Exposing the LASIK Scam

One Surgeon at a Time
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 Post subject: Questions to ask, tests to request
PostPosted: Fri Aug 18, 2006 12:55 pm 

Joined: Sat Nov 26, 2005 1:23 pm
Posts: 2080
Patients who are having problems frequently ask, "What questions should I ask, which tests should I have performed?". I'll attempt to start a list here.

Always get a copy of all of your records - see http://www.lasikflap.com/forum/viewtopic.php?t=841

Be sure an operative report is included in your records.


Any remarkable findings with the slit-lamp?

How do my flaps look? Are they centered? Any irregularity? Any folds, wrinkles, or striae?

Any signs of edema, interface fluid, debris under the flap, inflammation, epithelial ingrowth?

Is the lens clear (cataract assessment)?

If you have experienced problems with floaters or flashes of light, request a retinal exam.


Refraction (what's your new glasses prescription?) Even a small refractive error can be the cause of some visual symptoms. If you're over 40, have your near vision tested also.

Snellen acuity (Which line can you read?) - uncorrected and best corrected. Test each eye individually and both eyes together.

Pupil measurement with a pupillometer in the dark after dark-adapting for 5 minutes. It is difficult to get an accurate measurement with a pupil card because the tester needs enough light to read the card. Ask what kind of device was used.

Topography (ask if the ablation is centered, any irregularity, size of the effective optical zone).

Orbscan (ask if there are signs of posterior steepening).

Intraocular pressure - Ask about the accuracy of this test on a post-LASIK cornea. Good luck.

Wavefront scan. Request the scan be taken at your maximum dark-adapted pupil diameter. Some aberrometers cannot take a scan larger than 6 mm. Scans taken at a diameter smaller than your dark-adapted pupil diameter will only tell you what's going on with your vision when your pupils are the diameter of the scan. It will NOT tell you what's happening in dim or dark conditions. If your problem is mainly a night vision issue, it is important to find an aberrometer that can measure the full diameter of your pupil. Ask that the print-out include a point spread function. If you had a custom/wavefront treatment, ask if your higher order aberrations decreased or increased (you'll need your pre-op records to determine this, and the scan diameters should be identical to make this comparison).

Contrast sensitivity (not all centers will offer this test).

If you are considering an enhancement, it is absolutely critical to measure your residual corneal bed. The two devices used for this purpose are 1) an Artemis scan, 2) confocal microscopy. Unfortunately most centers do not have these devices. Do not have an enhancement without it unless your records include intraoperative pachymetry -- most won't.

Dry Eyes: Request dry eye tests such as Schirmer's, tear break-up time, and vital staining. Ask for the results of these tests and get copies of the records of this exam.

Don't be afraid to ask questions. Good doctors don't get bent out of shape by patients who ask questions.

One thing to keep in mind when seeking 2nd opinions from LASIK surgeons -- They are SURGEONS, they usually recommend SURGERY. Don't take everything they say as the gospel. Get the information, understand it, then explore your options.

Veterans, did I forget anything?

Broken Eyes

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

Last edited by Broken Eyes on Fri Aug 18, 2006 8:00 pm, edited 2 times in total.

 Post subject: Compare full treatment zone with maximum pupil size!
PostPosted: Fri Aug 18, 2006 5:05 pm 

Joined: Sat Nov 26, 2005 1:06 am
Posts: 621
ASk how the size of the effective optical zone on your topography compares with your maximum pupil size. If you are not fully treated all the way out to your maximum pupil size then you have power changes within your entrance pupil. This decreases visual quality, especially in dim light. Central power changes can indicate flap problems such as buttonholes, and irregular laser treatment. You should have a smooth, solid color of treatment as large or hopefully larger than your maximum pupil size. Only one color!

Your topographies and wavefront scans must be in color to be useable. Make sure you insist on color copies of your scans when you ask for copies of your charts!

Dry eye tests to ask for are surface stainig (ask for a picture of your service staining and/or insist they assign it a grade level in your charts). You should also have a schirmer's test. Anything under 10 is dry. One surgeon, Dr. Doka, did LASIK on a patient with a schirmer's test of 5 and now she is in unremitting pain.

If your surgeon refuses a contrast sensitivity test ask him why... remind him that the VISX clinical trials for LASIK showed statistically significant loss of contrast sensitivity at all time points tested and they did not report these findings to the FDA. Ask your doctor if he thinks its OK that patients lose an important component of their vision (their ability to see well in dim light).

In Germany there is a separate night driving test - on one study over 70% of German patients who had LASIK failed this test. If 'First do no harm' is the law of medicine, why are LASIK surgeons still performing LASIK? It is clearly harmful.

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

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