Exposing the LASIK Scam

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PostPosted: Wed Dec 06, 2006 4:51 am 
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My orginal prescription was -2.25. Plus -1.00 diopter of asigmatism.
What complications does a low prescription reduce, if any?


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PostPosted: Wed Dec 06, 2006 5:17 am 
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Also, Someone wrote about ectasia. Since I have large pupils, what is ectasia and how does it relate to me?
I was considering CWR but I don't know what ectasia is.
Could you tell me what that is if you don't mind?


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PostPosted: Wed Dec 06, 2006 2:00 pm 
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APizzo667 wrote:
My orginal prescription was -2.25. Plus -1.00 diopter of asigmatism.
What complications does a low prescription reduce, if any?


The induction of spherical aberrations (night vision disturbances) increases with increasing amounts of myopia, everything else being equal.

With lower myopia, less tissue is ablated, which reduces the risk of ectasia.

APizzo667 wrote:
Also, Someone wrote about ectasia. Since I have large pupils, what is ectasia and how does it relate to me?
I was considering CWR but I don't know what ectasia is.
Could you tell me what that is if you don't mind?


Ectasia is a progressive forward bulging of the cornea that results when the cornea becomes too thin and weak following the cutting of a flap and ablation of tissue. It can lead to corneal transplants. Read section 4 of The LASIK Report about ectasia.
http://www.thelasikflap.com/forum/viewtopic.php?t=863

The reason CWR carries a risk of ectasia is because more tissue is being ablated. The wider the treatment (to treat larger pupils), the more tissue is ablated.

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 Post subject: Long Term Solution
PostPosted: Sat Dec 23, 2006 6:05 am 
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Does anyone know of any anti depressant that does not induce mydrasis?
I am terrified of taking ativan, espically since I am really prone to addicition now. And since ativan could be habit forming, I get bad anixety just thinking about being addicted. Any substance that could potentially make me feel better, I take, which is a deadly thing to do... I tried dozens of medicines, but all gave me mydrasis. I am trying to find a homopathic doctor before the end of the year. I am really hoping that this doctor would have a natural anti depressant so that I can find something before the end of the year (which is when I go off my parents insurance...but I am still not able to work and have my own insurance... :cry: )

I know that I am never going have my life what it was, but to be able to function would be great. Hopefully a medicine could help me do this. I realize now that I am able to function during the day and not at night. This is a small victory in a sense. After reading all of the post of the Thelasikflap,com, I realized that most people on here can still function.
Since I can function until about 4PM, espically on longer days with more light, I can exist.

But on a happier note, last year, I went to Italy to study for my MBA and to test to see if I could make it on my own, even with my bad eye sight. I just graduated last week and my thesis is going to be published in English and Italian. Hopefully one day, with the right support I can start dreaming again and live more independently - for the long term.

Merry Christmas to everyone on the flap. And thank you Nell for your phone call a few weeks back. It really inspiried me to be more proactive. Once I start working, I will make sure to get that Artemis scan.
Buon Natale.

Anthony


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 Post subject: Anitdepressants difficult for post-LASIKs w/large pupils
PostPosted: Sat Dec 23, 2006 8:57 pm 
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LASIK-damaged patients with large pupils have it rough. Drugs that shrink pupils are unsafe/and or ineffective for long-term use. Most antidepressants make the pupil larger, making depression due to damaged vision worse.

You should discuss with your doctor whether an anti-anxiety medication may be right for you. Weigh the pros and cons together. Many anti-anxiety medications are habit forming, but your doctor can monitor you carefully to make sure you are not escalating in your dosage.

I am addicted to caffeine, but I really don't care because the benefits of enjoyment of the beverage and increased alertness are worth it to me.

Similarly, the benefits of an antianxiety medication may outweigh the risks of dependency if the drug helps you function better and feel more normal.

Anxiety from a poor LASIK outcome can be permanent. I have heard large pupil patients more than 5 years out from surgery claim that their damaged night vision still hits them "like a ton of bricks" each time they go outdoors at night.

My post-LASIK night vision is truly appalling, like a double-exposed, blurry picture of an explosion in a fireworks factory. The Christmas season is terrible for me. Christmas trees with lights are positively a horror. My tree has no lights. I gave away all my strings of lights. My botched LASIK surgery was performed by Dr. Terry Kim, MD at Duke University Medical center on a VISX S4 laser. The S4 is the most current model of the VISX laser, for any of you readers out there who are actually considering having this surgery on your own eyes...

My post-LASIK aberrations are worse over time, not better.

You are worried about the risk of dependency on anti-anxiety medication and you have had a poor LASIK outcome? It seems to me that the higher order concern is getting yourself in a good mental place where you are functioning well. You can anways work on tapering off your antianxiety medication later. Some patients turn to alcohol, and that can be a damging dependency. Taking a valium now and then seems somehow, to me, to be a better bet than drowning post-LASIK sorrows in alcohol. Alcohol is a poison to the system, kills brain cells and is horrible on the liver.

The fact that you finished your master's degree is an excellent sign. Congratulations on that, and a very Merry Christmas to you!

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We can easily forgive a child who is afraid of the dark. The real tragedy of life is when men are afraid of the light. -Plato


Last edited by Scientist on Tue Sep 04, 2007 3:10 am, edited 2 times in total.

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 Post subject: Wavefront systems & aberrometers capabilities
PostPosted: Sun Dec 31, 2006 2:15 am 
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Higher Order Aberrations in Normal Eyes Measured With Three Different Aberrometers

Journal of Refractive Surgery Vol. 22 No. 9 November 2006

Ahmet Z. Burakgazi, MD; Bernard Tinio, MD; Alejandro Bababyan, MD; Kevin Kevork Niksarli, MD; Penny Asbell, MD


Quote:
The VISX Fourier Wavefront system has the ability to capture and treat wavefront information on patients with larger pupils and use this data for optical zone treatments up to 7 mm. Transition zones are adjustable up to 9.5 mm. WaveScan uses the patient?s corneal keratometric values and wavefront measurement to create the optimal corneal shape for each individual, whether it be prolate, oblate, or spherical. The Fourier-based wavefront algorithm deliver the highest resolution. It uses more data points and accurately reconstructs all peripheral data to capture and treat higher and lower order aberrations up to 7-mm diameter pupil.



Don't confuse "capabilities" with FDA approval or what a surgeon actually does with the device. All may be different. Keep in mind the larger the treatment, the more tissue is removed which increases the risk of ectasia.

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 Post subject:
PostPosted: Fri Jan 05, 2007 10:54 pm 
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I am currently trying to research what is the role of the transition zone.
From what I understand, the transition / blend zone exists to take the optical zone out to the full length of the dilated pupil.

I remember reading in a different forum subject that any optical zone smaller than the full dilated pupil is worthless. This really worries me since larger optical zones are much riskier and can induce esctasia (forgive my spelling!) as well as a host of other problems. Since I know 8.5mm optical zones will never exist or ever by FDA approved, I plan on going to my refractive doctor and asking him what his take on my 6.0mm optical zone is.

Also, once I can hopefully work in the future, I really want to get plugs placed in the ducts of my eye to hopefully ease my dry eyes.


I think I am going to schedule an appointment with my orginal lasik surgeron soon, so I will post an updated soon on my situation as well as what the doctor has to say about my case.


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 Post subject:
PostPosted: Sat Jan 06, 2007 2:12 am 
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APizzo667 wrote:
I am currently trying to research what is the role of the transition zone.
From what I understand, the transition / blend zone exists to take the optical zone out to the full length of the dilated pupil.


That is not correct. The transition zone is to prevent a sharp transition between the treated and the untreated cornea. It creates a smoother transition from the optical zone to the untreated cornea. It also helps minimize shrinkage of the optical zone. It does not take the optical zone out to the full diameter of the ablation zone, nor does not take the optical zone out to the full diameter of the dilated pupil. Only the optical zone is fully treated by the laser. But that doesn't mean the optical zone has a uniform power.

APizzo667 wrote:
I remember reading in a different forum subject that any optical zone smaller than the full dilated pupil is worthless.


In order to minimize visual disturbances in dim light, the optical zone used should be as larger or even larger than the scotopic pupil. That's why you and I were bad candidates. You can't give a patient an 8mm optical zone with LASIK because it would take off too much tissue and we'd get ectasia.


APizzo667 wrote:
This really worries me since larger optical zones are much riskier and can induce esctasia (forgive my spelling!) as well as a host of other problems. Since I know 8.5mm optical zones will never exist or ever by FDA approved, I plan on going to my refractive doctor and asking him what his take on my 6.0mm optical zone is.


And I'll bet you don't get a truthful answer. Ask for a new topography and get a color copy for yourself. I'd like to take a look at it.

APizzo667 wrote:
Also, once I can hopefully work in the future, I really want to get plugs placed in the ducts of my eye to hopefully ease my dry eyes.


There are pros and cons to plugs, too. That's a whole other thread. I've been plugged, unplugged, cauterized, and had the cautery reversed. My puncta are a mess.

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"The price good men pay for indifference to public affairs is to be ruled by evil men." Plato


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 Post subject:
PostPosted: Sat Jan 06, 2007 2:27 am 
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J Cataract Refract Surg. 2004 Nov;30(11):2336-43.

Effect of expanding the treatment zone of the Nidek EC-5000 laser on laser in situ keratomileusis outcomes.Macsai MS, Stubbe K, Beck AP, Ravage ZB.

Division of Ophthalmology, Evanston Northwestern Healthcare, Glenview, IL 60025, USA. mmacsai@enh.org

PURPOSE: To evaluate the effect of expanding the treatment zone of the Nidek EC-5000 laser on postoperative visual acuity as well as night glare and halos after laser in situ keratomileusis (LASIK) using 4 ablation zone diameters.

SETTING: Division of Ophthalmology, Evanston Northwestern Healthcare and Northwestern University Medical School, Glenview, Illinois, USA.

METHODS: This prospective study comprised 301 eyes of 154 consecutive patients who had LASIK in 1 or both eyes using the Nidek EC-5000 laser by 1 surgeon with experience in keratomileusis and excimer laser refractive surgery. A 6.5 mm optical zone was used with a transition zone 1.0 mm larger than the pupil under scotopic conditions (7.5, 8.0, 8.5, or 9.0 mm). Targeted correction was calculated according to a customized clinical nomogram. All patients were queried about glare and halos preoperatively and 3 months postoperatively using a questionnaire assigning numeric values to the degree of perceived visual disturbance (0 = no glare or halos, 1 = minimal, 2 = moderate, 3 = severe).

RESULTS: The baseline uncorrected visual acuity (UCVA) was 20/200 or worse in 293 eyes. The baseline best spectacle-corrected visual acuity was 20/20 or better. The mean preoperative refractive sphere was -6.33 diopters (D) +/- 2.80 (SD) (range -1.00 to -16.25 D) and the mean preoperative refractive cylinder, 0.86 +/- 0.83 D (range 0 to +3.25 D). Three months postoperatively, 78% of eyes had a UCVA of 20/20 and 99%, of 20/40 or better. Preoperatively, 94 eyes (31%) had glare and halos. At 3 months, glare, halos, or both were present in 19 eyes of 11 patients (6.3%) (P<.0001); in 14 eyes, patients reported less severe glare and halos postoperatively than preoperatively.

CONCLUSIONS: The use of a peripheral transition zone 1.0 mm larger than the pupil under scotopic conditions resulted in a low incidence of glare and halos postoperatively and did not adversely affect visual acuity. There was no increase in postoperative complications including corneal ectasia.

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"The price good men pay for indifference to public affairs is to be ruled by evil men." Plato


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 Post subject:
PostPosted: Sat Jan 06, 2007 3:13 am 
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http://www.ascrs.org/publications/jcrs/editjun02.html

Quote:
What happens to the edges of divided corneal collagen bundles? Do they retract and add to the steepness of the edges of the treated zone?


A blend zone/transition zone helps prevent this steep edge.

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"The price good men pay for indifference to public affairs is to be ruled by evil men." Plato


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 Post subject:
PostPosted: Sat Jan 06, 2007 3:39 am 
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The following study looks at how much smaller the functional optical zone is compared to the actual optical zone when no transition zone is used:

J Cataract Refract Surg. 2002 Jun;28(6):948-53.

Evaluation of corneal functional optical zone after laser in situ keratomileusis.

Boxer Wachler BS, Huynh VN, El-Shiaty AF, Goldberg D.
Jules Stein Eye Institute, UCLA Department of Ophthalmology, Los Angeles, California 90095, USA. bbw@jsei.ucla.edu

PURPOSE: To evaluate the corneal functional optical zone (FOZ) after laser in situ keratomileusis (LASIK) using a primary 6.0 mm ablation diameter without a transition zone.

SETTING: University-based practice.

METHODS: In this retrospective study, 76 eyes of 53 patients who had LASIK for myopia were evaluated. The size of the preoperative and postoperative FOZ was compared in each eye. Preoperative refraction, attempted correction, and achieved correction were correlated with the preoperative and postoperative FOZ using regression analysis.

RESULTS: After LASIK, the FOZ decreased a mean 1.2 mm +/- 0.67 (SD) (P < 0.0001). The size of the FOZ was correlated with the preoperative manifest refraction, attempted correction, and achieved correction (P <.0001). The FOZ reduction was significantly correlated with the preoperative manifest refraction, attempted correction, and achieved correction (P <.05). Before LASIK, there was no correlation between the FOZ and the preoperative manifest refraction (P = 0.9427).

CONCLUSIONS: Spherical aberrations exist within the laser ablation zone and are related to the amount of myopic treatment. This has implications for patients with large pupil diameters under mesopic conditions. Future studies are necessary to understand the implications in patients with high refractive errors.

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"The price good men pay for indifference to public affairs is to be ruled by evil men." Plato


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 Post subject:
PostPosted: Wed Jan 10, 2007 3:46 am 
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You quoted this text...

CONCLUSIONS: The use of a peripheral transition zone 1.0 mm larger than the pupil under scotopic conditions resulted in a low incidence of glare and halos postoperatively and did not adversely affect visual acuity. There was no increase in postoperative complications including corneal ectasia.

That is the first time I read or heard anything regarding the a transition zone larger than the pupil. I think that the conclusion of that study is absolutly correct. My orginal refractive surguron suggested a 9MM transition zone for any enhancement (Never...) My orginal surgury had a transition of 7MM. Very interesting and benefical to know for sure.


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 Post subject:
PostPosted: Wed Jan 10, 2007 4:11 am 
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Ah..

You asked to see one of my charts to see my information.

That makes me think...

After my unsuccessful surgury, I went to about 10 "world famous, experienced, great, amazing...etc, etc" refractive surgurions to help me figure out what my eye problems were.

Most doctors refused to see me, others saw me for two minutes and said there was nothing wrong, and some even said that all the problems were mental. My mother and I always left their offices with the worst feelings a human can experience. I have been insulted, called names and felt every human emotion possible with this damn refractive surgery.
But not once, not once, did any of those "professional doctors" ever, ever, ever ask to see a chart from my past.

It took me a while to realize that those doctors were LYING to me. It broke my heart because I was lied to for so long. I began to think that maybe it was not my large pupils that caused my problems. I began to think those doctors that were lying to me were the ones that were right, that maybe I was one of the "1 or 2% of people who have unfortunate outcomes after LASIK."

Then after a conversation with another member here, I brought up the fact that if any doctor ever compared an image of my optical zone to my full pupil size, that they would see a large ring around my eye. I never know how to "scientificly" explain this to my doctor, so what I always told him that if I cut at a hole in a piece of paper and looked through it, that my vision was much, much, much better. He then made up some BS, but now I understand so much more. I only wish that even just one, just one of those doctors that I saw after my surgery gave me some straight, honest advice.

-----

But I will make sure as soon as I am able to work that I will get my medical records to send you over color copies of my information to see were I stand.

I don't know how you know so much about refractive surgery, but I am sure glad you do. I can only imagine its the same reasons that I am trying to learn as much about the surgery as possible.

Anthony


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 Post subject:
PostPosted: Wed Jan 10, 2007 2:09 pm 
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Generally speaking, worst to best in terms of vision quality:

1. Optical zone smaller than pupil size, no blend (me).
2. Optical zone smaller than pupil size plus blend zone larger than pupil size.
3. Optical zone as large or larger than pupil size plus blend zone.
4. No refractive surgery at all.

I'm out of time... more later.
BE

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"The price good men pay for indifference to public affairs is to be ruled by evil men." Plato


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 Post subject:
PostPosted: Thu Jan 11, 2007 2:55 am 
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APizzo667 wrote:
Ah..

You asked to see one of my charts to see my information.

That makes me think...

After my unsuccessful surgury, I went to about 10 "world famous, experienced, great, amazing...etc, etc" refractive surgurions to help me figure out what my eye problems were.

Most doctors refused to see me, others saw me for two minutes and said there was nothing wrong, and some even said that all the problems were mental. My mother and I always left their offices with the worst feelings a human can experience. I have been insulted, called names and felt every human emotion possible with this damn refractive surgery.
But not once, not once, did any of those "professional doctors" ever, ever, ever ask to see a chart from my past.


That doesn't surprise me. If you mentioned your pupil size, they knew what the problem was, and they are covering up.

Dare one of them to take a topography and to analyze the size of your effective optical zone. Dare one of them to take a wavefront scan at the full diameter of your pupils, if their aberrometer is even capable of it.

APizzo667 wrote:
It took me a while to realize that those doctors were LYING to me. It broke my heart because I was lied to for so long. I began to think that maybe it was not my large pupils that caused my problems. I began to think those doctors that were lying to me were the ones that were right, that maybe I was one of the "1 or 2% of people who have unfortunate outcomes after LASIK."


That's what they want you to believe! They are covering up for the surgeon who did this to you. They are trying to get you to shut up and accept what happened to you and blame yourself. This is not your fault. You were a bad candidate and should never have had LASIK.

APizzo667 wrote:
Then after a conversation with another member here, I brought up the fact that if any doctor ever compared an image of my optical zone to my full pupil size, that they would see a large ring around my eye.


The edge of the effective optical zone (myopic LASIK) is typically seen on topography by yellow, then red. The color changes show the refractive power changes across the cornea. If the periphery is steeper (yellow/red), the retinal image will be distorted if the pupil is large enough to allow light to pass through this area. This is not correctable with glasses. They cannot dispute this. Oh, they'll try to squirm out of it, but the proof is in the topography.

APizzo667 wrote:
I never know how to "scientificly" explain this to my doctor, so what I always told him that if I cut at a hole in a piece of paper and looked through it, that my vision was much, much, much better.


Naturally, because looking through a pin hole you are blocking out all the multifocality from the different areas of your cornea. Remember the power changes I just explained? If you pin hole, you only see through a tiny area. It's like having a tiny pupil.

APizzo667 wrote:
He then made up some BS, but now I understand so much more. I only wish that even just one, just one of those doctors that I saw after my surgery gave me some straight, honest advice.


You'll never get a straight answer until you know as much as they do. As long as they think they can BS you, they will.

One of the top surgeons in the world told me I know more about LASIK than 90% of LASIK surgeons. :lol:

APizzo667 wrote:
But I will make sure as soon as I am able to work that I will get my medical records to send you over color copies of my information to see were I stand.

I don't know how you know so much about refractive surgery, but I am sure glad you do. I can only imagine its the same reasons that I am trying to learn as much about the surgery as possible.


You're exactly right. I had to know the truth. I knew I wasn't getting it from the surgeon who screwed up my vision. He had the nerve to tell me that for one patient it took a full year for the starbursts and halos to resolve. Well, it's been 6 1/2 years, they've never gotten any better, and they never will, unless I live to be 112, at which time I calculated that my pupils will shrink to the size of my optical zone! :roll:

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"The price good men pay for indifference to public affairs is to be ruled by evil men." Plato


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