Exposing the LASIK Scam

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 Post subject: TLC Big Sky Laser Center sued by Richard Zickefoose
PostPosted: Tue Nov 29, 2005 8:56 pm 
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Joined: Wed Nov 16, 2005 4:12 pm
Posts: 4
Location: Cody, Wyo.
July 22, 2004

Re: Richard Zickefoose

Dear Mr. Grubbs,

Thank you for asking me to review the case Richard Zickefoose, who had LASIK surgery at TLC on March 24, 2000. I have had the opportunity to review Richard Zickefoose?s medical records as well as examine him personally in my office.

I am a board-certified Ophthalmologist. I completed my ophthalmology residency at the University of Pennsylvania/Scheie Eye Institute. I then completed a Corneal Fellowship at the University of Texas/Southwestern Medical School, where I was trained in surface laser correction & LASIK

As the cornea specialist at my practice and as a refractive surgeon, I have been intimately involved with the preoperative evaluation of patients considering refractive surgery. As well, I have also co-authored chapters in textbooks on the preoperative evaluation of patients considering refractive surgery.

Richard Zickefoose entered the process of determining his candidacy for LASIK with an evaluation by a TLC affiliated optometrist, Richard Jones, OD. Dr. Jones performed an evaluation on Mr. Zickefoose to determine whether he was an appropriate candidate for LASIK. As a TLC affiliate, Dr. Jones charged Mr. Zickefoose $800 for his preoperative examination along with the postoperative care. With the high charge for this preoperative exam, Mr. Zickefoose assumed he would receive a top level exam. Unfortunately, Richard Zickefoose received a substandard preoperative exam.

The first major lapse in the preoperative exam was the failure for comprehensive dry eye testing. Mr. Zickefoose has a history of dry eyes. The medical literature clearly linked LASIK with dry eyes, and as well has found that patients with preoperative dry eyes were at higher risk of dry eye postoperatively. Therefore, Dr. Jones as part of his preoperative evaluation to determine whether LASIK was appropriate for Mr. Zickefoose should have performed standard dry eye tests to determine the level of dry eye. These tests include fluoroscein stain of the cornea, Schirmer?s testing, and tear break up time. By not performing these tests, Mr. Zickefoose was not properly evaluated and thus was not informed of his actual level of dry eyes pre-LASIK. He therefore was not able to make an informed decision as to his risk for developing significant dry eyes post-LASIK.

Dr. Jones also failed to perform a measurement of the pupil size in darkness. The preoperative form used by Dr. Jones had a place for pupil size, but this was left blank. The medical literature had advised doctors to carefully screen the pupil size of patients, since patients with large pupils who undergo LASIK have been found to be at increased risk of night time vision problems. The risk of serious night time problems in patients with large pupils was known to be increased with higher degrees of myopia and higher degrees of astigmatism. Mr. Zickefoose had significant myopia in the right eye and significant myopia plus astigmatism in the left eye. He would therefore be at higher risk of night time vision problems if he had large pupils. Unfortunately, Dr. Jones did not perform this standard test preoperatively.

The importance of preoperative pupil size measurements preoperatively was especially critical for Mr. Zickefoose?s left eye ? which had a combination of myopia and astigmatism. The optical zone used by the VISX laser for the left eye was only 6.5mm x 5.0mm. The peer-reviewed medical literature includes separate studies by Jack Holladay, MD and Brian Boxler Wachler, MD, who independently found that as the level of treatment increases, the final ?functional optical zone? shrinks. So the final functional optical zone following Mr. Zickefoose?s laser treatment would be significantly smaller than the 6.5mm x 5.0mm programmed optical zone.

Mr. Zickefoose unfortunately entered the TLC system, where the optometric exam is relied upon for determination of candidacy for LASIK. A comprehensive preoperative exam was not performed at the TLC center. Pupil size was not measured. Dry eye testing was not conducted. Other standard tests including a dilated exam was also not performed at TLC. By relying soley on the substandard optometric exam, TLC failed as an LASIK service corporation to provide Mr, Zickefoose with the information he needed to make an informed decision on his personal risks versus the benefits of undergoing LASIK. Mr. Zickefoose of course underwent LASIK at TLC, and has suffered a variety of problems following his LASIK procedure.

I conducted my own eye exam on Mr. Zickefoose on August 29, 2003. His complaints on that exam were those of severe dry eye (?gritty feeling and dryness?) along with poor quality of vision and poor night time vision (?Starbursts, double vision, and poor depth perception?).

On my exam, he had significant dry eye disease. He had staining of the inferior portion of the cornea in both eyes. His Schirmer?s tests scores were both less than 5mm (normal is greater than 10.0mm) and his tear break up time was more rapid then normal (tear break up was 6 seconds OD, 8 seconds OS ? normal is 10 seconds or greater).

Colvard Pupillometry was performed in darkness, and the pupil size was found to be 7.0mm. The VISX wavefront analyzer was used and it captured the pupil size in moderate darkness (not pitch black). It found the pupil size to be almost 7.0mm OD and 6.5mm OS (photos documenting the enlarged pupil size are present in my chart).

Mr. Zickefoose?s current ocular and visual problems are related to the mistakes made during the preoperative exam. If the proper tests had been performed, then Mr. Zickefoose could have been properly advised of his risks of postoperative dry eyes and his risks of significant night vision problems if he decided to undergo LASIK. Unfortunately, the failure in the screening process led to Mr. Zickefoose agreeing to LASIK surgery without knowing his actual risks of developing these postoperative problems.

The underlying method of delivering care by TLC is clearly the major flaw in the lapses that occurred in the care of Mr. Zickefoose. TLC has set up a network of optometrists that are paid a significant amount of money for performing a comprehensive preoperative exam along with postoperative care. The fees paid to the optometrists via TLC are significantly higher than for similar services provided by the optometrists. The surgeons rely on the preoperative exam and do not routinely perform a comprehensive independent evaluation. Since the preoperative exam performed by Mr. Zickefoose?s optometrist was inadequate and no further dry eye or pupil size measurements were documented at the TLC facility, Mr. Zickefoose ended up undergoing LASIK without being informed of his specific risks for postoperative complications.

It is important to note that in 2003 and 2004, the lasers used with LASIK have new features designed to reduce the risk of developing serious night time vision problems with LASIK. So if proper preoperative testing had been done, one potentially option would have included the choice for Mr. Zickefoose to wait until 2003 to have LASIK when more advanced technology would be available.

Additionally, recent studies have shown that with careful preoperative assessment of dry eye ? patients diagnosed with dry eye preoperatively can undergo treatment for their dry eye. Once their dry eye have been treated properly, they can consider LASIK, since their risk of significant postoperative dry eye is dramatically reduced by the preoperative treatment. Mr. Zickefoose never had comprehensive preoperative dry eye testing, so this was never a possible option.

In summary, Mr. Zickefoose entered the TLC system for LASIK and had an incomplete preoperative exam by his optometrist. Further testing was not performed at the TLC center. The failures in the preoperative exam prevented Mr. Zickefoose from understanding his actual risks of developing post-LASIK complications of serious dry eye, night vision problems, and poor quality of vision.

I state all of the opinions herein contained to a reasonable degree of medical probability.

Thank you
[Name of expert witness removed]

_________________
There is no Lifetime Commitment with TLC or Dr. David Boes!


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