Exposing the LASIK Scam

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 Post subject: The truth behind Patient Satisfaction Surveys
PostPosted: Fri Nov 25, 2005 3:06 pm 
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http://www.ncbi.nlm.nih.gov/entrez/quer ... uery_hl=26

J Cataract Refract Surg. 2005 Aug;31(8):1537-43.
Changes in quality of life after laser in situ keratomileusis for myopia.

Garamendi E, Pesudovs K, Elliott DB.

Department of Optometry, University of Bradford, Richmond Road, Bradford, West Yorkshire, United Kingdom. e.garamendi2@bradford.ac.uk

PURPOSE: To measure quality of life (QoL) outcome in prepresbyopic myopic patients having laser in situ keratomileusis (LASIK) refractive surgery using the Quality of Life Impact of Refractive Correction (QIRC) questionnaire and to compare the QoL of preoperative patients with a sample of spectacle and contact lens wearers not considering refractive surgery.

SETTING: Department of Optometry, University of Bradford, Bradford, and Ultralase, Leeds, West Yorkshire, United Kingdom.

METHODS: The validated QIRC questionnaire was prospectively completed by 66 patients before and 3 months after LASIK. Patients had myopia greater than 0.50 diopters (D) (range --0.75 to --10.50 D) and were aged 16 to 39 years. Patients were also directly asked to evaluate their QoL after surgery.

RESULTS: Overall QIRC scores improved after LASIK from a mean of 40.07+/- 4.30 (SD) to 53.09+/- 5.25 (F(1,130)=172.65, P<.001). Greater improvements occurred in women (53.83+/- 5.46) than in men (49.39+/- 5.94; F(1,64)=9.37, P<.005). Overall, 15 of the 20 questions (especially convenience, health concerns, and well-being questions) showed significantly improved scores (P<.05). Patients who "strongly agreed" (53.96+/- 4.91, n=33) or "agreed" (51.78+/- 6.19, n=23) had improved QoL and had significantly higher QIRC scores than those who "neither agreed nor disagreed" (44.36+/- 4.97, n=5) or "strongly disagreed" (42.82, n=1) (F(1,60)=11.24, P<.001). The matched group not contemplating LASIK scored 42.41 +/- 3.89 on QIRC overall.

CONCLUSIONS: Large improvements in QIRC QoL scores were found after LASIK for myopia in the majority of patients, with greater improvements in women. A small number of patients (4.5%) had decreased QIRC QoL scores, and these were associated with complications. People presenting for LASIK scored measurably poorer than matched patients not contemplating refractive surgery.



Now for the truth behind the survey (from the full-text):

"McDonnell et al.8 assessed refractive-error-related QoL in patients following refractive surgery with the NEI-RQL; a 42-item questionnaire that included subscales related to clarity of vision, expectations, near vision, far vision, diurnal fluctuations, activity limitations, glare scale, symptoms, dependence on correction, worry, suboptimal correction, appearance, and satisfaction with correction. Improved QoL was mostly correlated with expectations, near and far vision, diurnal fluctuations, activity limitations, symptoms, dependence on correction, worry, perceptions about having suboptimal correction, appearance, and satisfaction with correction. However, symptoms of glare were significantly worse after refractive surgery and clarity of vision showed no significant change. Schein and coauthors7 used the RSVP, a 42-item questionnaire to measure vision-related health status in patients with refractive error including domains such as concern, driving, expectations, physical and social functioning, symptoms, optical problems, glare, and problems with corrective lenses. Patients reported significantly improved QoL after refractive surgery in subscales related to expectations, physical and social functioning, and problems with corrective lenses. However, driving, symptoms, optical problems, and glare showed significantly worse scores after surgery."

"A small number of patients (n=3; 4.5%) had overall lower QIRC QoL scores after surgery. One former high myope was very disappointed with her quality of vision, and 2 former moderate myopes reported having better vision with their contact lenses prior to surgery than postoperatively. Their QIRC scores showed a worsening in items related to visual function, symptoms, concerns, and well-being. One patient (high myope), who had a significantly lower score postoperatively (preoperative QIRC score 50.57; postoperative QIRC score 42.82), ?strongly disagreed? that her QoL improved after refractive surgery. This patient reported some common complications of laser refractive surgery such as having better vision with contact lenses prior to surgery, eyes sensitive to bright light, and misty and unclear vision, especially when driving at night."

"the optical zone was at least 6.0 mm, increased to 0.5 mm greater than the scotopic pupil for pupils over 5.5 mm".

"... other factors, such as the Hawthorne effect and cognitive dissonance, should be considered. Participating in a clinical trial or study can make patients report a significant positive effect of the surgery due to the added attention being made toward them (the Hawthorne effect)."

"Cognitive dissonance states that a change in attitude or belief occurs in an attempt to be consistent with the choice taken. Patients who have chosen to have surgery could justify this choice by indicating that the outcome was successful".


Last edited by Bill on Fri Oct 26, 2007 3:24 am, edited 1 time in total.

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PostPosted: Wed Jan 25, 2006 2:24 am 
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CLAO J. 2001 Apr;27(2):84-8.

Patient satisfaction after LASIK for myopia.

Miller AE, McCulley JP, Bowman RW, Cavanagh HD, Wang XH.

University of Texas Southwestern Medical Center at Dallas, USA.

PURPOSE: To determine satisfaction among patients treated with laser-in-situ-keratomileusis (LASIK) for various degrees of myopia (-0.75 D to -16.00 D) and myopic astigmatism (+0.50 D to +4.50 D) and assess factors which may affect satisfaction.

METHODS: One-hundred seventy-four consecutive patients treated with LASIK between November 1, 1997 and October 31, 1998 were surveyed. Charts were reviewed to collect refractive data.

RESULTS: Eighty-three patients (163 eyes) returned surveys for a response rate of 53%. Of the responders, 55% were female, the average age was 39.6 years (range 21-59), the mean preoperative sphere was -6.36 +/- 0.23 D, cylinder +0.94 +/- 0.07 D, and spherical equivalent-5.89 +/- 0.23 D. Ninety-six percent of eyes enjoyed freedom from corrective lenses following LASIK. Twenty-nine percent reported reduced night vision clarity following LASIK and 27% noted more eye dryness following LASIK. Overall, 84.8% were at least "very pleased" with the results of the procedure and 97% indicated that they would decide again to have LASIK. Uncorrected visual acuity and lower preoperative cylinder correlated positively with satisfaction, while increased postoperative dry eyes correlated negatively with satisfaction.

CONCLUSIONS: This study demonstrates a very high level of patient satisfaction following excimer laser treatment for myopia and myopic astigmatism. A great deal of literature has evaluated objective outcomes of LASIK, but this is one of few studies to examine patient satisfaction.


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PostPosted: Wed Jan 25, 2006 2:29 am 
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J Cataract Refract Surg. 2005 Oct;31(10):1943-51.

Functional outcomes and patient satisfaction after laser in situ keratomileusis for correction of myopia.

Tahzib NG, Bootsma SJ, Eggink FA, Nabar VA, Nuijts RM.



A total of 92.2% of patients were satisfied or very satisfied with their surgery, 93.6% considered their main goal of surgery achieved, and 92.3% would choose to have LASIK surgery again. Satisfaction with uncorrected vision was 3.03 +/- 0.71. The mean score for glare was 3.0 +/- 0.9. At night, glare from lights was believed to be more important than before surgery by 47.2%. Glare from oncoming car headlights after surgery was reported by 58.4% and was believed to be more bothersome for night driving than before surgery by 52.8%. Night driving was rated more difficult than before surgery by 39.4%, whereas 59.3% had less difficulty driving at night.


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J Cataract Refract Surg. 2005 Dec;31(12):2313-8.

Sensitivity of the National Eye Institute Refractive Error Quality of Life instrument to refractive surgery outcomes.

Nichols JJ, Twa MD, Mitchell GL.


From the full text (you won't see this in the abstract):

Quote:
"One might also predict these 2 groups to report a significant difference in glare. However, the design of the clinical trial for these LASIK patients limited enrollment to those who were unlikely to experience this problem (ie, low to moderate myopia and pupil sizes less than 7.5 mm)."




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There is something terribly wrong with this picture. They exclude high myopes and patients with large pupils in their "quality of life" survey in order to make LASIK look good. Some in the industry keep saying pupil size doesn't matter and others say there's still debate on whether or not pupil size matters. But if pupil size didn't matter, why not include patients with large pupils in these surveys?

It's all just a big cover-up. They know good and damn well pupil size matters.

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Bill

"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: Fri Jun 09, 2006 1:01 pm 
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Cesk Slov Oftalmol. 2006 May;62(3):206-17.

[Effect of lasik on objective and subjective visual functions in patients with myopia]

[Article in Czech]

Hejcmanova M, Horackova M.

Ocni klinika, LF MU, FN Brno-Bohunice. m_hejcmanova@hotmail.com

PURPOSE: To determine the effect of laser in situ keratomileusis (LASIK) on visual functions: visual acuity (VA) and contrast sensitivity (CS) and to evaluate functional complaints. PATIENTS AND METHODS: Prospective study includes results of VA and CS preoperatively and 1, 3, 6 and 12 months after the surgery in patients with middle and high myopia. 105 eyes of 53 patients (37 females, 16 males) were divided according to spherical equivalent into 2 groups: group A (more than -5D, 51 eyes) and group B (less than -5D, 54 eyes). Mean patients' age was 28,2 years. Visual acuity was measured on log MAR charts. Contrast sensitivity at spatial frequency of 3, 6, 12 and 18 c/deg was tested using CSV 1000 Contrast sensitivity Unit. Influence of glare on CS was determined by BAT (Brightness Acuity Tester). Functional complaints were evaluated using a wide-ranging questionnaire focusing on 4 main topics. RESULTS: Visual acuity preoperatively in both groups was significantly decreased in comparison to controls. A considerable decrease can be detected at 1 month postoperatively but later (1 year after the surgery) it reaches the values of 1.02. Postoperatively, a significant decrease of CS can also be detected, above all at intermediate spatial frequencies. During postoperative period, values of CS slowly increase in both groups. However, only in group B (with less than -5D), the preoperative values have been reached. Further, glare has decreased CS at spatial frequency of 6 c/deg, i.e. the most sensitive spatial frequency for human eye. The satisfaction with final outcome has reached 91%. However, some patients (14%) reported reduced vision under dim illumination and at night and also difficulty with night time driving. CONCLUSIONS: Our study suggests that both used methods (VA and CS) are very sensitive to evaluation of visual functions after refractive surgery. Changes of contrast sensitivity can reveal even slightly changed optic factors of cornea that can cause subjective complaints of patients.

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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: Sat Aug 26, 2006 1:43 pm 
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This is not a peer-reviewed article, but it goes with this thread.

http://www.time.com/time/magazine/artic ... 18,00.html

Quote:
My eyesight before LASIK was about 20/900--which amounts to being legally blind. Three weeks after LASIK, I am at 20/50. I'm using artificial tears pretty regularly, but I am thrilled that I can see what I could not before. Was I expecting better? Sure! Am I satisfied? You bet!
LARRY JOACHIM Sugar Land, Texas

LASIK was a disappointment, a let-down. The patient's vision is not nearly as good as it was with glasses, and the patient has dry eyes. But he's satisfied. This is a classic example of a satisfied LASIK patient.

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Bill

"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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 Post subject: cognitive dissonance!
PostPosted: Sun Aug 27, 2006 12:52 pm 
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This is why 90% are satisfied with lasik. Talk about cognitive dissonance! They are fooled into thinking they have to settle for compromised vision after lasik and are "supposed" to be happy with it. They arent fooling me or anyone who is informed about flawed, dangerous lasik. The best vision you can have is by sticking with glasses.

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Lasik damages every eye! Lasik induces more aberrations, even so called "wavefront!" Stick to glasses!


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PostPosted: Fri Sep 22, 2006 11:53 am 
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Here's another non peer-reviewed article.

OSN SuperSite Breaking News 9/18/2006

At 5 years, LASIK patients remain happy with results

Quote:
Of those who responded to the questionnaire, 6.2% indicated they had worse vision now than before LASIK, and 21% said their night vision was worse than it was before. "But when you ask people if they would do laser again, everyone, bar none, said they would do it again, and 100% said they would refer a friend," Dr. Cummings said.


http://www.osnsupersite.com/view.asp?rid=18493

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PostPosted: Sat Aug 18, 2007 2:09 pm 
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J Cataract Refract Surg. 2004 Sep;30(9):1861-6.

Reasons patients recommend laser in situ keratomileusis.

Bailey MD, Mitchell GL, Dhaliwal DK, Wachler BS, Olson MD, Shovlin JP, Pascucci SE, Zadnik K.

Ohio State University College of Optometry, Columbus, OH 43210, USA. mbailey@optometry.osu.edu

PURPOSE: To evaluate the reasons patients who have had laser in situ keratomileusis (LASIK) recommend it to others and examine the disparity between high levels of satisfaction and patient reports of night-vision symptoms and/or dry eye after LASIK.

SETTING: Northeastern Eye Institute, Scranton, and the University of Pittsburgh, Pittsburgh, Pennsylvania, and the University of California at Los Angeles, Los Angeles, California, USA.

METHODS: Questionnaires assessing symptoms and satisfaction after LASIK were mailed to 2,100 patients. The questionnaires included items about night-vision symptoms and satisfaction and an open-ended question for patients to give their reasons for recommending LASIK to others. The open-ended responses were categorized and tabulated.

RESULTS: Four hundred thirty-four patients provided reasons for recommending LASIK to others. Sixteen categories of reasons were identified. "No more spectacles/contact lenses" was listed by 180 patients (42%), followed by "better vision" (21%) and "convenience" (15%). Women were significantly more likely to cite "better comfort" (27 women versus 3 men; chi square = 8.99, P =.003) and "better quality of life" (41 women versus 9 men; chi square = 7.36, P =.007) as a reason for recommending LASIK. Of the 35 patients who reported dissatisfaction with post-LASIK vision, 20 (57%) would recommend LASIK to a friend because "LASIK helps others."

CONCLUSIONS: Categories of reasons for recommending LASIK to others were similar to reasons given by patients for seeking LASIK. Some patients who reported dissatisfaction with their vision said they would recommend LASIK, suggesting that recommendation of LASIK to others is not necessarily a measurement of the quality of a patient's vision after LASIK.

From the full text:

Quote:
Previous investigations have characterized patient satisfaction and complaints, such as night-vision symptoms and dry eye, after laser in situ keratomileusis (LASIK).1, 2, 3, 4, 5, 6 Although night-vision symptoms have been reported in 12% to 57% of patients3, 4, 5, 6, 7, 8, 9 and dry-eye symptoms have been reported in 4% to 9%,2, 10 post-LASIK satisfaction remains very high. For example, Hill6 reported that 15 (7.5%) of 200 patients considered their night-vision symptoms to be ?considerably worse? than before LASIK. Yet, 195 of them (97.5%) reported they were ?extremely happy? and only 1 reported being ?slightly unhappy.? Similar disparities have been reported after photorefractive keratectomy (PRK). Brunette et al.11 found that 31.7% of PRK patients reported a decrease in night vision; nevertheless, 91.8% were satisfied or very satisfied with their surgery.

In a previous study,9 we characterized the factors associated with night-vision symptoms and decreased satisfaction following LASIK. We also found a disparity between the relatively frequent report of postoperative night-vision symptoms and high patient satisfaction. Ninety-seven percent of patients in our sample of LASIK patients would recommend LASIK to a friend.9 When asked to rate satisfaction with their vision, patients reported a median score of 100% of the maximum value on the visual analogue scale (mean 87.2%). Yet, 30.0% reported halos, 27.2% reported glare, and 24.5% reported starbursts when asked about these symptoms in a questionnaire. While this disparity can be explained by assuming that the symptoms were not severe enough to adversely affect satisfaction reports, there may be other explanations.

The purpose of this study was to further investigate explanations for this disparity by examining and categorizing the reasons post-LASIK patients say they would recommend LASIK to a friend. We also looked for associations between categories of reasons for recommending LASIK and factors known to be associated with an increase in postoperative night-vision symptoms and decreased satisfaction after LASIK.


Quote:
There is more than 1 plausible explanation for the disparity between the relatively common frequency of postoperative complaints and the high levels of satisfaction after LASIK. The first is that the night-vision symptoms and symptoms of dryness after LASIK are mild relative to the benefits of LASIK, so patient satisfaction remains high. There are, however, other explanations.

The discrepancy between symptoms and satisfaction has also been reported after PRK. Brunette et al.11 conclude, ?[Patients'] self-conditioning to the belief in the success of this expensive and irreversible surgery was not assessed in the present study. However, if such a psychological process prevailed, one would expect patients to deny the secondary effects such as glare and night vision problems. This was not the case here. Patients may simply adapt to their new condition.? The idea that patients may adapt to their new condition is a second explanation for the disparity between symptoms and satisfaction.

The third explanation for this disparity is one that is dismissed by Brunette et al. Although a specific ?psychological process? is not mentioned in their report, they may be referring to a process called cognitive dissonance. The theory of cognitive dissonance suggests that individuals need to have consistency among their attitudes or beliefs.15 The theory can apply to many types of decisions, ie, purchases and surgical procedures, and the effects of cognitive dissonance have been investigated in nonocular surgical procedures.16, 17 Certain criteria are required for dissonance to be induced following a decision.18 First, the decision must be important and the consumer/patient must have invested substantial money or psychological cost. Second, the consumer/patient must freely choose to make the purchase or have the surgical procedure. Finally, the commitment must be irreversible.

It is evident that the LASIK procedure meets all 3 criteria for inducing cognitive dissonance in patients who have post-LASIK complications/side effects. Homer and coauthors17 predict that cognitive dissonance might have less effect on specific questions about symptoms and a greater effect on questions about the overall success of the surgical procedure, such as whether the patient would have the procedure again or recommend the procedure to others. This prediction is supported by our previous study in LASIK patients and by Brunette et al.9, 11 Cognitive dissonance should be explored in future studies as an explanation for the disparity between the relatively frequent occurrence of postoperative symptoms and the high levels of satisfaction.

_________________
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 Mon Sep 03, 2007 3:17 pm, edited 1 time in total.

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J Cataract Refract Surg. 2003 Jun;29(6):1152-8.

Six-year follow-up of laser in situ keratomileusis for moderate and extreme myopia using a first-generation excimer laser and microkeratome.

Sekundo W, B?nicke K, Mattausch P, Wiegand W.
Department of Ophthalmology, Philipps-University Marburg, Germany. sekundo@med.uni-marburg.de

PURPOSE: To evaluate objectively and subjectively the long-term outcome of laser in situ keratomileusis (LASIK) in patients with high and very high myopia.

SETTING: Department of Ophthalmology, Philipps University, Marburg, Germany. METHODS: Thirty-three eyes of 19 patients were followed for a mean of 76 months (range 50 to 84 months) after primary LASIK using the Keratom I excimer laser (Schwind) and the ALK microkeratome (Chiron). Refraction, glare, pachymetry, corneal topography, and tear-film secretion and stability were measured. At the last examination, patients also answered a 14-item questionnaire.

RESULTS: Preoperatively, the mean spherical equivalent was -13.65 diopters (D). At 1 year, it was -0.25 D and after 6 years, -0.88 D. Fifteen percent of eyes lost > or =2 lines of best spectacle-corrected visual acuity (BSCVA), and 9% gained > or =2 Snellen lines. At the end of the study, 46% of eyes were within +/-1.0 D of the attempted corrected and 88% were within +/-3.0 D. There were 5 microkeratome-associated complications; 3 resulted in loss of BSCVA. The latest pachymetry showed a mean corneal thickness of 498.5 microm (range 396 to 552 microm). There were no cases of keratectasia. Seventy-five percent of patients noted an increase in their quality of life. Seventy-one percent were satisfied with their postoperative visual acuity; however, 75% noticed glare and halos at night.

CONCLUSIONS: Laser in situ keratomileusis correction of very high myopia did not cause keratectasia in the long term provided the corneal thickness was respected. A flap thickness setting of 130 microm with a first-generation microkeratome resulted in a high number of cut failures. Most patients were happy with the results despite a modest level of accuracy and glare.

From the full text:

Quote:
On a scale of 0 to 10 for current satisfaction with one?s visual acuity, the mean score was 5.7. Scores from 0 to 4 were considered ?being unhappy?; 29% of patients were not happy with their UCVA. This percentage was smaller than that immediately after surgery, 35%. Eighty-one percent noticed an improvement in their UCVA after surgery as opposed to the time before LASIK. Twenty-eight percent of patients described their BSCVA as ?worse than before surgery? and 72%, as better or unchanged. The preoperative refraction of patients who were dissatisfied with their BSCVA was ?12.0 D.


Quote:
There were no microkeratome-associated complications in this group; however, 2 eyes of the same patient developed severe dry-eye disease and peripheral epithelial ingrowths and 2 eyes had decentrations of 1.5 mm and 2.0 mm. After almost 7 years, 75% continued to complain of ghosting images and/or halos. Patients who graded their halos between 8 and 10 also felt a decline in their BSCVA (see above) and had irregular flaps due to cut failures or a preoperative refraction greater than ?15.0 D. However, 81% of all patients questioned said they would recommend the surgery to friends and would have the surgery again.


Quote:
Our study highlights the problems of quality of vision. Often, Snellen acuity, particularly after enhancements, is given as a measure of success.11, 12 Nevertheless, 75% of our patients have glare at night, with the worst symptoms in patients who had decentrations, cut problems, or treatments over ?15.0 D with subsequent flat corneas down to 32.5 D in 1 extreme case. Our decentration rate of >0.5 mm was 15%. This relatively high number can be the result of using retrobulbar anesthesia and pilocarpine in contrast to patient self-fixation supported by the eye-tracker technology of modern lasers. Objectively, virtually all patients in this study had poor mesopic vision. Moreover, our study leaves no doubts that this problem continues to persist in the long term and possibly forever.


Quote:
A question still to be answered is why 81% of patients appeared to be quite happy with the overall results when all of them had poor night vision.

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Broken Eyes

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


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PostPosted: Wed Aug 29, 2007 12:31 pm 
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JCRS
Analysis of ectasia after laser in situ keratomileusis: Risk factors
Volume 33, Issue 9, Pages 1530-1538 (September 2007)
Perry S. Binder

Quote:
Two contralateral eyes developed ectasia 2 years after LASIK (Figure 1). This patient was still satisfied with the surgery as the least involved eye has 20/30 uncorrected visual acuity.

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Not peer-reviewed.

http://www.sciencedaily.com/releases/20 ... 074604.htm

Quote:
Nearly a quarter to a third of patients that underwent LASIK surgery reported problems seeing at night, a new study suggests. Even so, 97 percent of the subjects said they would recommend LASIK to a friend.


Quote:
The researchers sent questionnaires to 605 patients, asking if they were satisfied with the surgery or if they had nighttime vision problems. They also examined the patients' medical charts. All subjects in the study had at least six months of recovery time.


Quote:
Ninety-seven percent of the patients in the study said they would recommend LASIK to a friend, in spite of the side effects. Of the patients that would make the recommendation, on average, one out of four experienced some nighttime vision problems, compared to an average of two out of three patients who would not recommend the surgery.



I located the actual study:

Ophthalmology. 2003 Jul;110(7):1371-8.
Patient satisfaction and visual symptoms after laser in situ keratomileusis.
Bailey MD, Mitchell GL, Dhaliwal DK, Boxer Wachler BS, Zadnik K.
College of Optometry, The Ohio State University, 338 West Tenth Avenue, Columbus, OH 43210, USA. mbailey@optometry.osu.edu

PURPOSE: To examine preoperative risk factors for decreased satisfaction and symptoms of glare, halos, and/or starbursts after laser in situ keratomileusis (LASIK).

DESIGN: Retrospective, case-control study.

PARTICIPANTS: Participants were 604 previously myopic patients who underwent LASIK at least six months prior to completing the questionnaire.

METHODS: Questionnaires about satisfaction and night vision symptoms were mailed to 2100 patients from the Northeastern Eye Institute, UCLA, and the University of Pittsburgh. Preoperative and postoperative ocular variables were collected from the medical charts of the 841 subjects who returned the questionnaire.

MAIN OUTCOME MEASURES: Responses to various satisfaction and night vision symptom questions were compared to demographic and preoperative ocular variables using multivariate logistic regression.

RESULTS: The questionnaire return rate was 42.9%. The mean age for all subjects was 43.0 +/- 10.6 years, and 63% of the subjects were women. Overall, 97% of the subjects would recommend LASIK to a friend. Among subjects who would not recommend LASIK to a friend, a significantly larger percentage reported that they experienced glare, halos, or starbursts (13 of 16 (81.3%) vs. 206 of 388 (53.1%), chi(2) = 4.9, p = 0.03). Also, subjects with flatter preoperative minimum corneal curvature values were more likely to report that they would not recommend LASIK to a friend (OR = 0.71, 95% confidence interval (CI) = (0.52, 0.96), p = 0.03). The median score for satisfaction with vision was 100%, or the maximum value of 127 mm on the visual analog scale. Increasing age was significantly associated with dissatisfaction with vision after LASIK (OR = 1.68, 95% CI = (1.10, 2.56), P = 0.02). Halos were reported by 30%, glare by 27%, and starbursts by 25% of all subjects. Subjects who reported starbursts had a significantly flatter preoperative minimum corneal curvature (43.54 +/- 1.60 D versus 43.92 +/- 1.69 D, t = 2.15, p = 0.03). Also, subjects who had surgical enhancement were more likely to experience glare, halos, and/or starbursts (OR = 2.14, 95% CI = (1.33, 3.46), p = 0.002).

CONCLUSIONS: Most subjects are satisfied with their vision after LASIK. Our study suggests, however, that certain factors are associated with decreased satisfaction and night vision symptoms after LASIK. Some of these factors include: increasing age, flatter preoperative minimum corneal curvature, and surgical enhancement.

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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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Maguire LJ.
Keratorefractive surgery, success, and the public health.
Am J Ophthalmol. 1994 Mar 15;117(3):394-8.

Quote:
A keratorefractive patient may simultaneously be happy with the result of surgery and have degraded vision ? how can refractive surgery be a potential public health problem if patients are happy with the results? Inherent in this question is the assumption that a patient without complaint is a patient without optical degradation. That argument does not hold up to closer scrutiny. The keratorefractive literature contains disturbing examples of patients who have visual handicaps that place themselves and others at significant risk for nighttime driving accidents and yet they are happy with the results.

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J Cataract Refract Surg. 2001 May;27(5):645-6.
Measuring patient outcomes after refractive surgery.
Koch DD.

Quote:
Another striking finding, again seen in the article?s figure, is that there was only modest overlap among patients who expressed dissatisfaction with vision without lenses and those who reported statistically significant worsening in 3 or more of the 7 RSVP subscales. In other words, patients may report overall satisfaction with their surgical outcome and yet indicate a decrease in quality of function in 1 or more areas. This prompts an obvious question: Does the RSVP ask patients the correct questions? Presumably, the answer is yes. This dichotomous response makes the crucial point that even for many satisfied patients, there are areas in which refractive surgery must improve to further enhance quality of life. For example, in this particular study, the percentage of patients who reported significant worsening in RSVP subscales ranged from 2.3% in the subscale trouble with corrective lenses to 29.5% in the subscale driving.

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Ophthalmology. 2000 Sep;107(9):1790-6.
Functional outcome and satisfaction after photorefractive keratectomy. Part 2: survey of 690 patients.
Brunette I, Gresset J, Boivin JF, Pop M, Thompson P, Lafond GP, Makni H.
Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada.

PURPOSE: To document patient satisfaction and self-perceived quality of vision after bilateral photorefractive keratectomy (PRK). DESIGN: Noncomparative, interventional case series.

PARTICIPANTS: Consecutive patients who underwent bilateral PRK from May 1994 through May 1997 by the 12 surgeons of four collaborating centers with a minimum of 4 months since the last surgery and up to 30 months since the first surgery.

METHODS: A questionnaire with known psychometric properties was self-administered by the patients.

MAIN OUTCOME MEASURES: Responses to individual questions and scale scores.

RESULTS: A total of 929 questionnaires were sent, of which 690 were answered and returned (74.3% response rate). The preoperative spherical equivalent ranged from -0.38 diopters [D] to -27.75 D (mean, -5.32 D; standard deviation, 2.85 D). Although 91.8% of the patients were satisfied or very satisfied with their surgery, 96.3% considered that their main goal had been reached, and 95.7% would still choose to have surgery if they had it to do over. The degree of satisfaction was proportional to the postoperative uncorrected visual acuity in the best eye expressed in LogMAR (r = -0.18, P: = 0. 0001) and was negatively correlated with the importance of the corneal haze (r = -0.23, P = 0.0001). Daytime glare was reported to be greater than before surgery by 55.1% of patients. A decrease in night vision was reported by 31.7% of patients, and 31.1% of patients reported increased difficulty driving at night because of their vision.

CONCLUSIONS: Overall satisfaction after PRK for low to severe myopia appears to be very good. Glare and night vision disturbance, particularly bothersome for night driving, seem to constitute significant secondary effects that deserve further investigation and should be kept in mind for future improvements in the technique.

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