LASIK is a FLAWED PROCEDURE
EyeSeeWell
is therefore biased and is creating a smokescreen TO TRY TO PRVENT
many more lasik lawsuits. SOME OF THE SURGEONS HE REPRESENTS HAVE
BEEN SUED SUCCESSFULLY. ALSO, THE INSURANCE COMPANY OMIC (REPRSENTS
OPHTHALMOLOGISTS) IS DOWNPLAYING THE COMPLICATIONS WITH LASIK. THEY
RECENTLY REPORTED EXPONENTIAL GROWTH IN LASIK LAWSUITS; HOWEVER MANY
ARE NOT PUBLIC...THEY ARE SETTLED OUT OF COURT.
In the email he states "> To further indicate how poorly written
this survey is, it lists
> "Cornea flattening" as a complication." Yes the cornea is flattend and an unnatural cornea is created "oblate shape cornea"
MR. HAGELE DO PROLATE SHAPE CORNEAS SEE BETTER THAN OBLATE EYES?
Finally, the big issue with LASIK is that it is a flawed procedure
because
1)The microkeratome cuts through the central optical zone
2)The cornea is weakened because the "elastic bands" or biomechanical
structure that hold it STRONG are severed with a blade
3)The Keratome severs nerves and causes dry eye post LASIK
4)The cornea becomes "oblate" or concave and thus our natural visual
system is reversed.
--Means that a 20/20 SNELLEN or ETDRS chart will not test the quality
of vision. it tests just the quantity.
5)Contrast testing hasn't been performed in refractive surgery
centers.
www.contrastsensitivity.net This TEST was just made the standard in
refractive, cataract and contact lens by the American National
Standard Institute.
6) The LASER removes tissue from the center part of the eye.
7) LASIK is creating ectasia in eyes or keratacon like symptoms, in
which patients have a cornea transplant or have Intacs Rings to fix
the problem.
--
Warm regards,
Eyeseewell
"Glenn Hagele - Council for Refractive Surgery Quality Assurance" <glenn....@usaeyes.org> wrote in message news:3d800c71...@news.concentric.net...
> On Wed, 11 Sep 2002 17:04:40 -0700, "Simpledog" <jwe...@gte.net>
> wrote:
>
> >http://www.ohiolionseyeresearch.com/lasik_survey_results.htm
> >
> >
>
> It is very interesting, however it is also fatally flawed.
>
> Rather than a representative selection of refractive surgery
> recipients, the survey is open to anyone who visits the website.
> There are no controls on who submits information or how many times the
> same person submits information.
>
> Virtually all survey professionals agree that a sampling of 1,000
> appropriately selected individuals is a minimum requirement for survey
> accuracy. This survey has 175 people who participated.
>
> As anyone who has watched this newsgroup has come to understand, the
> anti-refractive surgery zealots are quick to jump on anything that
> might put refractive surgery in a bad light. Not once, but again and
> again. With no controls, there is nothing to keep one person from
> submitting one negative outcome after another, again and again.
>
> The cover page of the survey, titled "LASIK PROBLEMS", states that the
> purpose is to "provide a venue for web site visitors to register their
> complications related to LASIK surgery". This is not a survey, this
> is a list of types of complications people have incurred.
>
> To further indicate how poorly written this survey is, it lists
> "Cornea flattening" as a complication. Flattening the cornea is
> exactly what myopic refractive surgery does in order to correct myopic
> refractive error.
>
>
> Glenn Hagele
> Executive Director
> Council for Refractive Surgery Quality Assurance
> http://www.usaeyes.org
> glenn....@usaeyes.org
>
> I am not a doctor.
Glenn Hagele - Council for Refractive Surgery Quality Assurance
Eyeseewell,
In my response I have changed the use of upper case letters to normal
netiquette. Not to change your emphasis, but upper case letters means
SHOUTING in netiquette and I think we can all hear you fine. I have
responded to each of your concerns within your original posting.
>Mr. Hagele is a paid professional for the LASIK surgeon community.
I am employed by the nonprofit organization that I founded. The
organization is funded by certification fees collected from refractive
surgeons. These fees are not related to the number of patient
referrals or any similar arrangement. In FY2000, I received $28,750
in wages and other compensation. My pay will go up as funding allows,
but I'm obviously not in this for the money.
> He
>is therefore biased
Everybody is biased, but what is important is if that bias is
acknowledged and announced or is kept hidden. All the information
about CRSQA is available on our website. Our bias is clearly stated.
> and is creating a smokescreen to try to prvent
>many more lasik lawsuits.
Guilty as charged. I'm trying to prevent more refractive surgery
lawsuits by helping potential candidates understand if they can
reasonably expect what they want from refractive surgery and (if it is
appropriate for them) providing the candidate with ways to find the
better surgeons. If inappropriate candidates do not have surgery and
if those who do have surgery go to the better doctors, malpractice
suits are less likely because more people are satisfied.
You may think it is a sneaky plan, but reducing lawsuits by helping
patients get better results is not such a bad thing.
> some of the surgeons he represents have
>been sued successfully.
True. If anyone thinks that any doctor - no matter what his or her
credentials - is never going to make a mistake, then they need to
re-evaluate human nature. It would be wrong to think that by
selecting the best doctor you are guaranteed that everything will go
exactly as desired. There are no guarantees in refractive surgery -
or any surgery for that matter. Selecting the best doctor will only
increase your odds of success, but will not guarantee the outcome.
> also, the insurance company omic (reprsents
>ophthalmologists) is downplaying the complications with lasik.
Well, if they are, they are doing it in silence. OMIC has never made
any public or private statements regarding the probability of
refractive surgery induced complications and subsequent malpractice
suits. It is possible to see how many claims were paid and for what
amount, but these are just facts of past history that really have
nothing to do with probabilities.
> they
>recently reported exponential growth in lasik lawsuits;
There has been exponential growth in LASIK and there has been
exponential growth in related lawsuits. This is not really
surprising. There is often a lag time between when a new procedure
enters the marketplace and when claims make their way through the
legal system. The percentage of lawsuits when compared to the number
of surgeries is astronomically small.
>however many
>are not public...they are settled out of court.
True, and this cuts many ways.
A doctor may decide to settle a small claim out of his or her own
pocket to avoid involving the malpractice insurance company, but this
can become very costly if the doctor has many claims.
The malpractice insurance companies have the right to settle a suit in
just about any manner they please, and without the doctor's approval.
Even if the surgeon knows that there is absolutely no legitimate
malpractice claim, the insurance may elect to pay off the claimant
because it is often less expensive to settle than to litigate.
>
> In the email he states "> To further indicate how poorly written
>this survey is, it lists
>> "Cornea flattening" as a complication." Yes the cornea is flattend and an unnatural cornea is created "oblate shape cornea"
>
>Mr. Hagele do prolate shape corneas see better than oblate eyes?
Apples and oranges. The question was not if the cornea shape was
changed for prolate to oblate. The question was if the cornea was
flattened and that is the purpose of myopic refractive surgeryůto
flatten the central part of the cornea.
According to studies primarily by Jack Holladay, MD, an prolate cornea
provides superior central focus than a oblate cornea. That is not to
say that an oblate cornea does not provide excellent vision, it is
just that the prolate cornea may provide superior vision.
>
>Finally, the big issue with LASIK is that it is a flawed procedure
>because
>1)The microkeratome cuts through the central optical zone
Anything that disturbs the central optical zone (visual axis) has the
potential to reduce visual acuity. The important point is to what
degree (if any) visual acuity is negatively affected. Based upon
clinical evaluations and the millions of people who are ecstatic about
their refractive surgery, it appears that it is not too negatively
affected.
>2)The cornea is weakened because the "elastic bands" or biomechanical
>structure that hold it STRONG are severed with a blade
I don't know about your "elastic band" theory, but it is true that
thinning the cornea and making an incision can weaken the cornea. The
issue is if this change negatively affects the patient. Most doctors
agree that if 250 microns of corneal tissue remain untouched, the
cornea will remain stable. Less than 250 microns is inviting trouble.
>3)The Keratome severs nerves and causes dry eye post LASIK
Perhaps this is not the only cause of LASIK induced dry eye, but it
most certainly is a contributing factor. Some doctors have switched
to a nasal LASIK hinge so one half of the primary corneal nerves that
tell the eye how to handle tears are relatively unscathed. As the
nerves heal, the dry eye problems dissipate. Even when the nerves are
severed, not every patient suffers dry eye problems. Again, this is a
matter of degree. If the patient had a healthy wet eye before
surgery, even the amount of dry eye induced by LASIK may not be enough
to cause problems. We suggest that everyone should expect some dry
eye for a short time and it may be necessary to treat with drops or
punctal plugs, but that for the vast majority of patients dry eye is
resolved within six months through healing.
>4)The cornea becomes "oblate" or concave and thus our natural visual
>system is reversed.
Overcoming the "natural" visual system is the purpose of refractive
surgery. The natural system of someone considering refractive surgery
is myopic, hyperopic, and/or astigmatic. As I stated before, a
prolate cornea may provide superior vision over an oblate cornea, but
this very small change may be less important to someone who cannot see
four inches in front of them without glasses.
If you would only be happy with uncorrected 20/10 vision after
surgery, you should not be having refractive surgery no matter what
the prolate or oblate shape of the cornea.
>--Means that a 20/20 Snellen or ETDRS chart will not test the quality
>of vision. it tests just the quantity.
I don't know if your "quantity" statement is exactly accurate, but it
is true that a test of sharp edged black letters on a backlit white
background in a controlled environment is not what most people
encounter throughout the day. Snellen is only one way to measure
visual acuity and is not always the best way.
>5)Contrast testing hasn't been performed in refractive surgery
>centers.
>www.contrastsensitivity.net
The website to which you refer is funded by the for profit Vision
Sciences Research Corporation (VSRC). VSRC sells contrast sensitivity
equipment. It is really not surprising that they are advocates of
contrast sensitivity testing.
>This TEST was just made the standard in
>refractive, cataract and contact lens by the American National
>Standard Institute.
The American National Standard Institute (ANSI) is a non-profit
organization that administers and coordinates the U.S. voluntary
standardization and conformity assessment system of electronic
devices. An example is ANSI standards that allow your computer's
components to work with each other.
ANSI has nothing to do with healthcare and I have not a clue as to
what you are talking about. My best guess is that the electronics of
the equipment used to test contrast sensitivity uses ANSI compliant
standards. Perhaps you can explain your logic on this one.
Although contrast sensitivity testing is not currently standard
protocol for evaluating a refractive surgery candidate, perhaps it
should be. Someone with pre-existing low contrast sensitivity could
be advised that they may have poor low light vision after refractive
surgery.
>
>6) The LASER removes tissue from the center part of the eye.
Well, duh. For myopic change, tissue is removed from the central part
of the eye to cause a flattening of the cornea and a shift in the
focusing of light passing through the cornea. If you are implying
that removal of tissue in the central part of the eye is bad, it would
be better if it were not required, but that is how most refractive
surgery is done today. The real issue is if removing tissue from the
central part of the eye is a problem. For the vast majority of the
millions of people who have had refractive surgery, this is not a
problem.
>
>7) LASIK is creating ectasia in eyes or keratacon like symptoms, in
>which patients have a cornea transplant or have Intacs Rings to fix
>the problem.
Ectasia is an overall forward bulging of the cornea, causing greater
myopia. Keratoconus is bulging of the cornea in a smaller spot,
causing irregularities. Both occur naturally. You said
keratoconus-like symptoms and this is an important distinction.
Refractive surgery does not cause keratoconus, but may induce symptoms
similar to symptoms caused by keratoconus.
The cause if ectasia and similar effects is a cornea that is not
stable. As I mentioned before, most doctors believe, and history has
found, that leaving 250 microns of corneal tissue untouched keeps the
cornea stable.
Eyeseewell brought up a lot of problems with refractive surgery that
are real problems and should not be ignored. Equally, they do not
make refractive surgery an unsafe procedureůjust an unguaranteed
procedure.
Refractive surgery is not for everybody. Someone with thin corneas,
low contrast sensitivity, history of eye disease, dry eyes, or many
other conditions may be excluded from refractive surgery. That is why
it is so important to be evaluated by a competent surgeon. It is the
doctor's job to evaluate all these variables to tell the patient if
they are a good candidate or if they are not, what problems they could
expect.
Observer3
favorable posts in the sci.med.vision newsgroup gave me more confidence to
have the procedure. In fact, it enabled me to email other people and get
more information. One guy gave me an excellent recommendation on a local
Lasik surgeon who eventually did my eyes. As of today, I am 20/15 in both
eyes, after having worn glasses or contacts for 23 years with a -8.5
proscription in both eyes with mild astigmatism.
This NG was started in June 2000, and for the first 6-8 months, was
mostly pro-Lasik. But since then, posts in this NG have been mostly
negative, taken over by people who've unfortunately had bad outcomes with
Lasik. They have a right to do that, but I hate to see a procedure that was
so wonderful for me get pounded on a daily basis. If I had waited until
2001 or 2002, all this negative talk would probably have scared me off
Lasik. Which meant I would still be wearing spectacles with thick lenses or
irriating contact lenses. Thank goodness that didn't happen.
Observer3
using AOL at the time, and they didn't add alt.lasik-eyes to their newsgroup
listing until June 2000.
"Observer3" <nospam@nospam!.com> wrote in message
news:Uk6j9.144801$N9.24...@twister.neo.rr.com...
Simpledog
possible negative outcomes. I will always ask his advice. He is a nice
man, and always has time to answer questions. In fact, when I go to
Sacramento, I'm gonna stop in an buy him lunch.
What needs to be done to lasik is that it needs to be not so commodotized.
The pure prophet motive from perfuming a 15 min operation needs to go away.
Surgeons should be the only individual inspecting prospective candidates. A
video should be shown indicating both successful and unsuccessful results.
The lasik industry is a good one, but , in my opinion, it needs to be
regulated. Mr. Hagele is one attempt to do that, but it's not enough.
For the record, I had semi-succesful lasik. I came from +5 down to +.75. I
lost a line of bcva and have some ghosting. rgps lenses have helped in
these regards. According to Dr. Rab, and other's, the flap never fully
heals.....so......wait.....and wait....until the technology get's better,
and the pro's are the only ones doing it.
"EyeSeeWell" <chac...@excite.com> wrote in message
news:b739dff7.02091...@posting.google.com...
Eddie
> For the record, I had semi-succesful lasik. I came from +5 down to +.75. I
> lost a line of bcva and have some ghosting. rgps lenses have helped in
> these regards. According to Dr. Rab, and other's, the flap never fully
> heals.....so......wait.....and wait....until the technology get's better,
> and the pro's are the only ones doing it.
I've had a similar result to Simpledog (and corresponded with him personally)
and agree with his comments. I was a high hyperope also and have not had a
result I am 100% happy with because of similar problems.
A lot of you think that Mr. Hagele's ultimate goal is to sell as much LASIK as
he can under the guide of his certification scheme. All I can say to that is
that before I went in and had the surgery (which is in the UK where his
certification does not extend), I found his the CRSQA web site useful and
balanced, and made me think more about what I was getting into. Since, Glenn
has answered questions from me personally and in the newsgroup. If he was just
after my money, he would only be interested talking to those who've not had
surgery yet, and he talks to those who've long been given the brush off from
disreputable clinics and surgeons.
His website is in contrast to other sites which either seem to be either totally
positive or totally negative about LASIK. I took the negative opinions on board
too, and anyone worth their salt should consult as many sources of information
as possible.
As it happens, if I lived in the US, I probably wouldn't even have asked for a
CRSQA-certified surgeon - personal recommendation is better, IMHO.
Simpledog
really successful cases out there. I got a buddy who has 20/15 20/12
vision., coming from -3 script. They are out there. There are also some
dorked up ones. Thank god the only thing I got was some minor ghosting and
a loss of bcva with spectacles in one eye. Contacts help with this. Do the
contact thing, and let science take it's course. I'm 36, and will be
investigating new surgical techniques (such as wavefront) in a few years.
There are a few out there that, even under the best conditions, see multiple
vision and can't get below 20/50. I, UCVA, am a 20/30 baby. BCVA with
glasses 20/25 and 20/15. With contacts, I'm a soft 20/20. I'm happy - for
now.
Thanks Mr. H. And........what do you like for lunch?
"Eddie" <sp...@spam.com> wrote in message
news:5Ghj9.3893$937.40...@news-text.cableinet.net...
Glenn Hagele - Council for Refractive Surgery Quality Assurance
wrote:
>I know this much. He's on our side, and theirs as well. There are some
>really successful cases out there. I got a buddy who has 20/15 20/12
>vision., coming from -3 script. They are out there. There are also some
>dorked up ones. Thank god the only thing I got was some minor ghosting and
>a loss of bcva with spectacles in one eye. Contacts help with this. Do the
>contact thing, and let science take it's course. I'm 36, and will be
>investigating new surgical techniques (such as wavefront) in a few years.
>There are a few out there that, even under the best conditions, see multiple
>vision and can't get below 20/50. I, UCVA, am a 20/30 baby. BCVA with
>glasses 20/25 and 20/15. With contacts, I'm a soft 20/20. I'm happy - for
>now.
>
>Thanks Mr. H. And........what do you like for lunch?
>
>
Thanks for the kind words gentlemen. How about lunch in your
neighborhood next time I'm down. I love the Prado in Balboa Park.
Glenn