Exposing the LASIK Scam

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PostPosted: Mon Sep 03, 2007 3:04 pm 
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JCRS
Volume 30, Issue 9, Pages 1867-1874 (September 2004)

Survey of complications and recommendations for management in dissatisfied patients seeking a consultation after refractive surgery

Nada S. Jabbur, MD, Keiko Sakatani, MD, Terrence P. O?Brien, MD

Quote:
Qualitative visual disturbances can affect patients' activities of daily living and include subjective complaints of variable ?glare, halos, difficulty with night driving, ghosting, and shadows,? as expressed by our patients. These can be a result of residual refractive errors or irregular astigmatism related to a decentered ablation and deeper myopic and/or astigmatic ablations sometimes in association with larger pupil size in mesopic conditions.

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PostPosted: Sun Oct 28, 2007 7:53 pm 
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Curr Opin Ophthalmol. 2006 Aug;17(4):373-9.

Pupil size and corneal laser surgery.

Salz JJ, Trattler W.
University of Southern California and Los Angeles County Medical Center, Los Angeles, California 90048, USA. jjsalzeye@aol.com

PURPOSE OF REVIEW: The role of scotopic pupil size as a factor in predicting night vision complaints is controversial. This review summarizes reports in the literature, some that have found and some that have failed to find a correlation with scotopic pupil size and night vision complaints.

RECENT FINDINGS: Pupil-measuring devices are discussed along with informed consent issues and reports showing that wavefront aberrations increase with increasing pupil size. A new objective measuring device (Larson) showed a correlation with postoperative starbursts and pupil size and a decrease in starbursts with wavefront-guided treatments compared with conventional excimer laser treatments. Cortical adaptation allows many patients to adapt to their new night vision. Treatment options for those who remain symptomatic include drops to reduce pupil size and wavefront-guided retreatments.

SUMMARY: Reports in the literature are conflicting, and refractive surgeons would be wise to inform their patients that large scotopic pupil size is a potential risk factor for night vision complaints. By doing this they will follow the recommendations in recent patient information brochures of both VISX (Santa Clara, California) and Alcon (Orlando, Florida) and on the United States Food and Drug Administration web site.

From the full text:

Quote:
The results of these two studies help us understand that following laser vision correction with the VISX laser, the objective size of starbursts visualized by patients increases with increasing pupil size.

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"What concerns me is that if the person informing the patient is themselves poorly or inaccurately informed then how on earth can consent ever be truly informed?" Dr. Sarah Smith


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PostPosted: Wed Nov 28, 2007 9:55 pm 
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Int Surg. 2006 Jan-Feb;91(1):36-8.

Surgical complications caused by inaccurate scotopic preoperative pupillary measurement in cataract and lasik surgery: case report and review of the literature.

Fournier JH, Golden MI.
Department of Ophthalmology, Northwestern University Medical School, Chicago, Illinois, USA.

Accurate scotopic preoperative pupillary measurements in both cataract and lasik surgery cases are critical to avoid in individuals with naturally briskly dilating pupils under scotopic conditions postoperative visual disability related to low light reflections, disabling illuminance, glare disability, halos, starbursts, and diplopia with night vision. Both edge reflections of the pseudophakos implant in cataract surgery and the ablated corneal margin in lasik surgery can contribute to serious visual disability in patients who have larger scotopic pupils exposing the edge of the implanted lens or the surgical optical zone of the ablated cornea to the entrance pupil. A case is presented in which cataract surgery was performed initially with a 5.5-mm-diameter optic lens in one eye and later a 7.0-mm-diameter optic lens in the other eye. Because of a naturally briskly dilating pupil of 7.0 mm, the eye with the smaller implant experienced significant night vision difficulties because of edge reflections of the exposed implant. The other eye in the very same patient with the larger lens implant was asymptomatic. This case underscores the importance of accurate preoperative pupillary measurements under scotopic conditions to avoid this preventable disabling surgical complication in both cataract and lasik cases.

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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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PostPosted: Sun May 25, 2008 7:30 pm 
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J Cataract Refract Surg. 2008 Jun;34(6):963-7.
Efficacy of brimonidine tartrate 0.2% ophthalmic solution in reducing halos after laser in situ keratomileusis.
Lee JH, You YS, Choe CM, Lee ES.
From the Yonsei Eye Clinic (J.H. Lee), Uijeongbu, Nune Eye Hospital (You, Choe), and Institute of Vision Research (E.S. Lee), Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.

PURPOSE: To quantitatively evaluate the effect of brimonidine tartrate 0.2% (Alphagan) on halo and pupil size in patients who had symptomatic night-vision difficulties after laser in situ keratomileusis (LASIK). SETTING: Nune Eye Hospital, Seoul, Korea.

METHODS: This study comprised 28 eyes of 14 patients with symptomatic night-vision difficulties after LASIK. Pupil diameter was measured with a Colvard pupillometer (Oasis Medical, Inc.). Quantitative analysis of halos was performed by measuring the area using a new computerized method. Pupil size and halo size were evaluated under scotopic and normal room light conditions. Alphagan was administered, and the effect was measured after 30 minutes and 1, 6, 12, and 24 hours.

RESULTS: There was a statistically significant correlation between pupil size and halo size (r = 0.527; P<.0001; slope = 691.6 pixel/mm). Pupil size and halo size decreased significantly 30 minutes after Alphagan instillation under both luminance conditions (all P<.0001). Under normal room light, the pupil and halo remained decreased until the last measurement at 24 hours. Under scotopic conditions, the pupil returned to its preinstillation size at 24 hours while the halo remained decreased. The maximum effect on halos was observed after 6 hours, when the mean reduction over preinstillation size was 28.2% and 29.1% under normal room light conditions and scotopic conditions, respectively.
CONCLUSION: Alphagan effectively reduced halo size and pupil size in postoperative LASIK patients with night-vision symptoms.

From the full text:

There was a significant correlation between pupil size and halo size.

Factors known to increase the risks for such disturbances include large pupils, small optical treatment zones, and higher-order aberrations.

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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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