Exposing the LASIK Scam

Add me to the list of post-lasik flaps that is following Dean's results and is considering treatment in Dr. Stojanovic's clinic...

It seems that topography-guided treatments may be much more reliable than wavefront-guided treatments, both in general, but also specifically for post-LASIK complications

See here for the latest report
http://www.crstodayeurope.com/Html%20pa ... anovic.pdf

It does seem like he's doing very well at improving things. It briefly describes a lot of the shortcoming of wavefront instruments, particularly for complex cases--namely that they lack resolution and have no knowledge of what to treat outside the pupil zone. Of course, it does seem to work sometimes, as has seemingly occurred in zadaw's case. Perhaps that system in HK is using an aberrometer of higher resolution than the VISX ones in the US. Though I thought that Alcon used something called CustomCornea, which I thought was also topography-guided.

APizzo--I can completely relate to the experience of being a young man confronted suddenly, just setting out on a career, by the challenge of post-LASIK complications...

Alcon CustomCornea is wavefront-guided.

Hi all -

I am very happy for zadaw that he was able to have his situation somewhat relieved. Stories like his always make me feel hopeful, even though stories like his are very rare, but its great to hear about people improving their eyesight.

However, the main problem that seperates him and I is pupil size.

I think I read that zadaw has about 7.25mm pupils (correct me if I am wrong), while my pupils are about 8.5mm. But thanks for the link to Dr. S's report, I thought that it was extremely informative when I read that refractive surgery equipment is made for virgin eyes, not complicated eyes - first time I heard that from a doctor.

On a side note - at first I did not understand why this site was called "the lasik flap." I did not even know what that meant. But more and more everyday that the term "the lasik flap" is making more and more sense to me. Now that I am very much against anyone ever getting refractive surgery, I see now the benefits of a topoguided treatment to the barbaric shredding of the nerves in my eyes, with a flap that could pop off with the right amount of force, but those damned floaters - for me, the floaters are the worst of all my lasik side effects. The word microkeratome makes me sick to my stomach up, it really does.

But to finish on a positive note, thanks for all the replies to my posts, I am understanding more and more each day about refractive surgery. I may have insurance again within the next few months, so hopefully I can finally get my dry eyes checked out, maybe go visit that floaters doc...so hopefully I can start posting with some good news and progress.

Anthony,

I think your floaters are a result of a couple of things -- the suction ring used to create the flap and/or the pilocarpine that your doctor prescribed to reduce the size of your pupils after he gave you an optical zone too small for your pupil size.

If most aberrometers only measure 6mm of the scoptic pupil, what information is being used in the worthless "blend zone"?

For example, in a patient with 9mm pupils, who had an aberrometer that only measured out to 6mm, where is the blend zone information coming from?

The more I think about this damn surgery the more I hate those involved with it in any way. I am trying for disability in the next few months. Only 23 my life is ruined. Thanks refractive surgery. And the funny thing to think is that I would be *LUCKY* to be on disability. Believe me, when I was studying for my MBA and planning on going to doctorate school, going on long term government disability was not a part of my game plan. Now its my last option.

I've been trying to read the peer reviewed medical information but just what some of these doctors are writing about lasik makes me sick. One doc called lasik "magic." I don't know what's so magic about placing black tape over every power light in my bedroom so that little power light indicator on your cable box, tv, vcr, etc does not turn into a massive firework in the middle of the night. I am sure some of you know what I mean.

Anthony, the blend is just a small amount of laser energy applied outside the optical zone to prevent a sharp "drop-off" at the periphery of the treatment. There is no information coming from anywhere except the way the laser is programmed. It's just blasting tissue. I wish I could think of a good analogy to make you understand.

In my case, I was treated with a 6mm broad beam laser with NO BLEND which means there is a sharp transition from the treated area to the untreated area of my cornea... when my pupils dilate beyond the treated area the light passes through that sharp drop-off and light scatters like mad. I was a higher myope than you, which means my optical zone is even smaller... more like 5mm. The reason the industry moved away from using broad beam lasers with no blend to the newer technologies with blend zones and more laser energy applied in the periphery (wavefront) is because patients like me with large pupils were severely visually impaired by the older technology. The newer technology lessened the severity of the visual impairment, but it didn't fix the problem for patients with large pupils. Patients whose pupils are larger than the optical zone (not counting the blend) are not good candidates for LASIK.



I know exactly what you mean. This is how I see headlights at night.

You know how you hear all those LASIK ads that proclaim, "Wake up and see the clock!".... Well, THIS IS HOW I SEE THE CLOCK NOW WITH GLASSES ON!

Anthony, I really feel that you should list out your complications in order of importance and deal with them one at a time as they are probably inter-related.

Reading your posts, my impression that your order of importantce s

1. Psychiatric/Psychological complications
2. Floaters
3. HOAs
4. Dry-Eyes

You really have to attack these psychiatric complications first. Your floaters may improve as your brain adapts but if you keep on thinking about them all the time, they will not improve. As far as HOAs go, you may see some improvement if your eyes are not that dry. If required, I would adjust your lifestyle so that you will see as few HOAs and floaters as possible so as to improve your psychological state.

I did seek some psychiatic help after my HOA complications but it improved once I decided not to go for surgery immediatley but not to give up that option either. In fact, my recent surgery was not initiated by myself but by my surgeon who was now quite confident of success.

I still see substantial starbursts with my untreated R eye. However they never really bothered me. Perhaps because the night-time environment is quite well-lit in Hong Kong, and I rarely see them at night. I never did have any problems with night-time driving. However, I can imagine that if I drove in a place with no street lamps, I could well get into problems.


Best of luck

Derek

Derek,

Excuse me, but I have to seriously disagree with your assessment of Anthony's situation. I have reviewed all of his medical records. His main problem is that his pupils were way too large for LASIK. His surgeon planned an optical zone much smaller than his scotopic pupil size, hence the spherical aberrations. His optical zone is also not well centered, hence the coma-like aberrations. Spherical aberrations and coma are the primary HOAs causing Anthony's visual disturbances. Then, his surgeon prescribed Pilocarpine to reduce his pupil size, which apparently caused the floaters (it is well known that Pilocarpine can cause vitreoretinal complications). Please don't blame Anthony's problems on "Psychiatric/Psychological complications". That's insulting, in my opinion. Anthony will learn to move on and cope with his situation in his own time. It took me several years. LASIK complications are life-altering and traumatic. I know what he's going through because I've been through it and I still live with destroyed vision every day.

Broken Eyes, I think you misinterpreted my comments.

"Please don't blame Anthony's problems on "Psychiatric/Psychological complications". That's insulting, in my opinion."

I would be one of the last persons to blame a post-lasik patient's problems on psychology because I went through it myself. I know his HOAs and floaters are major complications and the psychiatric symptomes arose because of it. I was on psychiatic drug treatment for 6 months and it took more than a year for me to recover. Whenever I saw those double images, I got into a anxious/depressed/angry state. I blamed myself for undergoing that surgery in the first place and got extremely anxious as to what to do next. Psychatric complications are one of the most dangerous complications of lasik because it could lead to suicide, self-harm and harm to others. Anthony has stated earlier that his mother is affected by depression as well.

What I am trying to say is that Anthony seems to be suffering very much from depression/anxiety which is secondary to his post-lasik complications. The problem is that this could act as a viscious cycle. As you have pointed out, his complications seem to be related to one another. The treatment of one complication seems to make another worse.

All I am recommending is that he tries to concentrate on one component at a time realistically i.e. identify the ones that are easiest to improve and concentrate on it.

HOA - it may not be advisible to have further treatment. If possible, I would try to avoid situations where they are rampant.
Dry eyes - it may or may not improve eventually. Certainly, the HOA and visual acuity would be improved if the eye is not dry.
Floaters - this may or may not improve. If it does improve, it may be due to adaption by the brain. The adaptation would be harder if one is constantly "looking out for the floaters". In any case, I feel that he must avoid the use of drugs that may cause further floaters
Depression/Anxiety/Anger - this is difficult to deal with but hopefully it will settle down a bit eventually. What I am worried he is that Anthony is using drugs that may further affect his vision.

If just one of the components improve a little bit, then the others may improve as well.


Regards

-Derek

Thank you BE and Derek for your replies. I take away extremely valuable information away from both of you.

Just for the record, my mother's depression was a result of my result depression, which was a result of my lasik eye surgery. She has become my unqualified, yet effective consuler. The surgery itself did not give me depression / anxiety / etc. but the effects sure well did 110%. That is the hardest part explaining things to people sometimes.

I LOVE the picture of the alarm clock and cars BE - I have been looking for pictures to print to show my brothers and father how I see, but I had trouble printing the images from the visual simulation website. But that alarm clock picture is dead on. I am going to print it today. (Side note - having that on the t-shirts would be SO effective, along with your quote!!!!) It's terrible, but the only thing I would change about that alarm clock picture would be to able floaters throughout the parts of the clock that are giving off light.

I do like the idea of tackling my issues one by one, but this is a source of constant debate within myself. I want to tackle the emotional problems, but all the emotional problems are 100% caused by my eye problems. This raises the question, did I try to help my eyes first or my mind first? It's like the 10 major problems that I have related to eyes (HOA, floaters dry eyes, severe light sensitivity, mixed astigmatism, etc, etc) permeate the thousands of other aspect of my life. Which makes me think, what do I do first?
To be honest, since I truly can't work at moment, and since I take some powerful anti-anxiety medicine already, I am going to write a letter to my eye surgeon asking him to pay for my medical expenses. I need to address my dry eyes first, seek some medical counciling for a while, then take it from there. I really just want my independence back, if I can get back on my feet at least, then I can stop leeching off others for support. That causes me such great guilt. I never relied on others and now its just the opposite, 100% of what I need comes from others - whether it be information (thelasikflap) or financial (living with the parents).

My only question is for BE - you said I had a decentered ablation. I trust you more than anyone so can I ask, how could I tell by looking at my charts that I have a decentered ablation and what are the effects of this? I only ask because if I ever visit my orginal lasik eye surgeron again (solely for examinations) I would want to be able to look at my charts and point out to him myself that I have decentered ablations.

Sorry for taking so long to respond sometimes, especially when the people on this site are very prompt with their help. I will say that out of every week, I can force myself to sit down, function, elaborate on my condition, for about 30 minutes.

Thanks again both of you for your help.

Anthony

Anthony, I can tell that your ablations are decentered by looking at your color topographies -- notice how the red starts encroaching on the optical zone in an unsymmetrical pattern -- I don't have your topos in front of me at the moment, but if I recall correctly, your ablations are decentered superiorly. I can also tell by the high levels of coma on your wavefront scans. The topographies pinpoint where the problem is coming from at the corneal level, and the wavefront scan tells me what that does to your retinal image. These should mirror each other to a large degree, and in your case they do. The only information missing from your wavefront scans is the impact your pupil size has on your night vision because the scan diameter is smaller than your pupil size.

Anthony, I am quite sure that decentred ablation was the main cause of the problem in my L eye. My coma in that eye was substantial and I remember that I may not have fixated firm on the red light during that surgery. My main problem were the double images and glare, which was fixed following this recent treatment.

However, significant HOAs remain in my R eye and I do not large starbursts under dark conditions. Therefore I am very familiar with the pictures posted by Broken Eyse and I still see these. Since I was really never that bothered by the Starbursts, I declined further surgery on my R eye.

It seems that advances are being made in the treatment of decentration. It may help if your main problem is with double images and glare. However, since your pupil sizes are large, it may not work that well for Starbursts. If the decentration is small, it can be treated be complex wavefront retreatment. If they are large, then topography assisted treatment is thought to be better. Therefore I would suggest that you follow John's recommendations and make contact with Dr. Stojanovic. But since you feel that your biggest current problem is with floaters. I feel that they must recede first before you take any further action.

Cheers

Derek

I haven't seen a shred of data to indicate that any treatment of excimer laser induced higher order aberrations are safely and effectively reduced by further excimer laser surgery.

Dean Kantis has mixed feelings about his retreatment.

Supposedly most of the more modern lasers have eye tracking devices, and coma is still induced. The larger the patient's pupils, the more significant the effects of decentration. You shouldn't be blaming yourself for your decentration.

It is unlikely that most patients have had their higher order aberrations measured at their full pupil diameter, although they surely experience them whenever their pupils are larger than the scan diameter of their wavefront measurement.

What makes you think that floaters will ever recede?

I would offer Anthony these suggestions:

If you don't have lower punctal plugs try them. If your eyes don't overflow with lower plugs, consider lower punctal cautery because plugs tend to leak over time and become colonized with bacteria. Work really hard with Omega 3 supplementation, oral antioxidants and good lid hygeine to get your tear film and ocular surface health in the best possible shape.

Then go to a contact lens fitter who is experienced in fitting patients who have visual problems induced by corneal refractive surgery.

Right now the weight of evidence supports the notion that surgical options are not effective, and will cost you precious corneal tissue and rack up even more nerve damage.

Thanks everyone once again.

A quick update on me:

Going through the medical records I received from KREMER LASER EYE CENTER - I noticed another inconsistency.

It appears that on my medical records that my dry eye IMPROVED after my laser eye surgery.
First I would like to say that this is amazing, since I was never given a dry eye test BEFORE or AFTER my eye surgery at Kremer Laser Eye Center. No Schemers, no test of any kind, at any point. But if you look at my records, my dry eye got better!

I had dry eye problems before the laser eye surgery, and that's the only reason I know of the Schemers test because I was given this test about 6 months prior to the surgery with slightly before average results for someone of my age. None the less, the frustration I have reading that my dry eye improved from my medical records is absolutely infuriating.

I go for a disability hearing Thursday, Sept. 13 at my local social security office. Since the only medical records I have are from my laser eye center, I feel it is important for me to collect on my own my psychiatrist records and my family doctor medical records. Both of those records will 100% support my cause. Also, I printed out picture of before / after photos from lasikdisaster.com to help show the people at social security how I used to see and how I see know. Keep your fingers crossed for me everyone and hope that the information I am submitting to supplement my lasik records will be accepted and maybe within a month or two I can finally start to get things back on track.

One final piece of incredible interesting info, is that I notice when I use eye drops throughout the day, especially right after waking up and before going to sleep, that my vision improves. I read on the flap that dry eye causes mixed astigmatism (correct my if I am wrong?). So I never really knew I had such dry, dry eyes until recently. So I am very, very anxious to get insurance one day and try eye plugs. I hope that scientist had luck with her plugs. If I was able to get some eye plugs, disability, and finally try some contacts, that is that best I could ask for. I know my floaters will never go away, although I do hope that in time, my pupils return to their full size. My left eye was 8.25mm before surgery, now its about 8.00mm. This might sound good, but my right eye is still 8.25mm, and the left eye has the severe floaters while the right has somewhat less.

Thanks again everyone, I will keep you all updated on my disability hearing.