Exposing the LASIK Scam

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 Post subject: Plugs
PostPosted: Thu Jun 08, 2006 12:56 pm 
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EyeWorld, May 2006

http://www.eyeworld.org/article.php?sid=3200

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?The tears have a number of different roles,? Dr. Price said. One of those roles includes flushing debris, bacteria, contaminants, and allergens from the surface of the eye, he said. If you plug both ducts, you can form what can be likened to a stagnant pond near the eye, and a place ripe for infection.

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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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 Post subject: The requirement for plugs after LASIK means damaged nerves
PostPosted: Sat Jun 10, 2006 9:21 pm 
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The fact that patients who did not need plugs BEFORE corneal refractive surgery often require plugs AFTER surgery to keep their eyes moist is a direct result of the nerve damage caused by corneal refractive surgery.

Some people need to wear plugs for life. I am one of those people. My eyes are STILL uncomfortably dry even with plugs.

It is unthinkable that there are surgeons who rationalize performing surgery that requires a substantial fraction of patients to wear little plastic bits to block their tear ducts because of the extensive nerve damaged caused by the *elective* procedure.

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We can easily forgive a child who is afraid of the dark. The real tragedy of life is when men are afraid of the light. -Plato


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 Post subject:
PostPosted: Wed Jul 05, 2006 11:57 am 
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Quote:
?The tears have a number of different roles,? Dr. Price said. One of those roles includes flushing debris, bacteria, contaminants, and allergens from the surface of the eye, he said. If you plug both ducts, you can form what can be likened to a stagnant pond near the eye, and a place ripe for infection.''


This is especially bad news since plugs are often used in combination with Restasis and contact lenses for post refractive patients. I had dissolvable lower plugs put in and the right one fell out on the first day. I did not notice a significant improvement in the plugged eye but I did notice a subtle sandy feeling. I may not have noticed it as much if both eyes had been plugged. I definitely believe the sandy sensation was caused by a build up of artificial tears, dust, and allergens. I may have had a higher quantity of tears with the plug, however, the low quality of the tears actually made my eye feel worse.


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 Post subject: LASIK surgeons act like causing need for plugs perfectly OK!
PostPosted: Sat Jul 08, 2006 4:35 pm 
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One of the many things that bother me about the corneal refractive surgery industry and its participants is the glib attitude about corneal nerve damaged caused by these elective eye surgeries.

Surgeons discuss installing plugs as if it is perfectly OK to damage a patients corneal nerves and then turn their once healthy tear pool into a cesspool.

Permanent nerve damage is NOT OK. Patients should be informed of this consequence of corneal refractive surgery and its HOST of possible life-altering downstream effects (chronic painful burning eyes, contact lens intolerance, loss of vision due to poor tear film, etc).


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 Post subject:
PostPosted: Sat Dec 09, 2006 2:15 pm 
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Graefes Arch Clin Exp Ophthalmol. 2006 Nov 22; [Epub ahead of print]

Bilateral canaliculitis following SmartPLUG insertion for dry eye syndrome post LASIK surgery.

Scheepers M, Pearson A, Michaelides M.
Royal Berkshire Hospital, Reading, Berkshire, RG1 5AN, UK.

BACKGROUND: Dry eyes are a common symptom following LASIK corneal refractive surgery. Treatments include topical lubricants to supplement the tear film, and punctal occlusion to reduce tear outflow. Canaliculitis is a recognised complication of punctal plugs, but has not previously been described following insertion of newer generation semi-permanent intra-canalicular plugs, such as the SmartPLUG.

METHODS: Case report.

RESULTS: We describe a 60-year-old female who underwent bilateral LASIK surgery leading to aggravation of her dry eye syndrome. She was managed with the insertion of semi-permanent intra-canalicular moldable silicone SmartPLUGs. She subsequently developed bilateral canaliculitis requiring bilateral canaliculotomy.

CONCLUSIONS: To the best of our knowledge, this is the first report of bilateral canaliculitis following intra-canalicular SmartPLUG insertion. This case illustrates that punctal occlusion with the newer generation intra-canalicular plugs carries a risk of canaliculitis and that irrigation is not always effective in removing these devices.

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 Post subject:
PostPosted: Mon Sep 03, 2007 2:09 pm 
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Effect of Punctal Plugs in Patients With Low Refractive Errors Considering Refractive Surgery

Journal of Refractive Surgery Vol. 23 No. 5 May 2007

Monica B. Khalil, MD; Robert A. Latkany, MD; Mark G. Speaker, MD, PhD; Guopei Yu, MD, MPH

Quote:
The most commonly reported complication is punctal plug extrusion, which has been documented in approximately 51% of cases.


Quote:
Decreased tear production and ocular surface sensation have been documented with punctal plug placement, which is suggestive of an autoregulatory system involved in tear creation and clearance.

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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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 Post subject:
PostPosted: Mon Sep 03, 2007 2:30 pm 
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Am J Ophthalmol. 2001 Mar;131(3):314-23.

The effect of punctal occlusion on tear production, tear clearance, and ocular surface sensation in normal subjects.

Yen MT, Pflugfelder SC, Feuer WJ.

Ocular Surface and Tear Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA

PURPOSE: To evaluate the effect of temporary punctal occlusion on tear production, tear clearance, and ocular surface sensation in normal subjects.

METHODS: Noncomparative interventional case series. Punctal occlusion with silicone punctal plugs was performed on nine normal subjects without complaints of ocular irritation and no known history of ocular surface disease. The lower punctum of both eyes was occluded in five subjects. The upper and lower puncta of only one eye were occluded in four subjects. Corneal and conjunctival sensations were measured with the Cochet-Bonnet anesthesiometer. Tear fluorescein clearance was evaluated with a CytoFluor II fluorophotometer by measuring the fluorescein concentration in minimally stimulated tear samples collected from the inferior tear meniscus 15 minutes after instillation of fluorescein. Schirmer test was performed without anesthesia. The tests were performed at days 0, 1, 3, 7, and 14 to 17 after punctal occlusion. Relationships were analyzed with linear regressions, and a quadratic term was used to model a return to preocclusion levels. Paired t test was used to study the change in tear fluorescein concentration.

RESULTS: In subjects who had the lower puncta of both eyes occluded, conjunctival sensation decreased in both eyes (right eye, P =.008; left eye, P =.003), but there was no change in corneal sensation. Their tear fluorescein clearance did not show a significant change from baseline (P =.90). However, a decrease in Schirmer test scores approached statistical significance (P =.056). In subjects with both puncta of only one eye occluded, we noted a decrease in corneal sensation (occluded eye, P =.042; nonoccluded eye, P =.036), conjunctival sensation (occluded, P =.001; nonoccluded, P =.060), and Schirmer scores (occluded, P =.022; nonoccluded, P =.011). Linear regression did not show a significant change in tear fluorescein clearance for either eye (occluded, P =.28; nonoccluded, P =.44). However, paired t test showed a significant worsening of tear clearance in the occluded eye from day 0 to day 3 (P =.001) followed by a subsequent improvement in tear clearance from day 3 to the end of the study period (P =.045). Paired t test did not reveal any significant changes in tear clearance in the nonoccluded eye. The quadratic term of the linear regression model demonstrated an increase toward preocclusion levels that approached statistical significance for corneal sensation (occluded, P =.053; nonoccluded, P =.099). It was statistically significant for conjunctival sensation (occluded, P =.001; nonoccluded, P =.045) and Schirmer scores (occluded, P =.047; nonoccluded, P =.044).

CONCLUSIONS: Temporary punctal occlusion in normal subjects decreases tear production and ocular surface sensation. Our findings suggest that in addition to blocking tear drainage, punctal occlusion may affect the ocular surface/lacrimal gland interaction. These effects were more pronounced in subjects with both upper and lower puncta occluded. In normal subjects, there appears to be an autoregulatory mechanism to return tear production, tear clearance, and ocular surface sensation to preocclusion levels 14 to 17 days after punctal occlusion.

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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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 Post subject: Ducts / Cauterization
PostPosted: Sun Jan 06, 2008 11:33 pm 
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1. What is the approximate cost for temporary dissolvable plugs for the lower set of eye ducts? What is the appx. cost for cauterization of the lower eye ducts?

2. Are the results of having lower eye plugs and cauterization of the lower eye plugs similar? For example, if I have success with eye plugs, could I expect similar success with cauterization?

3. Does cauterization have a lower rate of infection than eye plugs?


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 Post subject:
PostPosted: Thu Jun 05, 2008 3:07 pm 
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Ophthal Plast Reconstr Surg. 2008 May/June;24(3):241-243.

Mycobacterium chelonae Canaliculitis Associated With SmartPlug Use.

Fowler AM, Dutton JJ, Fowler WC, Gilligan P.

Departments of *Ophthalmology and ?Microbiology, University of North Carolina, Chapel Hill, North Carolina, U.S.A.

Mycobacterium chelonae is ubiquitous in the environment but is an uncommon cause of ocular and periocular infections. It is a pathogen that has been gaining increased attention in the ophthalmic literature because of the relatively large number of infections associated with laser-assisted in situ keratomileusis and other forms of refractive surgery. The authors present 3 patients who developed canaliculitis culture positive for M. chelonae more than a year after SmartPlug placement. These cases highlight some of the clinical scenarios that may be encountered in those who present with canaliculitis with a history of intracanalicular plug placement. Therapeutic considerations are also suggested.

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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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