Exposing the LASIK Scam

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 Post subject: YAG laser capsulotomy
PostPosted: Sat Oct 20, 2007 7:52 pm 

Joined: Sat Nov 26, 2005 1:23 pm
Posts: 2080
http://www.eyemdlink.com/EyeProcedure.a ... edureID=24

I'm posting this link for a middle-aged female presbyope with astigmatism (no cataracts). The patient was interested in mono-vision LASIK. The surgeon did a contact lens trial which was unsuccessful. The surgeon suggested Restor multifocal refractive lens exchange which is not FDA approved for patients without cataracts. The patient sought a 2nd opinion and lower price and evenutally had the Restor IOL in the left eye, followed by ReZoom in the right. The left eye refractive result was unacceptable to the patient. Her reading vision was too close -- inches from her nose. The surgeon suggested and performed LASIK on the left eye to correct it. After LASIK, the patient needed reading glasses in the left eye. The ReZoom right eye had poor visual quality and halos. The right eye developed posterior capsule opacity secondary to the IOL implantation and required a YAG procedure.

Current glasses prescription:

OD +1.00 -1.25 X90 add +2.25
OS -1.00 -0.25 X20 add +2.25

The patient suffers from dry eyes, excruiating pain while reading, and anxiety.

Other links of interest:

http://www.aao.org/publications/eyenet/ ... eature.cfm

http://crstoday.com/PDF%20Articles/0605 ... Knorz.html

Presbyopic lens exchange (PRELEX) is a procedure that encompasses both a refractive lens exchange and the implantation of a multifocal IOL. When introduced more than 15 years ago, multifocal IOLs did not produce very good results. Back then, surgical techniques were not suited to the requirements of these IOLs. For example, extracapsular cataract extraction was still the procedure of choice and mainly done without a capsulorhexis, which led to IOL decentration and a loss of multifocality. Additionally, the large incision caused significant astigmatism and reduced UCVA. Today, multifocal IOLs are a refractive surgery tool designed to free patients from their spectacles. However, patients must desire this independence and be willing to accept the visual side effects that may occur with multifocal IOLs, such as halos and glare, especially at night. Because these lenses are designed to provide good UCVA at all distances, they are superior to monofocal IOLs or an aged, presbyopic human lens.

http://www.aao.org/publications/eyenet/ ... pearls.cfm

ReStor Apodized Diffractive IOL

How does it work? The ReStor multifocal IOL uses three separate but complementary optical principles (refraction, diffraction and apodization) to achieve satisfactory near and far visual acuity. The refractive portion of the optic functions like a standard IOL, with the optic periphery dedicated to distance vision and designed to optimize night vision when the pupil dilates under scotopic conditions. The diffractive portion of the optic consists of 12 concentric rings on the anterior surface of the optic, and it is located within the central circle, which is 3.6 mm in diameter and is designed to provide distance and near vision in moderate to bright light. Apodization is the radial variation in optical properties that comes from decreasing the height of each concentric ring from the center toward the periphery of the optic surface (from 1.3 to 0.2 ?m). This balances the amount of light energy that is distributed between distance and near as a function of pupil size, which improves the efficiency and effectiveness of the quality of near vision achieved and reduces problems with glare and halos. Ring location, spacing and variation of height serve within the pupillary aperture to provide a satisfactory near image at approximately 25 to 33 cm.

How is it used? The ReStor IOL is a foldable IOL designed for placement within the capsular bag at the time of phacoemulsification. It is injected using the Monarch B or C cartridge through the traditional phacoemulsification incision.

Side effects. The side effect profile of the ReStor multifocal lens is very similar to that of traditional monofocal IOLs. However, with the ReStor, there is a greater chance of having significant halos (5 percent of all patients) or glare (5 percent) compared with a monofocal lens (1 percent and 2 percent, respectively). The halos or glare were severe enough that in studies conducted for Alcon by independent consultants 0.5 percent of patients requested that their ReStor IOL be removed. Another side effect of the ReStor IOL?s complex optics is increased adjustment time compared with a monofocal IOL. Driving at night or reading in the evening under dim illumination may be more difficult due to qualitative vision changes compared with a standard IOL.

The interaction of the ReStor IOL with various ocular conditions including glaucoma and retinopathy has not been established.

ReZoom Multifocal Refractive IOL

How does it work? The ReZoom IOL is a refractive, distance-dominant multifocal optic that enables good vision through a range of distances. It is an improved version of the Array multifocal IOL that received FDA approval in 1997. The ReZoom lens uses five optical zones to focus light on the retina at all pupil diameters. This enables distance-dominant vision with a near add of 3.5 D in the plane of the IOL. (A usual spectacle add is 2 to 2.5 D, but when the lens is placed closer to the retina as an IOL, it must be more powerful.) In comparison with the 4 D of near add that the ReStor IOL provides, the ReZoom IOL offers a 3.5 D near add that results in a slightly longer working distance for reading vision.

Posterior capsular opacification can disrupt the complex optical properties of both types of multifocal IOLs, and a moderate amount of opacification has the potential for causing scattering of light that could be bothersome. The ReZoom lens is made of acrylic with a sharp-edged optic design to attempt to reduce the development of capsular opacification and thus maintain proper visual acuity.

The ReZoom IOL also attempts to reduce edge-related halos and glare, two of the more common complications of the earlier Array multifocal IOL, by using a triple-edge design. The anterior edge is rounded to reduce internal reflections, the side edge slopes to cut down on edge glare and the posterior edge is squared off to facilitate contact with the posterior capsule.

How is it used? The ReZoom is a foldable IOL designed for capsular bag placement following standard phacoemulsification cataract surgery, using a 3.2-mm posterior limbal incision centered on the axis of plus cylinder. Limbal relaxing incisions are safe, effective and predictable in the treatment of mild to moderate amounts of corneal astigmatism. This IOL is injected using the AMO Unfolder Implantation System.

Side effects. The most common concerns for ReZoom lens recipients include distance blur and monocular diplopia, as well as glare and halos at night. Potential solutions to these side effects include correcting residual astigmatism, treating a dry eye that might be worsening these effects and using the dome light in the car during night driving. Although many patients will adapt to these effects, the occasional patient may require implant removal for severe symptoms. In order to avoid the risk of significant side effects, it is advised not to implant the ReZoom IOL in patients with significant dry eye, corneal scarring, pupil size less than 2.5 mm, a monofocal implant in the first eye, uncorrected astigmatism greater than 0.5 D or unstable capsular support.

Broken Eyes

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

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