Council for Refractive Surgery Quality Assurance
certification and the ISRS GLORY training/certification program was
released and announced by then ISRS president Michael Lawless, MD.
The current ISRS president is Jack Holladay, MD, who is also a member
of CRSQA's Board of Trustees.
Roger
Although LASIK Disaster is extremely specific about why they refer to
their experience as a disaster ...
and I am sending out a "LASIK SOS" ( I need help with my eyes,
remember ? ) ( Plus, the LASIK industry is continuing to create new
casualties without rectifying the practices that created the initial
casualties - consider it a "Double SOS")
Glenn Hagele has not yet, in my reading of this newsgroup, presented
us with a definition of either of these terms -
"Quality"
"Quality Assurance"
We know what refractive surgery is - it's a corneal alteration
procedure that increases the probability, by orders of magnitude, of
corneal disease manifesting in any given patient.
Glenn, if you've already defined "Quality" and "Quality Assurance"
on-line, why don't you tell us the URL ?
Roger
Is there a Doctor in the House ?
Copyright 2002 Roger E. Bratt
William Stacy
or did I dream it up? It would be interesting to see who's on the board of
directors, president, CEO, etc.
w.stacy, o.d.
Glenn Hagele - Council for Refractive Surgery Quality Assurance
the nation's best surgeons and you have had postoperative evaluations
by other doctors who are considered top notch. Your response to their
best efforts has been to publicly deride them, their profession,
suggest they are psychopaths and they conspire against patients,
intimate they are liars, camp in front of their medical offices with
an eye patch and a sign saying LASIK harmed you, and hiring a plane to
drag an anti-LASIK banner around southern California.
It is a pity that you have the difficulties you report and it would be
great if someone could help you, but in my opinion, no doctor in his
or her right mind would accept you or someone like you as a patient.
Glenn Hagele - Council for Refractive Surgery Quality Assurance
>If I'm not mistaken, Glenn's father is a refractive surgeon. Is that true,
>or did I dream it up? It would be interesting to see who's on the board of
>directors, president, CEO, etc.
>
>w.stacy, o.d.
That's a new one. No, my father is not a physician and does not have
any connection with healthcare. I have a distant relative with the
same last name who is an ophthalmologist, but I don't know if he does
refractive surgery. We met only once years ago at a family reunion.
Our Board of Trustees is listed on our website at
http://www.usaeyes.org/faq/trustees.htm.
William Stacy
organization, what 5 years ago or so? Were you ever associated with an
ophthalmology practice?
w.stacy, o.d.
Glenn Hagele - Council for Refractive Surgery Quality Assurance
>organization, what 5 years ago or so? Were you ever associated with an
>ophthalmology practice?
>
>w.stacy, o.d.
Never directly. I was an independent consultant to the healthcare
industry starting in 1982. Clients included hospitals, insurance
companies, ambulatory surgery centers, and physicians. Mostly
short-term project-based contracts. Some of those physicians were
ophthalmologists, but I've never been on a doctor or facility's
payroll.
There has been a lot of inaccurate information about me bandied about.
I'm not surprised that there would be a misunderstanding. No harm, no
foul. 8^)
Dan Abel
admini...@lasikcourt.com (Brent Hanson) wrote:
Some people are upset because they think that Glenn is taking money from
doctors. Now you are upset because you think he's NOT taking money from
doctors.
I think that certain people are going to be upset irrespective of where
the money comes from. They just want *everybody* to join their agenda of
bad-mouthing LASIK, and anyone who doesn't join, will be complained about
whatever they do.
--
Dan Abel
Sonoma State University
AIS
da...@sonic.net
The Real Bev
> Yes. And visual aberrations are not considered "complications" by
> this industry. They are explained away as "You are too picky about
> your vision"; "You are an active focuser";
What is an active focuser?
--
Cheers,
Bev
^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
"The language of victimization is infinitely extensible." -- Me
Brent Hanson
cash outflows and inflows is zero.
1) Glenn provides $250,000 worth of grants in the form of coupons to
the surgeons.
2) The doctors turn around and submit the coupons with their CRSQA
application.
3) Glenn gets a bunch of new surgeons, and becomes a bigger lasik
marketeer on this news group because he then has more "certified"
surgeons to promote.
Here's where it gets even better for Glenn. A year later when the
surgeons get hooked on referrals from Glenn's marketing racket, they
decide to cough up the $7,500 (?) application renewal fee to keep
their CRSQA certification.
Glenn's first cash outflow: $0 + paper processing costs.
Glenn's second year cash inflow: $250,000
Glenn would have never had to cut a single check to make this happen.
Next thing you know Glenn will announce that he has "grant" money
available for every single lasik surgeon on the planet.
Of course this is all speculative until Glenn names the source of the
"grant". I Hope I didn't give Glenn any good ideas.
Roger
> According to your website and your posts, you had surgery by one of
> the nation's best surgeons
Good point. You can have LASIK performed by a VIP LASIK surgeon, and
still ...
* have them lie to you, in order to close the sale.
* have them overlook prominent contra-indications, in order to close
the sale.
I should add that, even in the years 2001 and 2002, "VIP" LASIK
surgeons are still making the same mistakes - performing LASIK on
patients with minimal corneal disease, turning it into full-blown
debilitating and painful corneal disease. Glenn, you may think these
people - Binder and Tooma, for example - deserve a pat on the back.
Then again, you may be trying to sell them an expensive membership in
your "club".
and you have had postoperative evaluations
> by other doctors who are considered top notch.
I've seen about 8 doctors and one "doctor" post-op.
Your response to their
> best efforts has been to publicly deride them,
I deride Gordon, Binder, and Tooma because, in my opinion and for the
reasons cited, their treatment of patients is sometimes alien to that
which one would expect from a Doctor. Of those 3, only Gordon has
"treated" me - that is, he introduced me to corneal disease. If you
call that a best effort, I'd hate to see his worst effort.
Another "Doctor" who I have seen is Friedlaender. Though I saw him
about dry eye discomfort, he didn't even bother to mention some of the
basic cures that he mentions in his articles. Eminently aware as he
is that refractive surgery greatly increases the risk of corneal
disease, relative to Friedlaender's reputation as a "dry eye
specialist", I wonder if Friedlaender's specialty, relative to dry
eye, is to create more cases of painful dry eye. If you call that his
"best effort", I'd hate to see his worst effort.
My suggestion to you Glenn, is go let Gordon perform LASIK on you, and
then see Friedlaender about any complications that may develop. Then
report back to us.
> their profession,
Very true. To consider a human beings corneas to be expendable is
close to considering a human being to be expendable. To quote
"Disgruntled Doc" at Surgical Eyes, "The standard of care in the
profession of refractive surgery is to functionally blind a fraction
of their patients". Such a "profession" is worthy of derision.
Personally, I thought doctors were supposed to move their patients in
the direction of greater health.
> suggest they are psychopaths
I compared Gordon's performance against a four-parameter index
commonly used by psychiatrists in assessing psychopaths.
>and they conspire against patients,
Refractive surgeons do conspire to hide the ugly truths about
refractive surgery from the public and from their patients, both
pre-op and post-op. Eventually, their behavior will be revealed as
parallel to the tobacco industry, which tried very hard for a long
time to hide the connection between tobacco use and cancer. So, too,
are refractive surgeons working very hard to hide the connection
between refractive surgery and corneal disease.
And, for similar reasons - MONEY. Oh, yeah. And, perhaps so they can
continue telling themselves that they're "doctors".
As far as conspiring ... I wonder ... has TLC hired a private
investigator to tail a patient who experienced extreme damage to their
eyes after LASIK performed by one of TLC's "top surgeons" ? I wonder
~ is TLC hoping to catch this patient on video-tape hitting a 60
mile-per-hour fastball, or having more than 6 hours a day of pain-free
eye-time ? Is it really true that TLC would first, cripple a patient
and customer - and then pay a PI to tail that patient when they call a
lawyer ? My, what nice "doctors" they have at TLC.
> intimate they are liars,
Unfortunately, many of them have exhibited a pattern of deceptive
behavior in their treatment of patients, and in their communications
with the general public, whilst advertising their product.
camp in front of their medical offices with
> an eye patch and a sign saying LASIK harmed you,
I do wear an eye-patch to elevate the humidity around my left cornea
and to achieve BCVA post-LASIK. My sign says "LASIK impaired my
vision."
In general, given that I am witnessing an epidemic of corneal disease,
which onsets at the time of patient's refractive surgeries, I consider
it appropriate to warn other patients and the general public about the
dangers of refractive surgery, and the danger to their vision which
lies, mostly hidden, in the "medical" offices of countless refractive
surgeons.
Indeed, based on the interactions that I have had with passersby, I
see that there is certainly a difference between meeting a person who
stopped reading for pleasure after LASIK - and now listens to Books on
Tape ... and listening to an ad, or reading about "what could happen"
in an informed consent form. In fact, most of the people I meet are
grateful for the information.
and hiring a plane to
> drag an anti-LASIK banner around southern California.
Nice touch, don't you think ?
> It is a pity that you have the difficulties you report and it would be
> great if someone could help you
Thanks for the crocodile tears, Glenn. Ron Link told me you used to
have a connection with the insurance industry. If that is true, I'll
be impressed when you give up on CRSQA and go back to selling
insurance ... or when you use your connections with doctors to treat
the corneal disease which we are experiencing - which manifested at
the time of our refractive surgeries. Then leave it up to the scribes
at Surgical Eyes and elsewhere to document your noble efforts.
, but in my opinion, no doctor in his
> or her right mind would accept you or someone like you as a patient.
You need to remember that I tried asking nice for help for 3 1/2
years. It didn't work.
It is true and I will admit publicly - I am looking for better
treatment from a doctor than I received from Gordon or Friedlaender.
As far as the other 8 ophthalmologists and optometrists I've seen, I
am grateful for their candor and care.
Do you really think it's fitting for the head of a non-profit to be
seen publicly interfering with a patient's request for medical
assistance ? One might get the idea that Glenn Hagele and CRSQA are
working as a paid agent of the refractive surgery industry, working
assiduously to stifle dissent, occasionally literally defaming injured
patients.
Sincerely,
~ Roger ~
Roger Bratt
Copyright 2002 Roger Bratt
Roger
> by other doctors who are considered top notch
One other note about "Doctor" Friedlaender.
I asked him for help with my dry eye discomfort.
His primary comment was to tell me what a "great surgeon" "Doctor"
Mickey Gordon is. This un-solicited opinion was rendered with a
smile.
Following that, Friedlaender offered no therapeutic measures for my
eyes beyond, perhaps, punctal plugs, which I had already tried, for
six months, and had removed.
No Schirmer's, no review of state-of-the art eyedrops, and, again, no
mention of the therapies that he had previously described quite
plainly in medical articles that he co-authored - such as occlusive
goggles.
He also declined my request for an Orbscan, because I wanted to know
what my corneal thickness was. Apparently that request was considered
un-reasonable.
Glenn implies that I should be grateful for Friedlaender's "care." I
believe the term "care" is in-accurate - my perception is that
Friedlaender could give a f*ck about the health of my corneas. At the
time I was "just another member of the HMO" - this was 1 3/4 years
before I stood on the Scripps sidewalk with a sign.
Like I said, I tried asking nice - for 3 1/2 years. It just plain did
not work.
At the same time, when I do see a doctor, I show up on time, I speak
respectfully, I don't raise my voice ... "just another patient".
Dan Abel
roger...@yahoo.com (Roger) wrote:
> Very true. To consider a human beings corneas to be expendable is
> close to considering a human being to be expendable. To quote
> "Disgruntled Doc" at Surgical Eyes, "The standard of care in the
> profession of refractive surgery is to functionally blind a fraction
> of their patients". Such a "profession" is worthy of derision.
> Personally, I thought doctors were supposed to move their patients in
> the direction of greater health.
I'm sorry but there is risk in this world. Thinking that doctors are
responsible for our eyes is not realistic. WE are responsible for our
eyes. Every person who mows their lawn or trims their hedges without
wearing eye protection is endangering their eyes. People still do it. I
do it. Some people choose to risk their eyes by having surgery. I've had
many eye surgeries. I have assumed the risk. I would not assume the risk
of LASIK, but that's MY personal choice. Many people have assumed the
risk of LASIK, had a successful (to them) outcome, and are glad they did
it. Some lost the gamble and are unhappy.
To the extent that eye doctors are lying about the risks, I'm unhappy and
think that needs to be stopped. To the extent that the eye doctor did
everything reasonable, and the patient just had a bad outcome, I can offer
sympathy, but no blame to the doctor.
And yes, human beings are expendable. Whole bunches of people die every
year in car accidents. Why? Who's fault is this? There IS a simple
solution: stop driving. Most of us are willing to assume the risk of
death in order to get around. Does that make sense? Well, yes!
LASIKdisaster
> still ...
> * have them lie to you, in order to close the sale.
> * have them overlook prominent contra-indications, in order to close
> the sale.
Like the patient I know who went to not only a VIP LASIK surgeon, but
a CRSQA "Top Quality", "Certified The Best", "Safe", "Caring" and
whatever else they are supposed to be. She refused any procedure not
FDA-approved, yet his laser was set to override the approved
parameters without her knowledge or permission, and she is now
uncorrectable with either glasses or a hard contact lens. He said, "I
don't know what's wrong with your eye" and left the room because her
crying made him uncomfortable.
Another doctor has told her that only a transplant will restore her
vision.
Glenn, I think it's really pathetic that you refer patients to your
"doctors" for unnecessary surgery which can devastate a person to the
brink of suicide. You found a niche for yourself, but what you are
participating in is evil. LASIK may work well most of the time, but
it has left in its wake thousands of souls who are considered
expendable roadkill by a multi-billion dollar industry that only cares
about profits.
I guess I'll start another thread and ask my question again.
Bill in Colorado
Is there any industry that cares about anything else but profits? (maybe
I'm a bit jaded). Bottom line, this whole refractive surgery thing is
just a crap shoot. Some come out unscathed, and some don't.
But you're right, to the extent that the doctor *was* at fault, he should
be held accountable, and the risks of this surgery should be clearly
advertised and not trivialized.
Roger
> Is there any industry that cares about anything else but profits? (maybe
> I'm a bit jaded). Bottom line, this whole refractive surgery thing is
> just a crap shoot. Some come out unscathed, and some don't.
Nothing wrong with caring about profits, per se. It seems that the
intersection of business and medicine offers the chance for certain
individuals to utilize their MD's in a manner that takes advantage of
people's trust.
I think there was a time for most of us when we put doctors on a
pedestal. I know there's still some darn good ophth's out there; one
of them saved my sister-in-law's father's eye from falling out of his
head. It had swollen up to about the size of a golf ball ... he was
wearing a metal shield to keep the eye from literally falling out of
his head. Then his "miracle" doctor had an insight - realized that
there was an arterial blockage. The patient had a surgery where they
ran a little Roto-rooter thing from a leg artery up into his head.
Within 48 hours the gross swelling had completely subsided.
> But you're right, to the extent that the doctor *was* at fault, he should
> be held accountable, and the risks of this surgery should be clearly
> advertised and not trivialized.
Careful, Bill. You're beginning to sound like me.
Roger
Bill in Colorado
Well, I think I've already stated I had a mini-RK back in the old days
(fortunately it was just a 4 incision mini-RK), and while my vision is now
close to 20/20, the side effects of glare and starbursting are still there,
and they probably should have been stressed more at the time, and not just
trivilialized as in.... "in rare cases...."
Glenn Hagele - Council for Refractive Surgery Quality Assurance
with dreadful outcomes, but evil? You are falling deep into
hyperbole.
My participation in the "refractive surgery industry" is providing
objective information to potential patients that includes risks as
well as the potential benefits and educating people how to select a
surgeon if they decide they want refractive surgery.
Glenn Hagele - Council for Refractive Surgery Quality Assurance
>
>> But you're right, to the extent that the doctor *was* at fault, he should
>> be held accountable, and the risks of this surgery should be clearly
>> advertised and not trivialized.
>
>Careful, Bill. You're beginning to sound like me.
>
>Roger
On this point, everyone should sound the same.
JK
Council for Refractive Surgery Quality Assurance) wrote:
>At the ISRS meeting before last, a joint statement recognizing CRSQA's
>certification and the ISRS GLORY training/certification program was
>released and announced by then ISRS president Michael Lawless, MD.
Is the "GLORY training program" the 1 day or the 2 day LASIK course?
JK
have Glenn's head spinning.
Someone SHOULD forward this information to the state as there is no
apparent source disclosure of the alleged 250K. If this moneyexists
only on paper(ie;coupons). I believe YES it can be interpreted as
FRAUD.
Go ahead, make my day. Send the stuff to the attorney general.
As Glenn is an up an up straight shooter, I am sure he would not mind
cooperating with a minor investigation from either the state and/or
the IRS.
On 23 Dec 2002 13:48:39 -0800, admini...@lasikcourt.com (Brent
JK
Oh, don't forget to share the story with the media.
TV would love another Lasik industry story/investigation. I am sure
potential CRQSA surgeons would be most eager to affiliate with Glenn.
LASIKdisaster
> There are the unfortunate few
If we use your numbers of 3% still having problems with complications
after six months post-op, that's at least 90,000.
90,000 with damaged eyesight.
That is not just a few unfortunate souls. That is widespread damage.
like you who have refractive surgery
> with dreadful outcomes, but evil? You are falling deep into
> hyperbole.
Evil, as in the doctor who began to see cases of ectasia
(surgically-thinned corneas bulging under normal intraocular eye
pressure) and tried to get case studies published but was continually
refused, because this was "BAD NEWS" and we cannot have a bad light
cast over this multibillion dollar industry, can we Glenn?
Evil, as in the white wall of silence we encounter when we experience
complications. Let me give you an example.
Once I began reading Surgical Eyes and the ophthalmology journals and
realized that my pupils were probably way too big to have been a good
candidate for any kind of refractive surgery, and found out that my
ablation zones at their widest point were a full 2.5 mm smaller than
my night pupils, I found out that my surgeon had specifically chosen
the smallest ablation zone setting on the laser. There was no pupil
size on my chart, and I realized that no one had ever taken this
critical measurement.
I made the rounds to a bunch of docs, and specifically asked one,
"Shouldn't my surgeon have been checking for a pupil size when he
chose the ablation zone?".
He answered, "Not necessarily".
He's a CRSQA surgeon. And yes, my doctor should have noticed when he
was selecting the zone that my pupils were never measured.
>
> My participation in the "refractive surgery industry" is providing
> objective information to potential patients that includes risks as
> well as the potential benefits and educating people how to select a
> surgeon if they decide they want refractive surgery.
But then they chose one of your doctors and come out needing a cornea
transplant.
BICisfag
Aren't you the same idiot who says, "Sure, go out and get LASIK.. don't worry
about anything"
And here you can't see shit at night. LASIK isn't THAT much better
RK. It is all butchery and you should be the Poster Child to
STOP the eye surgery. But you are probably so bitter from
what has happened to you and want others to do the same.
Misery loves company and you ARE miserable Bill.
Merry Christmas Bill 'StarBurst in Colorado'
Just another uninvited comment for Bill in Colorado. You know
the drill TROLL.
PS I don't have any startbursts at night because I've never gotten
eye surgery.
BICisfag
Glenn Hagele - Council for Refractive Surgery Quality Assurance
>Evil, as in the doctor who began to see cases of ectasia
>(surgically-thinned corneas bulging under normal intraocular eye
>pressure) and tried to get case studies published but was continually
>refused, because this was "BAD NEWS" and we cannot have a bad light
>cast over this multibillion dollar industry, can we Glenn?
But LASIKdisaster, case studies on refractive surgery induced ectasia
have been presented at the ophthalmic conferences for years. That was
one of the reasons the 250-micron minimum untouched cornea protocol
came about. Case studies have been published in peer-reviewed
journals and the trade magazines (not peer reviewed) had stories of
concerns about LASIK induced ectasia long, long ago.
Come to think of it, you tend to use quotes from these very
publications on this newsgroup to bolster your anti-refractive surgery
claims.
It is due to the free exchange of information about limitations and
problems with surgeries and treatments that corrections and
modifications come about. This is true for refractive surgery as well
as every other component of medicine. Thanks to the exchange of
information, doctors now know that the patient will have a have a high
risk of LASIK induced ectasia if they ablate below the 250-micron
level. Why an individual doctor's study was not published could
simply have been that it was redundant.
>
>Evil, as in the white wall of silence we encounter when we experience
>complications. Let me give you an example.
>
>Once I began reading Surgical Eyes and the ophthalmology journals and
>realized that my pupils were probably way too big to have been a good
>candidate for any kind of refractive surgery, and found out that my
>ablation zones at their widest point were a full 2.5 mm smaller than
>my night pupils, I found out that my surgeon had specifically chosen
>the smallest ablation zone setting on the laser. There was no pupil
>size on my chart, and I realized that no one had ever taken this
>critical measurement.
You had your surgery in 1999. At that time the full extent of the
pupil size vs. ablation zone was not well understood. Even today,
there have been presentations of studies where pupil size was not
indicative preoperatively of low light vision problems (I don't buy it
totally, BTW, but that is what the studies have supported). If I
remember correctly, we had our explanation about the importance of
pupil size on our website in 1999.
http://www.usaeyes.org/faq/subjects/pupil_size.htm
Although some doctors have always felt pupil size was a primary
consideration regarding low light vision problems, it took a while for
others to accept and implement the protocols. Some still do not.
As I said, even today there are doctors who do not subscribe to the
idea that an ablation zone smaller than the naturally dilated pupil
will cause low light environment vision problems. One of the reasons
they can support this theory is that there are thousands of LASIK
patients who have no low light vision problems even though their
ablation zones are smaller than their naturally dilated pupil.
As we state in the linked article shown above, low light problems are
multifactorial. It's not just about pupil size, but about amount of
refractive error, type of refractive error, curvature of cornea, depth
of ablation, size of transition zone, and other issues as well. We
also state in this article that if the ablation zone is not equal to
or larger than the scotopic pupil size, the patient has a higher
chance of low light environment vision problems. Problems are not
guaranteed, but there is a higher chance.
>
>I made the rounds to a bunch of docs, and specifically asked one,
>"Shouldn't my surgeon have been checking for a pupil size when he
>chose the ablation zone?".
>He answered, "Not necessarily".
>
>He's a CRSQA surgeon. And yes, my doctor should have noticed when he
>was selecting the zone that my pupils were never measured.
Not necessarily is absolutely correct. In 1999, many, refractive
surgeons were not measuring pupil size. What is known at the end of
2002 is greater than what was known in 1999. As I said before, even
today the issue of pupil size vs. ablation zone is not universally
accepted. There are many other reasons why in 1999 measuring your
pupil size may not have been an issue based upon the knowledge at the
time and your individual circumstances.
BTW, you previously said your vision problem was because of a
malfunctioning microkeratome, not a pupil size issue.
We have in our 50 Tough Questions that all doctors today should be
checking for scotopic pupil size preoperatively. That measurement
needs to be included in the consideration of ablation size. In the
link above we provide a lengthy explanation of some of the concerns
about pupil size. If you find any inaccuracies in what we state in
this article, please let me know so I may correct them.
>> My participation in the "refractive surgery industry" is providing
>> objective information to potential patients that includes risks as
>> well as the potential benefits and educating people how to select a
>> surgeon if they decide they want refractive surgery.
>
>But then they chose one of your doctors and come out needing a cornea
>transplant.
I don't personally know of any patient who used our services and then
needed a transplant, but nonetheless, the issue you raise is
important. Even with the best surgeon, all the preoperative tests
imaginable, and everything done according to plan, a patient can still
have a bad result. This is surgery. Surgery has risks. Even if the
risks are small, they exist and no one can guarantee a perfect result.
We tell people this on our website. I have said it here again and
again. We explain that refractive surgery is not a slam-dunk like
some of the ads say. On many occasions in many forums I have
explained to individuals who are considering refractive surgery that
their particular circumstances indicate that they are at a higher risk
of problems. We make it clear that even our evaluated doctors have
undesirable outcomes on occasion.
Then we do what is apparently unconscionable to you; we let people
make their own decision. That is our guilt; we are not so arrogant as
to condemn someone because they don't do what we think they should do.
We are willing to make the information available and let them decide
on their own.
Apparently you demand that refractive surgery be perfect and that
every refractive surgeon be perfect every time or everything must stop
and no one can have refractive surgery. Surgery is not perfect.
Never has been, never will be.
What seems to bother the anti-refractive surgery zealots most is that
there are people who even after reading CRSQA's information and
visiting every anti-refractive surgery website including yours, still
decide to have refractive surgery. The truth is, sometimes I can't
understand why someone, when I have made it perfectly clear that they
are probably going to have major trouble, go ahead with surgery
anyway.
There is the old saying that you can lead a horse to water but you
cannot make him drink. You, on the other hand, seem intent on
poisoning the well and harrassing anyone who suggests that the water
is possibly okay.
Bill in Colorado
> HA HA HA Bill in Colorado. Having problems seeing at
> night?
Not really.
> Aren't you the same idiot who says, "Sure, go out and get
> LASIK.. don't worry about anything"
No, I never said that.
> And here you can't see shit at night. LASIK isn't THAT much better
> RK. It is all butchery and you should be the Poster Child to
> STOP the eye surgery. But you are probably so bitter from
> what has happened to you and want others to do the same.
> Misery loves company and you ARE miserable Bill.
Nope. I'm a happy camper, just like you. Except I don't have to hide my
real identity, like you apparently do, Stargazer. So maybe I'm happier
than you.
> Merry Christmas Bill 'StarBurst in Colorado'
Merry Christmas, StarGazer (in disguise)!
Linda
> HA HA HA Bill in Colorado (The TROLL). Having problems seeing at night?
> Aren't you the same idiot who says, "Sure, go out and get LASIK.. don't worry
> about anything"
> And here you can't see shit at night. LASIK isn't THAT much better
> RK. It is all butchery and you should be the Poster Child to
> STOP the eye surgery.
I understand from your posts that you have not had eye surgery. I
don't understand where all the anger is coming from. My own surgery
was very successful. I absolutely hated glasses and contacts, so when
I could no longer tolerate contacts, I took the plunge into Lasik.
There were other reasons as well, such as the maintenance required in
contact lenses which anyone will tell you is a pain in the arse. I
also like to surf which is downright impossible with contact lenses
in. As I was -6.50 in each eye before Lasik, I couldn't see anything
when I was in the surf without my contacts.
But you are probably so bitter from
> what has happened to you and want others to do the same.
> Misery loves company and you ARE miserable Bill.
>
> Merry Christmas Bill 'StarBurst in Colorado'
>
> Just another uninvited comment for Bill in Colorado. You know
> the drill TROLL.
Can someone explain to me what a troll is? I get the impression that
it is someone who is not really interested in the site, they just want
to cause trouble and incite people to make nasty comments.
> PS I don't have any startbursts at night because I've never gotten
> eye surgery.
So my question is, why do you dislike Laser surgery so much?
Regards, Linda
BICisfag
who are minding their own business. They do it for the fun of it.
Maybe LASIK worked out for you but for many it has not.
I personally know of one who it was a disaster. And many more
report here.
Now watch how Bill in Colorado replies to my post... this is
TROLLING.
BICisfag
You'll just have to let it go cause I'm not
StarGazer. Sounds like he really did a
number on you.
And... you must be a liar because you
said you have problems seeing at night.
So which is it Billy?
Bill in Colorado
to continue to hide behind your multiple false identities, because you have
a problem accepting yourself, then so be it.
Bill in Colorado
to continue to hide behind your multiple false identities, because you have
a problem accepting yourself, then so be it.
Linda
> A TROLL is someone like Bill in Colorado who attacks strangers
> who are minding their own business. They do it for the fun of it.
> Maybe LASIK worked out for you but for many it has not.
You still do not say whether you have had Laser Eye Surgery. It is
very unusual to get so upset if the damage does not relate to you
personally.
> I personally know of one who it was a disaster. And many more
> report here.
When you really look at the posts, there are really not that many bad
outcomes. It only seems that way because the same people post over and
over again (which they are fully entitled to).
> Now watch how Bill in Colorado replies to my post... this is
> TROLLING.
I have to defend Bill because he has been posting here for a long time
and has interesting information to share. However he is a big boy and
I am sure he can defend himself.
Regards, Linda
Bill in Colorado
>> A TROLL is someone like Bill in Colorado who attacks strangers
>> who are minding their own business.
(You weren't minding your own business, Stargazer, cause you don't have
any).
>> They do it for the fun of it.
>> Maybe LASIK worked out for you but for many it has not.
>
> You still do not say whether you have had Laser Eye Surgery. It is
> very unusual to get so upset if the damage does not relate to you
> personally.
He has not. Look at his old posts under his "real name". (He is just
talking out of a vacuum).
>> I personally know of one who it was a disaster. And many more
>> report here.
>
> When you really look at the posts, there are really not that many bad
> outcomes. It only seems that way because the same people post over and
> over again (which they are fully entitled to).
>
>> Now watch how Bill in Colorado replies to my post... this is
>> TROLLING.
>
> I have to defend Bill because he has been posting here for a long time
> and has interesting information to share.
TNX, Linda. Whereas Stargazer makes such enlightening comments as
"anybody who gets LASIK is an idiot"... (but he has to change his *alias*
every month...)
> However he is a big boy and I am sure he can defend himself.
You can come to my rescue anytime, Linda!! :-)
** OK, Stargazer, enlighten us some more....(it beats watching the Pink
Panther)
LASIKdisaster
> LASIKdisaster wrote:
>
> > Yes. And visual aberrations are not considered "complications" by
> > this industry. They are explained away as "You are too picky about
> > your vision"; "You are an active focuser";
>
> What is an active focuser?
A condescending phrase invented by a lasik surgeon with an unhappy
patient, to make them go away.
LASIKdisaster
> You had your surgery in 1999. At that time the full extent of the
> pupil size vs. ablation zone was not well understood.
FROM 1991:
"Authors Applegate RA. Institution Department of Ophthalmology,
University of Texas Health Science Center, San Antonio. Title Acuities
through annular and central pupils after radial keratotomy (RK).
Source Optometry & Vision Science. 68(8):584-90, 1991 Aug.
Clinical implications include: (1) variations in visual performance
(e.g., acuity, contrast sensitivity, glare) and optical quality
measures (e.g., refraction, higher-order aberrations) as a function of
pupil size; (2) use of a large a surgery-free area as possible; (3)
careful centering of the surgery-free area on the natural pupil; (4)
new contact lens designs for correcting RK patients' residual
refractive error; and (5) counseling patients in general, and patients
with naturally large pupils in particular, concerning possible
variation in visual function with pupil size.
>Even today,
> there have been presentations of studies where pupil size was not
> indicative preoperatively of low light vision problems (I don't buy it
> totally, BTW, but that is what the studies have supported). If I
> remember correctly, we had our explanation about the importance of
> pupil size on our website in 1999.
> http://www.usaeyes.org/faq/subjects/pupil_size.htm
I don't buy it at all. Yes, other parameters can contribute, but
putting a 6 mm zone on an 8.5 mm pupil is malpractice.
>
> Although some doctors have always felt pupil size was a primary
> consideration regarding low light vision problems, it took a while for
> others to accept and implement the protocols. Some still do not.
They should try some Alphagan.
>
> As I said, even today there are doctors who do not subscribe to the
> idea that an ablation zone smaller than the naturally dilated pupil
> will cause low light environment vision problems. One of the reasons
> they can support this theory is that there are thousands of LASIK
> patients who have no low light vision problems even though their
> ablation zones are smaller than their naturally dilated pupil.
Doesn't Dr. Horn think that about 1/2 mm is okay? I know that he
doesn't think 2.5 mm is acceptable.
>
> As we state in the linked article shown above, low light problems are
> multifactorial. It's not just about pupil size, but about amount of
> refractive error, type of refractive error, curvature of cornea, depth
> of ablation, size of transition zone, and other issues as well. We
> also state in this article that if the ablation zone is not equal to
> or larger than the scotopic pupil size, the patient has a higher
> chance of low light environment vision problems. Problems are not
> guaranteed, but there is a higher chance.
Again, give them Alphagan and see if that doesn't help.
>
> >
> >I made the rounds to a bunch of docs, and specifically asked one,
> >"Shouldn't my surgeon have been checking for a pupil size when he
> >chose the ablation zone?".
> >He answered, "Not necessarily".
> >
> >He's a CRSQA surgeon. And yes, my doctor should have noticed when he
> >was selecting the zone that my pupils were never measured.
>
> Not necessarily is absolutely correct. In 1999, many, refractive
> surgeons were not measuring pupil size. What is known at the end of
> 2002 is greater than what was known in 1999. As I said before, even
> today the issue of pupil size vs. ablation zone is not universally
> accepted. There are many other reasons why in 1999 measuring your
> pupil size may not have been an issue based upon the knowledge at the
> time and your individual circumstances.
>
> BTW, you previously said your vision problem was because of a
> malfunctioning microkeratome, not a pupil size issue.
Huh? The Hansatome (Bausch and Lomb) jam was one of many things that
went wrong. I also had grade 4 DLK (or CTK) and the pupil size issue.
Not to mention that I had dry eyes and RGP-warped corneas prior to
surgery.
>
> We have in our 50 Tough Questions that all doctors today should be
> checking for scotopic pupil size preoperatively. That measurement
> needs to be included in the consideration of ablation size. In the
> link above we provide a lengthy explanation of some of the concerns
> about pupil size. If you find any inaccuracies in what we state in
> this article, please let me know so I may correct them.
If and when I have time.
>
>
> >> My participation in the "refractive surgery industry" is providing
> >> objective information to potential patients that includes risks as
> >> well as the potential benefits and educating people how to select a
> >> surgeon if they decide they want refractive surgery.
> >
> >But then they chose one of your doctors and come out needing a cornea
> >transplant.
>
> I don't personally know of any patient who used our services and then
> needed a transplant, but nonetheless, the issue you raise is
> important.
I do personally know of a patient who had this experience.
Even with the best surgeon, all the preoperative tests
> imaginable, and everything done according to plan, a patient can still
> have a bad result. This is surgery. Surgery has risks. Even if the
> risks are small, they exist and no one can guarantee a perfect result.
I hope everyone considering lasik understands what you just said.
This is what I say until I'm blue in the face. Choosing a CRSQA
surgeon does not guarantee you anything!
>
> We tell people this on our website. I have said it here again and
> again. We explain that refractive surgery is not a slam-dunk like
> some of the ads say. On many occasions in many forums I have
> explained to individuals who are considering refractive surgery that
> their particular circumstances indicate that they are at a higher risk
> of problems. We make it clear that even our evaluated doctors have
> undesirable outcomes on occasion.
>
> Then we do what is apparently unconscionable to you; we let people
> make their own decision. That is our guilt; we are not so arrogant as
> to condemn someone because they don't do what we think they should do.
> We are willing to make the information available and let them decide
> on their own.
Your information is biased and you are riding the lasik profit
coattails. Your CRSQA seal gives patients a false sense of security.
>
> Apparently you demand that refractive surgery be perfect and that
> every refractive surgeon be perfect every time or everything must stop
> and no one can have refractive surgery. Surgery is not perfect.
> Never has been, never will be.
I don't demand that it be perfect. I want people to know ALL of the
bad things that can happen to them if they have LASIK. Armed with
that knowledge, if they go ahead and get sliced and burned, that's up
to them. Do I think they're stupid if they have that knowledge and do
it anyway? Yeah, but I think I was stupid to trust my doctors, too.
>
> What seems to bother the anti-refractive surgery zealots most is that
> there are people who even after reading CRSQA's information and
> visiting every anti-refractive surgery website including yours, still
> decide to have refractive surgery. The truth is, sometimes I can't
> understand why someone, when I have made it perfectly clear that they
> are probably going to have major trouble, go ahead with surgery
> anyway.
I get so many letters thanking me for the information on my site, like
the guy who said "I just saw your site and after all of maybe six
seconds, I think I'll stick with my glasses!". My suffering and all
of my effort to shine a light on lasik's dirty secrets has not been in
vain.
>
> There is the old saying that you can lead a horse to water but you
> cannot make him drink. You, on the other hand, seem intent on
> poisoning the well and harrassing anyone who suggests that the water
> is possibly okay.
Does anyone know for sure that the water is okay? Possibly okay is
not good enough when we're talking about a person's vision...for life.
Glenn Hagele - Council for Refractive Surgery Quality Assurance
Glenn Hagele - Council for Refractive Surgery Quality Assurance
wrote:
>>
>> You had your surgery in 1999. At that time the full extent of the
>> pupil size vs. ablation zone was not well understood.
>
>FROM 1991:
>"Authors Applegate RA. Institution Department of Ophthalmology,
>University of Texas Health Science Center, San Antonio. Title Acuities
>through annular and central pupils after radial keratotomy (RK).
>Source Optometry & Vision Science. 68(8):584-90, 1991 Aug.
>
> Clinical implications include: (1) variations in visual performance
>(e.g., acuity, contrast sensitivity, glare) and optical quality
>measures (e.g., refraction, higher-order aberrations) as a function of
>pupil size; (2) use of a large a surgery-free area as possible; (3)
>careful centering of the surgery-free area on the natural pupil; (4)
>new contact lens designs for correcting RK patients' residual
>refractive error; and (5) counseling patients in general, and patients
>with naturally large pupils in particular, concerning possible
>variation in visual function with pupil size.
Yes, there have been many articles that predate your surgery. But the
fact remains that at that time pupil measurement was not yet standard
of care. Yes, it probably should have been, but it was not. Even
today, while I think it is safe to say pupil measurement is standard
of care, there are good doctors who do not automatically exclude
someone because their pupils are large.
>
>>Even today,
>> there have been presentations of studies where pupil size was not
>> indicative preoperatively of low light vision problems (I don't buy it
>> totally, BTW, but that is what the studies have supported). If I
>> remember correctly, we had our explanation about the importance of
>> pupil size on our website in 1999.
>> http://www.usaeyes.org/faq/subjects/pupil_size.htm
>
>I don't buy it at all. Yes, other parameters can contribute, but
>putting a 6 mm zone on an 8.5 mm pupil is malpractice.
Wow! You have 8.5mm naturally dilated pupils? That is huge. Or is
that 8.5 with a Colvard pupilometer? The infrared pupilometer adds
about 1.0mm to what happens in normal low light.
It would be great if malpractice were so simple as subtracting the
ablation size from the pupil size, but it is not. There are many
patients with ablation sizes smaller than their naturally dilated
pupils that have no problems at all.
Of course, when in doubt, error on the side of safety and have the
ablation zone larger than the pupil size. We make this clear on our
website and with my related Internet posts.
This part of this thread is because a doctor told you your doctor may
not have been required to measure your pupil size. At that time and
depending upon your individual circumstances, that may have been
correct.
>>
>> Although some doctors have always felt pupil size was a primary
>> consideration regarding low light vision problems, it took a while for
>> others to accept and implement the protocols. Some still do not.
>
>They should try some Alphagan.
For those who do not understand what you mean by this, Alphagan when
applied as an eye drop will cause the pupil to constrict. It is
common for people with halos and/or starbursts in low light
environments to have these problems disappear when the pupil size is
constricted with Alphagan or other means.
You made the same conclusion that I made when I heard this
presentation and I argued with the doctor that he had to be wrong, but
the assumption we made is wrong.
The first assumption is that halos are caused by light disruption at
the edge of the ablation.
I figured that because nearly all of the people who have halos in low
light environments have the halos disappear when the pupil is
constricted (this has been proven in several studies), that it was
obvious that the ablation size needs to be greater than the naturally
dilated pupil.
He pointed out that not all of the people who have ablation sizes
smaller than their naturally dilated pupil have low light environment
halos. This too has been proven in several studies.
So the first assumption is wrong. Or more accurately, partiatally
wrong. Halos are not always caused ONLY by light disruption at the
edge of the ablation. There are additional factors that must also be
present that are not yet fully understood or identified.
This is why the studies that state pupil size is not an accurate
predictor of low light environment halos are correct. There are
people with small ablation zones and large pupils who do not have halo
problems. Why they don't is still conjecture, but these people do
exist.
If pupil size vs. ablation size ALONE induced the halos, then 100% of
the patients who have ablations smaller than their naturally dilated
pupils should have halo problems. They do not, only some do.
Maybe it is ablation edge and corneal curvature after surgery. That
would explain why RGP lenses help without constricting the pupil size.
Perhaps it is a transition zone to ablation depth ratio of say 0.25mm
transition zone for every 20 microns of tissue removed that is safe
but 0.25mm for every 25 microns of tissue isn't safe. I'm just making
wild guesses here, but it is definitely something more than just
ablation size.
From our point of view, this debate is purely academic. The only way
a patient can have the lowest probability of low light vision problems
is to have the ablation larger than the naturally dilated pupil. That
is the safest route and the safest route is always the best.
Yes, some patients may have smaller zones and not have problems, but
it is impossible to predict at this time who will luck out and who
will have permanent halo problems.
>> As I said, even today there are doctors who do not subscribe to the
>> idea that an ablation zone smaller than the naturally dilated pupil
>> will cause low light environment vision problems. One of the reasons
>> they can support this theory is that there are thousands of LASIK
>> patients who have no low light vision problems even though their
>> ablation zones are smaller than their naturally dilated pupil.
>
>Doesn't Dr. Horn think that about 1/2 mm is okay? I know that he
>doesn't think 2.5 mm is acceptable.
I don't know what a particular doctor thinks is appropriate, but no
matter what number you pick, there will be someone who will say it is
fine and someone who will say it is not. There are few universally
accepted truths in medicine.
>> BTW, you previously said your vision problem was because of a
>> malfunctioning microkeratome, not a pupil size issue.
>
>Huh? The Hansatome (Bausch and Lomb) jam was one of many things that
>went wrong. I also had grade 4 DLK (or CTK) and the pupil size issue.
> Not to mention that I had dry eyes and RGP-warped corneas prior to
>surgery.
Sorry, I should have gone back to your website and looked this up.
I'm getting lazy.
>> We have in our 50 Tough Questions that all doctors today should be
>> checking for scotopic pupil size preoperatively. That measurement
>> needs to be included in the consideration of ablation size. In the
>> link above we provide a lengthy explanation of some of the concerns
>> about pupil size. If you find any inaccuracies in what we state in
>> this article, please let me know so I may correct them.
>
>If and when I have time.
You and I spend a lot of time discussing issues that have got to be
boring to most of the people visiting this newsgroup. I personally
enjoy our discussions because 1) you know your stuff and 2) you keep
me on my toes. Perhaps our time would be better spent elsewhere, but
I appreciate your intelligent debate and would welcome your comments
or concerns about anything on our website.
>> Even with the best surgeon, all the preoperative tests
>> imaginable, and everything done according to plan, a patient can still
>> have a bad result. This is surgery. Surgery has risks. Even if the
>> risks are small, they exist and no one can guarantee a perfect result.
>
>I hope everyone considering lasik understands what you just said.
>This is what I say until I'm blue in the face. Choosing a CRSQA
>surgeon does not guarantee you anything!
Well, a patient will know that the doctor has been evaluated by CRSQA
and has met our standards. That does NOT guarantee any person any
particular outcome. Even the very best doctors, CRSQA or non-CRSQA,
have unexpected and unfortunate outcomes.
When someone uses our website to search for a surgeon we state very
clearly "Past performance is NO GUARANTEE of future results. Even
patients of CRSQA Certified Refractive Surgeons can have poor results"
(original emphasis) and everyone seeking a referral to a CRSQA surgeon
must acknowledge this fact before we provide them doctor information.
This is one of the reasons I do not want a list of CRSQA doctors
posted on this newsgroup. Not only have the lists posted by others
already become outdated, but someone who does not go to our website
and have the opportunity to see that there are limitations and read
our words of caution, may inappropriately think that using a CRSQA
doctor guarantees them a good result. Wrong! There are no guarantees
in surgery.
The most someone can do is increase the probability of a good outcome,
but they cannot guarantee it. Using an evaluated surgeon increases
the odds. Understanding what refractive surgery can and cannot
provide increases the odds. Using our 50 Tough Questions to screen a
surgeon increases the odds. But a patient can do everything right and
still have a bad result. Even if it is more rare than a PhD at a
spitting contest, it still can happen.
> Your CRSQA seal gives patients a false sense of security.
If someone has a false sense of security, it is because of his or her
own false assumptions, not because of what we have said.
>> Apparently you demand that refractive surgery be perfect and that
>> every refractive surgeon be perfect every time or everything must stop
>> and no one can have refractive surgery. Surgery is not perfect.
>> Never has been, never will be.
>
>I don't demand that it be perfect. I want people to know ALL of the
>bad things that can happen to them if they have LASIK. Armed with
>that knowledge, if they go ahead and get sliced and burned, that's up
>to them. Do I think they're stupid if they have that knowledge and do
>it anyway? Yeah, but I think I was stupid to trust my doctors, too.
I don't know if we cover every last item that can go wrong no matter
how small the possibility, but we most certainly do discuss in detail
the ones that have occurred most often. In case we lack any
information, we provide links to other resources where more
information is available, including your website.
>> What seems to bother the anti-refractive surgery zealots most is that
>> there are people who even after reading CRSQA's information and
>> visiting every anti-refractive surgery website including yours, still
>> decide to have refractive surgery. The truth is, sometimes I can't
>> understand why someone, when I have made it perfectly clear that they
>> are probably going to have major trouble, go ahead with surgery
>> anyway.
>
>I get so many letters thanking me for the information on my site, like
>the guy who said "I just saw your site and after all of maybe six
>seconds, I think I'll stick with my glasses!". My suffering and all
>of my effort to shine a light on lasik's dirty secrets has not been in
>vain.
LASIK's "dirty secrets" are not so secret anymore and pretty much out
in the open. CRSQA's website, your website, SurgicalEyes, Roger
Bratt, Brent Hanson, media news items, and others sources have done a
good job of countering the embarrassingly pro-LASIK websites and
advertisements that had dominated the Internet and media.
>>
>> There is the old saying that you can lead a horse to water but you
>> cannot make him drink. You, on the other hand, seem intent on
>> poisoning the well and harrassing anyone who suggests that the water
>> is possibly okay.
>
>Does anyone know for sure that the water is okay? Possibly okay is
>not good enough when we're talking about a person's vision...for life.
Yes, for millions of people the water is not only okay, but splendid.
That is about 97% of the people who have had laser assisted refractive
surgery. The remaining 3% is a lot of people and that number needs to
get lower, but you and I both must acknowledge that for many people,
this is "good enough". If it is not, they should not elect to have
surgery.
Glenn Hagele - Council for Refractive Surgery Quality Assurance
Just in case someone misintrepreted my comment, I mean that "active
focuser" is BS, not LASIKdisaster's comments.
BICisfag
How does it feel to be a sicko?
BICisfag
And above ALL don't start e-mail with him.
eeeeeeck
BICisfag
weirdo
BICisfag
EyeSeeWell
Your company is the one that has ruined many eyes. Also, one of your
surgeons in Southern California, Torrance, CA was put on leave of
absence for six months for messing up many eyes. Don't you work with
Meister in Sacramento?
You have a financial interest to refer patients for LASIK.
By the way, I heard from one of your employees at Pacific Laser Eye
Center in Sacramento that TLC was going to invest or buy your centers.
Any truth to this statement?
William Stacy <wst...@obase.net> wrote in message news:<3E0755A8...@obase.net>...
> OK my error then. I thought I remembered something when you first started the
> organization, what 5 years ago or so? Were you ever associated with an
> ophthalmology practice?
>
> w.stacy, o.d.
>
> Glenn Hagele - Council for Refractive Surgery Quality Assurance wrote:
>
> > >If I'm not mistaken, Glenn's father is a refractive surgeon. Is that true,
> > >or did I dream it up? It would be interesting to see who's on the board of
> > >directors, president, CEO, etc.
> > >
> > >w.stacy, o.d.
> >
> > That's a new one. No, my father is not a physician and does not have
> > any connection with healthcare. I have a distant relative with the
> > same last name who is an ophthalmologist, but I don't know if he does
> > refractive surgery. We met only once years ago at a family reunion.
> >
> > Our Board of Trustees is listed on our website at
> > http://www.usaeyes.org/faq/trustees.htm.
Sharkstv
LASIKdisaster
that 8.5 with a Colvard pupilometer? The infrared pupilometer adds
about 1.0mm to what happens in normal low light.
Yes, Glenn, and the photograph of my pupils on my website was taken
after I sat in a dark room for a couple of minutes. They are very
obviously 8.2 and 8.3mm in the photo with natural dilation, and have
been measured at 8.5 with a Colvard.
>It would be great if malpractice were so simple as subtracting the
ablation size from the pupil size, but it is not. There are many
patients with ablation sizes smaller than their naturally dilated
pupils that have no problems at all.
And there are probably just as many who do have problems.
You say that it wasn't standard of care to measure pupil size at the
time of my surgery, but I disagree. So did my expert witness, my
attorneys, and my surgeon's and optometrist's attorneys and insurers.
Not only that, but my own surgeon publicly stated that 7-8 mm pupils
were too big, and during his deposition, he said that he doesn't do
LASIK on people with pupils measuring 7-8 mm.
As dumb as he is, even he knew that much. He was just too careless to
make sure that the measurement had been taken. He was reckless with
me, just as he had been with other patients, and that is why the
technician who assisted during my surgery eventually told me that my
surgeon is known as "The Butcher".
Han Sibot
inadequate lens power. I wonder what's appropriate. Is the average
longitudinal axis length in myopic people different from that in
hypermetropic people, or is that difference unknown? And what does the
abnormal longitudinal axis length mean for the spherical shape of the eye:
is a myopic eye cigar shaped, and the hypermetropic eye oblate?
Andre Berger
This is what the website of the Optometrists Association Australia
says about myopia: Myopia is caused by a mismatch between the power of
the optical components of the eye and the length of the eye (the
'axial length'). Either the power is too high, or the length is too
long, or both. Usually the cornea (the front surface of the eye) is
curved more steeply than average, increasing its optical power. ...
People with high levels of myopia often have very large, elongated
eyes, and their retinas may be stretched and thinner than normal. This
increases the risk of the retina developing holes and tears and the
risk of retinal detachments.
In other words, they don't provide data, but I get the impression that
axial length is increased only in a minority of the cases. However, in
a subgroup of that minority the axial length increase is very real.
Andre Berger
> what does the abnormal longitudinal axis length mean for the
> spherical shape of the eye: is a myopic eye cigar shaped?
The spheroid abberation is mentioned on a website
http://www.vision-training.com/Training/Myopia.htm. Apparently, myopic
eyes with an increased axial length are usually torpedo shaped:
"... plausible theory is offered by Peter R. Greene in his Ph.D.
thesis titled "Mechanical Aspects of Myopia," (1978). Greene evaluated
the stress experience on the eyes based on engineering principles. In
myopia only the back of the eyeball is elongated. The forward portion
remain normal. Eyes start out being approximately round but slowly,
typically over a 10 year period from age 8 to 18, the posterior sclera
slowly begin to take the shape of a prolate spheroid. Greene examined
the stress forces on the sclera [...] Greene found that the region
between the two oblique muscle attachments is subject to tensile
strength much higher than those at any other locate of the eyeball.
This theory, therefore, could account for the axial lengthening of the
eyeball that occur in high myopia."
leukoma
Refractive and axial component dimensions consistently show that
myopic eyes have longer vitreous chambers than emmetropic eyes.
Furthermore, the role of the extraocular muscles in creating this
elongation is not considered a serious line of scientific enquiry. In
fact, I have not seen it mentioned in any peer-reviewed study
published in the past five years. In this field, something published
in 1978 is considered ancient history.
DrG
Otis Brown
Subject: The experimental effort to relate focal status to length.
HS> Some people explain myopia by an elongated longitudinal axis, instead of
The standard theory (Donders-Helmholtz) maintains
that the eye is a rigid structure, and that only
the lens moves. The focal status of the eye
is measured by inducing preceptive blur on the
surface of the retina. This is strictly a relative
measurement.
In this theory it was assumed that a focal state of zero
was the perfect eye, and so the eye was assumed to be
a perfect spherical if the measured focal status was
exactly zero. The word "emmetropia" was coined to
describe this perfect situation.
Following this theory, then any focal
state that was not zero must prove that the eye has
a refractive error, (ametropia) and must be proven to be either
too long or too short.
A positve focal status of any degree was to be called
hyperopia, and a negative focal state was to be
called myopia or nearsighedness. Any focal state,
other than zero is considered a refractive error,
based on the above assumptions.
The eye does change its focal state as the visual
enviroment is changed. This is repeatedly demonstrated
by using "test" plus and minus lenses on chickens and primates, where
the visual enviroment could be controlled, and the focal
state measured accurately.
As to what "changed" to allow the natural eye to
match its focal sate to the aplied lens? I do not think
there is any agreement on that issue.
Best,
Otis
___________________
RESEARCH ITEM: The focal status of cats' eyes always follow the
average visual enviroment.
However, no relationship between the focal state of the
eye and its length. The jury is still "out" on that issue.
MYOPIA INDUCED IN CATS DEPRIVED OF DISTANCE
VISION DURING DEVELOPMENT
L. Rose, U. Yinon and M. Belkin
Vision Research Laboratory and the Department of
Ophthalmology, Hadassah University Hospital and Medical School,
Jerusalem, Israel
Abstract -- The refraction of 12 street cats' eyes and of 11
caged cats was measured by retinoscopy, and by antero-posterior
(axial) length of the eyeball was measured by ultra-sound.
While 87.5 percent of eyes in street cats were found to be hyper-metropic
(positive focal state +1.14 diopters, average), among cats caged for
periods of 8.5 to 14.0 months under conditions of near vision,
68.2 percent were myopic, (negative focal state -0.62 diopters,
average).
The antero-posterior (front-to-back) length of the eyeball was
practically equal in both groups (20.43 mm); it was also
practically equal for myopic and hyper-metropic (positive focal
status) eyes. The site of the refractive changes is discussed.
William Stacy
> Is the average
> > longitudinal axis length in myopic people different from that in
> > hypermetropic people, or is that difference unknown?
In general, yes, and it is well known and easily measurable.
> And what does the
> > abnormal longitudinal axis length mean for the spherical shape of the eye:
> > is a myopic eye cigar shaped, and the hypermetropic eye oblate?
1 mm error in axial length relates to approx 3.0 D. of refractive error, so no,
we are not talking cigars here.
> The focal status of the eye
> is measured by inducing preceptive blur on the
> surface of the retina.
Not true. It is measure by inducing clarity on the retina.
> In this theory it was assumed that a focal state of zero
> was the perfect eye, and so the eye was assumed to be
> a perfect spherical if the measured focal status was
> exactly zero. The word "emmetropia" was coined to
> describe this perfect situation.
Wrong again. No eye is anything close to perfectly spherical, as any ocular
anatomy text will show.
Emmetropia is defined as zero refractive error, or the condition where, when the
accommodative function is at complete rest, the eye is focused at optical
infinity.
> The eye does change its focal state as the visual
> enviroment is changed. This is repeatedly demonstrated
> by using "test" plus and minus lenses on chickens and primates, where
> the visual enviroment could be controlled, and the focal
> state measured accurately.
I think you will find that this was over a prolonged period during early
development, equivalent to infancy. It is easily explainable by the process of
emmetropization, which does not occur to any appreciable extent after infancy.
> As to what "changed" to allow the natural eye to
> match its focal sate to the aplied lens? I do not think
> there is any agreement on that issue.
I think there is very good agreement in the scientific community: axial length
modification. Study the phenomenon of emmetropization. You are attempting to
emmetropize a structurally myopic eye after infancy and it does not work, or
else we'd all be doing it, including me, since I'm a little myopic, and have
been for 40 years, and would rather not be.
w.stacy, o.d.
leukoma
> Dear Han,
>
> Subject: The experimental effort to relate focal status to length.
>
> HS> Some people explain myopia by an elongated longitudinal axis, instead of
> > inadequate lens power. I wonder what's appropriate. Is the average
> > longitudinal axis length in myopic people different from that in
> > hypermetropic people, or is that difference unknown? And what does the
> > abnormal longitudinal axis length mean for the spherical shape of the eye:
> > is a myopic eye cigar shaped, and the hypermetropic eye oblate?
>
> The standard theory (Donders-Helmholtz) maintains
> that the eye is a rigid structure, and that only
> the lens moves. The focal status of the eye
> is measured by inducing preceptive blur on the
> surface of the retina. This is strictly a relative
> measurement.
>
> In this theory it was assumed that a focal state of zero
> was the perfect eye, and so the eye was assumed to be
> a perfect spherical if the measured focal status was
> exactly zero. The word "emmetropia" was coined to
> describe this perfect situation.
You make this sound all so arbitrary. There is nothing relative, as
the refractive status - or the "focal status" - is determined without
the effects of accommodation, which is a variable in the
non-presbyopic eye. Furthermore, this refractive status can be
determined by objective means. The anatomy of the eye has been
studied in great detail for centuries, and it is well-known that
sphericity or lack of sphericity does not determine its refractive
status. Whether a refractive state of "zero" or "emmetropia" is the
"perfect" situation is in the eye of the beholder, so to speak.
However, emmetropia does allow for clear viewing at all distances
without resort to a prosthetic device in a non-presbyope,
accommodation being "designed into" the eye by nature for the purpose
of adjusting the focal length.
>
> Following this theory, then any focal
> state that was not zero must prove that the eye has
> a refractive error, (ametropia) and must be proven to be either
> too long or too short.
See above. It only follows from optics and physics that the image
whose conjugate is infinity and in the absence of accommodation will
have a focal point in front of the retina in the case of myopia and
behind the retina in the case of hyperopia. One could just as well
assume that the index of refraction of the media changes, or the
cornea changes shape. These things are determined by measurement, not
by convenience.
>
> A positve focal status of any degree was to be called
> hyperopia, and a negative focal state was to be
> called myopia or nearsighedness. Any focal state,
> other than zero is considered a refractive error,
> based on the above assumptions.
>
> The eye does change its focal state as the visual
> enviroment is changed. This is repeatedly demonstrated
> by using "test" plus and minus lenses on chickens and primates, where
> the visual enviroment could be controlled, and the focal
> state measured accurately.
>
> As to what "changed" to allow the natural eye to
> match its focal sate to the aplied lens? I do not think
> there is any agreement on that issue.
There seems to be a broad consensus that the length of the vitreous
chamber changes in response to hyperopic or myopic defocus, as this is
easily measurable. In some mammals, i.e. chickens, the choroid
thickens in response to hyperopic defocus in order to bring the retina
forward. In myopic defocus, the choroid has been observed to thin,
and the vitreous chamber is seen to lengthen, with subsequent
re-arrangment of the scleral matrix. This has been found to occur
also in eyes where the optic nerve has been sectioned, and where no
accommodation is allowed to take place, except in a certain type of
stumptailed macaque...;)
By the way, what is the date on this cat study, and why do you ignore
the plethora of studies showing the greater axial length of eyes with
"axial" myopia?
Also, in a recently published study of myopic children, heredity was
found to be the most significant variable.
Glenn Hagele - Council for Refractive Surgery Quality Assurance
>
>By the way, what is the date on this cat study, and why do you ignore
>the plethora of studies showing the greater axial length of eyes with
>"axial" myopia?
Because like many people who are more interested in forwarding their
own theory of what is right than in searching for what is true,
acceptance of an avalance of data that disproves their pet theory is
inconsistent with their agenda.
Otis Brown
Thanks for the reference to Dr. Peter Greene!
I will send him a copy. He will be please to see his
work taken seriously.
Pete and I worked for a number of years on the concept
of nearsighednes prevention for pilots.
We started a preliminary proposal to the U. S. Naval
academy, but could not get through the red tape.
Peter still continues to work the issue of providing
mathematical analysis of the eye's behavior.
I have also published some paper with Dr. Ronald Berger,
Columbia, MD. Any relationship?
Best,
Otis
otis...@pa.net
***********
Andre Berger
> Thanks for the reference to Dr. Peter Greene!
> I will send him a copy. He will be please to see his
> work taken seriously.
expert here, so I didn't mean to evaluate the outcome, but I
definitely appreciate the approach.
> I have also published some paper with Dr. Ronald Berger,
> Columbia, MD. Any relationship?
Not that I'm aware of, although we might have a mitochondrial ancestor
in common :-) http://www.vdare.com/sailer/sykes.htm
Otis Brown
The study that makes the over-correction of nearsighedness
with a minus lens seem "wonderful" -- while other studies that
suggest a go-slow approch would be wise with the minus lens are totally
ignored.
Depends on who has the "pet theory", and who has
the most to lose -- I would suggest.
Best,
Otis
******
Glenn Hagele - Council for Refractive Surgery Quality Assurance glenn....@usaeyes.org wrote in message news:<hcr52vosgv7rdf81d...@4ax.com>...
leukoma
>
> The study that makes the over-correction of nearsighedness
> with a minus lens seem "wonderful" -- while other studies that
> suggest a go-slow approch would be wise with the minus lens are totally
> ignored.
>
> Depends on who has the "pet theory", and who has
> the most to lose -- I would suggest.
>
> Best,
>
> Otis
>
> ******
Except that I cannot find your pet "studies" with my search engine
when I look in the database, but then I am not searching back two
decades, either. It also seems to me that I would somehow benefit
both ways by seeing more young children lining up for preventive lens
therapy, and keeping them there until they are beyond the age of risk,
and then prescribing minus lenses for people who opted not to stay in
blurryland. So, I guess I don't "get" your inference about who has
the most to lose. Sounds to me like it would be the one whose
reputations and theories have a weak foundation have the most to lose.
Personally, I remain "open" to the truth.
DrG
Otis Brown
Re: "They (the public) believe in making a distant picture clear and
they'll go from doctor to doctor in order to hear the answers they want."
OB> And I remain open to telling the truth about the effect
that the minus lens has on the focal state of the natural eye.
The truth is that the public is going to absolutly reject the
plus lens for prevention -- unless they change their own mind on
the issue.
OB> Here is a statemet by a research optometrists, Dr. William Ludlam
and Dr. Carl Cordova for your reading pleasure.
"This near-epidemic of myopia may be a combination of many
different factors," he said. "This is the first generation to
read. It's the first to use electrical lights and it's the first
generation to eat a non-protein diet. They're eating everything
from popcorn to Coke. Who can say what is causing their
nearsightedness."
The optometrist is now in the process of analyzing data on
525 children with an NIH grant. While in New York he and his
associates followed these children for several years, taking down
all the information they could, ranging from the size of the
eyeball to total weight. Now, the information is being analyzed
by computer.
"In a year, we should have most of the answers about what
affects what. We'll know exactly how one thing relates to
another. And then, we'll be able to make some kind of judgment,"
he said. "We'll know what factors relate to myopia and why there
is such an increase, even in the United States."
Dr. Ludlam also believes that heredity can pretty well be
discounted as a cause of myopia simply because of the fact that it
is growing much faster than if it were a genetic defect.
Although the "positive lens" theory works and can possibly
lead to a life free from the anchor of negative glasses, it is
extremely difficult to convince many patients that it will work
for them.
OB> Unless the public is prepared for the use of a plus lens,
the result will always be the same as stated by Dr. Carl Cordova:
A lower Bucks County (Pa.) optometrist, Dr. Carl Cordova
told us that many patients are reluctant to try the preventive
approach because it doesn't work right away. "They believe in
making a distant picture clear and they'll go from doctor to
doctor in order to hear the answers they want."
OB> Yes, I agree with Dr. Carl Cordova's statement. But I also
agee with Dr. Ludlam's statement that the preventive method
can "work" provided the peron involved has the motivation to
use it correctly. Since everyone is "different" in the
way they think, it is virtually impossible for an optometrist
to organize a "preventive" study. It take a great deal
of thoughtful discussion about these issues before a person
on the threshold of nearsighedness could make a responsible
decision about any of this. There is simply no time available
for an optometrist to discuss the details of these issues.
Perhaps this is why the sci.med.vision is available for
our discussions.
leukoma
>
> Re: "They (the public) believe in making a distant picture clear and
> they'll go from doctor to doctor in order to hear the answers they want."
It's a natural desire.
>
> OB> And I remain open to telling the truth about the effect
> that the minus lens has on the focal state of the natural eye.
Which is what? That by using a minus lens to create a "zero focal
state," this will "induce" the eye to "adapt" to a zero focal state by
becoming more myopic?
> The truth is that the public is going to absolutly reject the
> plus lens for prevention -- unless they change their own mind on
> the issue.
Absolutely not if they hear that an ounce of prevention is worth a
pound of cure.
>
> OB> Here is a statemet by a research optometrists, Dr. William Ludlam
> and Dr. Carl Cordova for your reading pleasure.
>
> "This near-epidemic of myopia may be a combination of many
> different factors," he said. "This is the first generation to
> read. It's the first to use electrical lights and it's the first
> generation to eat a non-protein diet. They're eating everything
> from popcorn to Coke. Who can say what is causing their
> nearsightedness."
>
> The optometrist is now in the process of analyzing data on
> 525 children with an NIH grant. While in New York he and his
> associates followed these children for several years, taking down
> all the information they could, ranging from the size of the
> eyeball to total weight. Now, the information is being analyzed
> by computer.
>
> "In a year, we should have most of the answers about what
> affects what. We'll know exactly how one thing relates to
> another. And then, we'll be able to make some kind of judgment,"
> he said. "We'll know what factors relate to myopia and why there
> is such an increase, even in the United States."
>
> Dr. Ludlam also believes that heredity can pretty well be
> discounted as a cause of myopia simply because of the fact that it
> is growing much faster than if it were a genetic defect.
Heredity does not predict ALL of the myopia, but of all the factors
studied, it is the single most significant factor. There's a
difference.
>
> Although the "positive lens" theory works and can possibly
> lead to a life free from the anchor of negative glasses, it is
> extremely difficult to convince many patients that it will work
> for them.
Although the "positive lens" theory has never been proven to work in
humans....it would not be difficult to convince many patients if
indeed it was proven to be truly efficacious.
>
> OB> Unless the public is prepared for the use of a plus lens,
> the result will always be the same as stated by Dr. Carl Cordova:
The public can be prepared if there is a good reason.