Exposing the LASIK Scam

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 Post subject: Stephen S. Lane tells surgeons to decieve
PostPosted: Wed Jan 04, 2006 12:57 pm 
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Stephen S. Lane, M.D. tells inexperienced surgeons to decieve patients, placing them at increased risk.

http://www.eyeworld.org/article.php?sid=2765

Stephen S. Lane, M.D.: "Make sure the first patient you enroll feels like you have been doing this for years with regard to your process, he said."


The medical literature shows that inexperience leads to higher complication rates and loss of best corrected vision.

http://www.ncbi.nlm.nih.gov/entrez/quer ... med_docsum

Am J Ophthalmol. 2006 Jan;141(1):13-23. Links


Complications and Visual Outcome of LASIK Performed by Anterior Segment Fellows vs Experienced Faculty Supervisors.

Al-Swailem SA, Wagoner MD, King Khaled Eye Specialist Hospital Excimer Laser Study Group.

Anterior Segment Division, Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.

PURPOSE: To determine the complication rates and visual outcome of laser-assisted in situ keratomileusis (LASIK) that is performed by anterior segment fellows and to compare their results with the results of their experienced faculty supervisors. DESIGN: A single-center, retrospective, interventional, nonrandomized, comparative case series. METHODS: Chart review of the initial 50 LASIK procedures that were performed by each of 10 anterior segment fellows and the first 50 inclusion criteria-matched, contemporaneously performed cases of four faculty members at the King Khaled Eye Specialist Hospital between March and December 2003. RESULTS: There were no statistically significant differences between fellow and faculty cases with respect to complication rates and final visual outcomes. The fellows were significantly more likely to experience microkeratome-related flap complications during their first 25 cases, compared with their second 25 cases (4.8% vs 1.2%; P = .03). Fellows were significantly more likely to perform enhancements (8.0% vs 2.0%; P = .0002), after which the eyes in their group were more likely to be within 1 diopter of the intended refractive target than those in the faculty group (96.0% vs 91.0%; P = .01). Although not statistically significant, eyes in the fellow group were four-fold (2.0% vs 0.5%) more likely to lose two or more lines of best spectacle corrected visual acuity than those in the faculty group. CONCLUSION: To minimize the adverse impact of complications during the learning curve of novice LASIK surgeons, the introduction of this procedure in a well-structured, supervised setting (such as a subspecialty fellowship training program) is recommended.


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 Post subject:
PostPosted: Mon Feb 13, 2006 2:23 am 
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Am J Ophthalmol. 1999 Feb;127(2):129-36.

Flap complications associated with lamellar refractive surgery.

Lin RT, Maloney RK.

Jules Stein Eye Institute and Department of Ophthalmology, UCLA School of Medicine, Los Angeles, California, USA.

PURPOSE: Corneal lamellar refractive surgery for myopia reduces the risk of corneal haze but adds to the risk of flap complications. We retrospectively determined the incidence of flap complications in the initial series of eyes undergoing lamellar refractive surgery by one surgeon. We assessed the incidence of flap complications overall, the trend in these complications during the surgeon's learning curve, and the impact of the complications on best spectacle-corrected visual acuity.

METHODS: Charts of the first 1,019 eyes that underwent myopic keratomileusis in situ or laser in situ keratomileusis were reviewed for flap complications and visual outcome.

RESULTS: Of the 1,019 eyes, 490 eyes underwent myopic keratomileusis in situ, and 529 eyes underwent laser in situ keratomileusis. Eighty-eight (8.6%) of 1,019 eyes had flap-related complications. Six eyes had two complications. Intraoperative complications included irregular keratectomy in nine eyes (0.9%), incomplete keratectomy in three eyes (0.3%), and a free cap in 10 eyes (1.0%). The incidence of intraoperative complications was six (6.0%) in the first 100 consecutive eyes, 14 (2.3%) in the next 600 consecutive eyes (P = .04, chi-square test), and one (0.3%) in the last 300 eyes (P = .03, chi-square test). Postoperative complications included displaced flaps that required repositioning in 20 eyes (2.0%), folds in the flap that required repositioning in 11 eyes (1.1%), diffuse lamellar keratitis in 18 eyes (1.8%), infectious keratitis in one eye (0.1%), and epithelial ingrowth that required removal in 22 eyes (2.2%). The incidence of flap displacement and folds in 200 eyes in which we irrigated under the flap and allowed it to settle without further manipulation averaged 8.5%, whereas the incidence in other groups of 100 consecutive eyes averaged 0.8% (P < .00001, chi-square test). The incidence of diffuse lamellar keratitis was 0.2% in eyes that had undergone myopic keratomileusis in situ and 3.2% in eyes treated by laser in situ keratomileusis (P = .0003, chi-square test). No eye lost 2 or more lines of best spectacle-corrected visual acuity because of flap complications.

CONCLUSION: Flap complications after lamellar refractive surgery are relatively common but rarely lead to a permanent decrease in visual acuity. Physician experience with the microkeratome and with the handling of the corneal flap decreases the incidence of flap complications.

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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:
PostPosted: Mon Feb 13, 2006 2:26 am 
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J Cataract Refract Surg. 1996 Jun;22(5):542-50.

Experience during the learning curve of laser in situ keratomileusis.

Gimbel HV, Basti S, Kaye GB, Ferensowicz M.

Gimbel Eye Centre, Calgary, Alberta, Canada.

PURPOSE: To identify pitfalls and offer hints on achieving a successful outcome during the early laser in situ keratomileusis (LASIK) learning process.

SETTING: Gimbel Eye Centre, Calgary, Alberta, Canada. METHODS: This was a retrospective review of the preoperative planning, surgical procedure, intraoperative and postoperative problems, and early postoperative anatomic and refractive results in the first 73 eyes that had LASIK.

RESULTS: Intraoperative complications included failure of the keratome to make a cut, excessively thin cap, repositioning difficulty, and inadequate intraocular pressure elevation. Early postoperative complications included excessive central and peripheral wrinkling of the cap, peripheral lipid deposits, and central edema of the cap. One month postoperatively, mean spherical equivalent refraction was -0.90 diopters (D) (range +1.75 to -6.00 D), and 45 eyes had a best corrected visual acuity between 20/15 and 20/40.

CONCLUSION: Our retrospective review of the problems experienced during the early LASIK learning process should help novice lamellar refractive surgeons avoid such problems and shorten the learning curve.

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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:
PostPosted: Mon Feb 13, 2006 5:53 pm 
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From Mr. Extreme Makeover himself, who does not like sick people:

http://www.capecodonline.com/cctimes/health/lasik22.htm

Quote:
''You don't want to be part of somebody's learning curve,'' Maloney said.

_________________
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:
PostPosted: Thu Apr 05, 2007 12:46 pm 
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http://www.crstoday.com/PDF%20Articles/ ... edpage.php


Stephen G. Slade
Quote:
I would conclude by emphasizing that we should always let patients know where we are in a process. Inform them that they are the first, second, or third individuals whom you are treating with a new technique or technology.

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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 Sep 29, 2007 6:03 pm 
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http://www.aao.org/publications/eyenet/ ... EyeNet.pdf

American Academy of Ophthalmology
Advisory Opinion of the Code of Ethics

Quote:
Of special consideration is the process of providing appropriate informed consent. The ophthalmologist should disclose his/her level of experience as a surgeon and level of experience with a new technique.

_________________
Broken Eyes

"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 Sep 29, 2007 6:17 pm 
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http://www.aao.org/publications/eyenet/ ... eature.cfm

Quote:
You can mislead a patient as far as your experience. They may ask a question and you may dodge it. That would be an ethical problem,? explained OMIC?s Mr. Weber. It?s a legal problem, he said, when the doctor uses a laser without adequate training, and harms the patient.



Charles M. Zacks, MD, Cornea specialist in private practice, Maine Eye Center, Portland; and chairman of the Academy?s Ethics Committee:

Quote:
We have the potential to really help patients with new technology, but we have to make sure that we offer it to patients who we believe will benefit, and that we do it competently,? he said. ?Whenever we introduce a new technique, if substantively different from before, there?s a learning curve element. If you?re offering to do a procedure, you need to be practiced at it and competent.


Quote:
There is an obligation on the part of the physician to disclose to patients his or her experience level with a new technique or device. ?If it?s the first procedure you?re doing on a patient, you look at it from the patient?s perspective. The patient would want to know,? said Paul Weber, JD, vice president of the risk management legal department at the Ophthalmic Mutual Insurance Company (OMIC). ?Most people would say the reasonable patient would want to know that it?s your first procedure.

_________________
Broken Eyes

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


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