Exposing the LASIK Scam

One Surgeon at a Time
It is currently Wed Nov 22, 2017 8:41 pm

All times are UTC




Post new topic Reply to topic  [ 5 posts ] 
Author Message
 Post subject: Only 1/3 of surgeons measure flap thickness
PostPosted: Thu Jan 05, 2006 12:06 am 
Offline
 Profile

Joined: Thu Nov 24, 2005 9:06 pm
Posts: 297
http://www.eyeworld.org/article.php?sid=2883

"Dr. Duffey said he also was surprised to see that only one-third of physicians measure true flap thickness intra-operatively as opposed to estimating what it should be based on the microkeratome used. Given the issue of ectasia, he said he personally wants to know where he is at to make sure he has not violated the 250-micron rule. ?I was expecting that number to jump this year, and it didn?t,? he said.
Regarding 250 microns as the acceptable minimum residual stromal thickness requirement for LASIK, Dr. Duffey said he also expects that number to rise to 275 or 300 microns. But the study has held stable with about 66% of physicians using 250 microns."

This is a perfect example of how standard of care (for legal purposes) is defined by what most surgeons are doing, not by what's safe and in the best interest of patients.

Who said "If they all stick a pencil in your eye, that's standard of care"?


Top
 
 Post subject:
PostPosted: Sat Jul 29, 2006 2:08 pm 
Offline
 Profile

Joined: Sat Nov 26, 2005 1:23 pm
Posts: 2080
http://www.revophth.com/index.asp?page=1_972.htm

?The historic standard is to have 250 ?m remaining, but there are many sur?geons who aim for a greater number. My current minimum is 270 ?m; some use 300 ?m or more as the low?er limit.

?Today, the best way to accurately determine residual stromal bed thickness is by doing pachymetry in the OR after the flap is lifted,? says Dr. Schallhorn, noting that this isn?t commonly done."

_________________
Broken Eyes

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


Top
 
 Post subject:
PostPosted: Mon Aug 14, 2006 6:17 pm 
Offline
 Profile

Joined: Sat Nov 26, 2005 1:23 pm
Posts: 2080
This one is from a peer-reviewed journal.

Curr Opin Ophthalmol. 2006 Aug;17(4):406-12.

Post-laser in-situ keratomileusis ectasia: current understanding and future directions.

Randleman JB.

Emory University Department of Ophthalmology and Emory Vision, Atlanta, Georgia, USA.

PURPOSE OF REVIEW: The aim of this article is to review the causes, risk factors, management, and future research directions for corneal ectasia after laser in situ keratomileusis.

RECENT FINDINGS: Complex corneal biomechanical processes influence the integrity of the normal and postoperative cornea, and developing an understanding of these processes facilitates recognition of risk factors for ectasia after laser in-situ keratomileusis. Currently identified risk factors include keratoconus, high myopia, low residual stromal bed thickness from excessive ablation or thick flap creation, and defined topographic abnormalities such as forme fruste keratoconus and pellucid marginal corneal degeneration. Ectasia can also rarely occur in patients without currently identifiable risk factors, and future identification of at-risk patients may be facilitated by corneal interferometry and corneal hysteresis measurements. Utilization of intraoperative pachymetry measurements at the time of surgery and confocal microscopy prior to enhancement to measure residual stromal bed thickness should avoid unanticipated low residual stromal bed thickness. Management options for ectasia after laser in situ keratomileusis include intraocular pressure reduction, rigid gas permeable contact lenses, and intracorneal ring segments, in addition to corneal transplantation. In the future, collagen cross-linking may reduce corneal steepening and improve refractive error.

SUMMARY: When ectasia develops, early recognition and proper management are essential to prevent progression, to promote visual rehabilitation, and to reduce the need for corneal transplantation for these patients.

_________________
Broken Eyes

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


Top
 
 Post subject:
PostPosted: Sat Jan 06, 2007 2:38 pm 
Offline
 Profile

Joined: Sat Nov 26, 2005 1:23 pm
Posts: 2080
http://www.escrs.com/PUBLICATIONS/EUROT ... torfor.pdf

Quote:
He added,?Any of the current recommendations for safe patient
selection are guesswork and unproven. The best we can do is to carefully
examine patients before surgery so to rule out those having topographic
abnormalities of forme fruste keratoconus or pellucid marginal corneal degeneration and to carefully evaluate flap dimensions intraoperatively, especially central flap thickness.


Quote:
?The thickness at the centre of the flap is not predictive of thickness in the periphery, and peripheral readings vary more than central readings. Practically speaking, a flap that measures 160 microns
at the centre can be as thick as 230 to 240 microns at its margin, which means the microkeratome has cut through more lamellae peripherally and caused greater biomechanical weakening of the cornea,?

_________________
Broken Eyes

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


Top
 
 Post subject:
PostPosted: Sun Mar 04, 2007 12:26 am 
Offline
 Profile

Joined: Sat Nov 26, 2005 1:23 pm
Posts: 2080
EyeWorld
Feb. 2007

Improved visual quality, new technology part of today?s refractive surgery trends


Quote:
The ectasia concern remains despite 60% of respondents reporting having never seen a case of post-LASIK ectasia among their patients. Sixteen percent reported that they have had one case, and 12% have seen two.

?People are more concerned about ectasia and malpractice issues,? said Perry S. Binder, M.D., San Diego. ?Therefore, we?re seeing more doctors say ?I want my residual thickness to be greater than 250 microns.??
In fact, 18% of surgeons last year said they would prefer a residual stromal thickness of 275 microns; 17% would prefer 300 microns. The majority of respondents still feel comfortable with 250 microns,
although that percentage has decreased as the higher numbers have increased. The percentage of surgeons that measure flap thickness intra-operatively increased from 31% in 2004 to 35% in 2006, reflecting another safety trend. Still, Dr. Duffey was surprised that more growth has not occurred in that area. ?To me it?s such a critical point?I keep expecting the numbers to be 50%, 75%, or even 90%, but it?s not,? he said.


http://www.eyeworld.org/article.php?sid=3621

_________________
Broken Eyes

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


Top
 
Display posts from previous:  Sort by  
Post new topic Reply to topic  [ 5 posts ] 

All times are UTC


Who is online

Users browsing this forum: No registered users and 1 guest


You cannot post new topics in this forum
You cannot reply to topics in this forum
You cannot edit your posts in this forum
You cannot delete your posts in this forum
You cannot post attachments in this forum

Search for:
Jump to:  
cron
Powered by phpBB © 2000, 2002, 2005, 2007 phpBB Group  
Design By Poker Bandits