Exposing the LASIK Scam

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 Post subject: Wish we were meeting under different circumstances
PostPosted: Fri Feb 15, 2008 6:25 pm 
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Hello. This is my first contribution to this board. However, I have been visiting from time to time over the past year. I only wish that I had been visiting before that.

For those who are interested, here is my story. I had my vision destroyed January 6th, 2007, by Dr. Jerome Swale and his accomplices at the Lasik Vision Institute (LVI) in downtown Chicago. Prior to the ?surgery,? I thought that my vision was poor. Unfortunately, like many here, I now know what poor vision really is like. I have largely remained in denial and mental seclusion for the past year, refusing to post here or elsewhere, afraid to learn more about what really happened to me, and wanting it all just to go away.

Let me make an attempt to describe my pre-LASIK condition. Please feel free to correct me if I misspeak or use the incorrect verbiage. I am now interested in educating myself as much as possible, so that the deception can stop. Best that I can tell, I was an OD -5.50+2.50X113, OS -7.00+1.75X090 before the slice and burn. I don?t exactly know what all of that means, but I do know that I was referred to at one point as a ?high myopia, moderately high astigmatism? patient. I have just over 6 mm pupils. My higher order aberrations were measured as under 5% by the VISX CustomVue machine. At the time, my mom and my sister both had vision correction surgery and had been happy with their results. In addition, I never got along well with contact lenses. Originally, I was fitted with rigid gas permeable lenses for my astigmatism. Later on, when toric lenses were developed, I got those. In the end, the results were always the same. I never was able to get comfortable with the lenses. Mostly, my eyes felt dry and itchy. I was sold on the lie that LASIK was some kind of ticket to a new life freedom. I would be able to gain quality of life, have more fun, be a better golfer, go inside on a cold day and not have a pair of lenses fog up, etc. What I wouldn?t give to just go back.

Anyway, I decided to go through with it. I am a natural pessimist, so I struggled mightily with the decision. I knew that there were risks. Of course, I was lied to and told that new technology has ?virtually eliminated? the risks. I was sold the biggest bottle of snake oil of all time, and drank it all, because I wanted to believe. I chose LVI based on price and convenience, of all things. ?Dr.? Swale was supposed to be this great surgeon with impeccable credentials, blah, blah. You can look at his bio here if you care to: http://www.lasikvisioninstitute.com/loc ... d=30&dist= I was told that I needed the ?custom? procedure due to my prescription.

I could continue to write a book about all of my pre- and during surgery details. In retrospect, there were so many warning signs that day, I had every opportunity to bail out, and I didn?t. Let me cut to the chase. I am now suffering from an all too common list of ?complications;? ghost images from both eyes in all lighting conditions, starbursts, halos, dry eyes, and floaters. If I were forced to chose which was the most troublesome, I would say the floaters. I have a desk job, and looking at the computer screen all day is just torture. My higher order aberrations are now over 50% in both eyes, with Coma and Spherrical aberration almost off the chart.

I am here for several reasons; first and foremost, to say ?Thank you? to those who have put this forum together, and who contribute to it so faithfully. The resource was there for me to avoid my current situation, and I chose not to use it. Secondly, I want to continue to educate myself on my current condition, and get input from you folks on what my options are, if any. Thirdly, I would like to stay abreast of any technological advancement that might be in the works to help folks like us. Lastly, I want to contribute in any way that I can.

As I mentioned before, there are a lot of details surrounding my visits before surgery, the day of surgery itself, and what has taken place afterwards. Hopefully, with time, we can discuss these details. Right now, however, I need your help with one issue in particular. I have visited three independent Ophthalmologists since my eyes were destroyed. Each of them has agreed on one very important aspect of my post-surgical condition. They all agree that I DID NOT receive a Custom laser treatment. Again, I was told that I needed to have Custom in order to ?achieve my best personal visual result.? I paid for Custom. My understanding, however limited, is that the non-Custom version of LASIK only has an effective treatment zone of 5-6 mm, and that Custom was designed specifically to deal with higher prescription patients with larger pupils. Does an ?oversight? like this constitute Medical Malpractice? At the very least, is it Consumer Fraud?

Thank you for entertaining my long post. I very much look forward to any and all feedback that you can provide both regarding my condition and the potential for litigation.

_________________
Didn't think it could happen to me.


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 Post subject:
PostPosted: Fri Feb 15, 2008 10:58 pm 
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Location: California
well if u are a praying man then perhaps this email address might help:
molitvene.nakane@medjugorje.hr
goes to Mary mother of Jesus and where Mary is, Jesus cannot be far from
(My soul magnifies the Lord)..Luke 1:46.............


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 Post subject: Re: Wish we were meeting under different circumstances
PostPosted: Fri Feb 15, 2008 11:15 pm 
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TheEyesHaveIt wrote:
Hello. This is my first contribution to this board. However, I have been visiting from time to time over the past year. I only wish that I had been visiting before that.

For those who are interested, here is my story. I had my vision destroyed January 6th, 2007, by Dr. Jerome Swale and his accomplices at the Lasik Vision Institute (LVI) in downtown Chicago. Prior to the ?surgery,? I thought that my vision was poor. Unfortunately, like many here, I now know what poor vision really is like. I have largely remained in denial and mental seclusion for the past year, refusing to post here or elsewhere, afraid to learn more about what really happened to me, and wanting it all just to go away.


Boy, do I know that feeling! When I first started posting on patient bulletin boards it was for the purpose of finding a fix for this mess and then to get on with my life. I was shocked at the horror stories and refused to believe my problems were permanent.

TheEyesHaveIt wrote:
Let me make an attempt to describe my pre-LASIK condition. Please feel free to correct me if I misspeak or use the incorrect verbiage. I am now interested in educating myself as much as possible, so that the deception can stop. Best that I can tell, I was an OD -5.50+2.50X113, OS -7.00+1.75X090 before the slice and burn. I don?t exactly know what all of that means, but I do know that I was referred to at one point as a ?high myopia, moderately high astigmatism? patient. I have just over 6 mm pupils. My higher order aberrations were measured as under 5% by the VISX CustomVue machine.


That means that higher order aberrations only represented 5% of the total defocus at the scan diameter on the report.

TheEyesHaveIt wrote:
At the time, my mom and my sister both had vision correction surgery and had been happy with their results.


My sister had it before me. She said she was happy. Several years later she was put on Restasis for chronic dry eyes.


TheEyesHaveIt wrote:
In addition, I never got along well with contact lenses. Originally, I was fitted with rigid gas permeable lenses for my astigmatism. Later on, when toric lenses were developed, I got those. In the end, the results were always the same. I never was able to get comfortable with the lenses. Mostly, my eyes felt dry and itchy. I was sold on the lie that LASIK was some kind of ticket to a new life freedom. I would be able to gain quality of life, have more fun, be a better golfer, go inside on a cold day and not have a pair of lenses fog up, etc. What I wouldn?t give to just go back.


We were all sold a lie.

TheEyesHaveIt wrote:
Anyway, I decided to go through with it. I am a natural pessimist, so I struggled mightily with the decision. I knew that there were risks. Of course, I was lied to and told that new technology has ?virtually eliminated? the risks. I was sold the biggest bottle of snake oil of all time, and drank it all, because I wanted to believe. I chose LVI based on price and convenience, of all things. ?Dr.? Swale was supposed to be this great surgeon with impeccable credentials, blah, blah. You can look at his bio here if you care to: http://www.lasikvisioninstitute.com/loc ... d=30&dist= I was told that I needed the ?custom? procedure due to my prescription.


Which laser, exactly, were you treated with? Who said you needed custom -- a technician, OD or surgeon?

TheEyesHaveIt wrote:
I could continue to write a book about all of my pre- and during surgery details. In retrospect, there were so many warning signs that day, I had every opportunity to bail out, and I didn?t. Let me cut to the chase. I am now suffering from an all too common list of ?complications;? ghost images from both eyes in all lighting conditions, starbursts, halos, dry eyes, and floaters.


Always my first question is, what is your current refraction? This is very important.

TheEyesHaveIt wrote:
If I were forced to chose which was the most troublesome, I would say the floaters. I have a desk job, and looking at the computer screen all day is just torture.


My sister had a co-worker who had floaters so badly after LASIK that while he was working he subconsciously fanned his eyes, as if he were batting at gnats. I developed a huge, curtain-like floater after LASIK. There are many, many reports of floaters after LASIK. We believe this is due to the effects of the suction ring...

http://www.lasikcomplications.com/vitre ... damage.htm

TheEyesHaveIt wrote:
My higher order aberrations are now over 50% in both eyes, with Coma and Spherrical aberration almost off the chart.


This means that after LASIK your lower order aberrations were reduced by LASIK (as they should be) and apparently your higher order aberrations were increased. Just a decrease in the lower order will cause a higher percentage for higher order, but most likely your higher order increased a lot. The numbers to look for are the numerical values for the spherical aberration and coma before and after surgery. And it's important to know the scan diameter.

TheEyesHaveIt wrote:
I am here for several reasons; first and foremost, to say ?Thank you? to those who have put this forum together, and who contribute to it so faithfully.


Those of us that post here really appreciate that.

TheEyesHaveIt wrote:
The resource was there for me to avoid my current situation, and I chose not to use it. Secondly, I want to continue to educate myself on my current condition, and get input from you folks on what my options are, if any. Thirdly, I would like to stay abreast of any technological advancement that might be in the works to help folks like us.


That's what this site is for -- to educate. Unfortunately your best option is probably going to be hard contact lenses. I wear SynergEyes PS. My vision is much improved with them. My extremely dry eyes are another matter and it makes it hard to wear the lenses. It's the LASIK catch-22.

If you are interested in surgical alternatives... well, don't get your hopes up too high. First things first. You need to know precisely what your residual stromal bed thickness is before ever considering more surgery. Unless your surgeon performed intraoperative pachymetry (not likely), you may not know unless you have a special test performed. Instruments that can measure your residual stromal bed after LASIK are not common in most eye doctors' offices. We can do a guesstimate, but I would never ever plan a surgery with a guesstimate. I'd need your records to do the guesstimate. Also the records will answer several other questions that I have about your surgery.

TheEyesHaveIt wrote:
Lastly, I want to contribute in any way that I can.


Stick around. Ask questions. Learn. Be part of our community. Tell everyone you know about this site and others like www.lasikcomplications.com

TheEyesHaveIt wrote:
As I mentioned before, there are a lot of details surrounding my visits before surgery, the day of surgery itself, and what has taken place afterwards. Hopefully, with time, we can discuss these details. Right now, however, I need your help with one issue in particular. I have visited three independent Ophthalmologists since my eyes were destroyed. Each of them has agreed on one very important aspect of my post-surgical condition. They all agree that I DID NOT receive a Custom laser treatment.


That will be in your records.

TheEyesHaveIt wrote:
Again, I was told that I needed to have Custom in order to ?achieve my best personal visual result.? I paid for Custom. My understanding, however limited, is that the non-Custom version of LASIK only has an effective treatment zone of 5-6 mm, and that Custom was designed specifically to deal with higher prescription patients with larger pupils.


Firstly, based on what you said above, you do not have large pupils. You said your pupils are 6+mm. It's possible they were measured inaccurately as mine were. "Large" is typically 7mm or larger. Conventional (non-custom) LASIK generally has up to a 6.5mm optical zone. With some lasers the optical zone is reduced when treating astigmatism. If you can scan and email me your operative report I can tell you exactly what your optical zone size is.

"Optical zone" and "effective optical zone" are different. The optical zone is the area that is intended to receive the full correction. The effective optical zone is the actual diameter of the cornea after LASIK that was fully corrected. Contrary to what patients are told by LASIK surgeons, the laser does not precisely sculpt the cornea like it does a flat piece of plastic or a dead human hair. One surgeon stated that it's like trying to precisely sculpt jell-o. The cornea contains water and there are biomechanics and healing responses that come into play, as well as the "cosine effect".

A color topography will usually show the effective optical zone.

TheEyesHaveIt wrote:
Does an ?oversight? like this constitute Medical Malpractice? At the very least, is it Consumer Fraud?


Fraud for sure. On all of us. Be sure to file a MedWatch report with the FDA. That's another way you can help. Before you do you'll need to know the exact laser used.

I know an attorney in Chicago that's helping another LASIK patient and would be happy to give you his name.

TheEyesHaveIt wrote:
Thank you for entertaining my long post. I very much look forward to any and all feedback that you can provide both regarding my condition and the potential for litigation.


I will help you anyway I can.

Regards,
BE

_________________
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 Feb 16, 2008 2:00 am 
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Location: Iowa
mrstarmens wrote:
well if u are a praying man then perhaps this email address might help:
molitvene.nakane@medjugorje.hr
goes to Mary mother of Jesus and where Mary is, Jesus cannot be far from
(My soul magnifies the Lord)..Luke 1:46.............


Thank you for your response. For what it is worth, I am a praying man. I have, as a result of this trajedy, questioned my faith at times. I have read others as they have openly discussed their faith on this board; especially as it relates to their own situation. I appreciate their candor. To an extent, their perseverence in faith through their own issues has reinforced my faith through mine.

Anyway, with all do respect, I don't need to send an email to Mary or Jesus. He made sure that we all had a direct line.

_________________
Didn't think it could happen to me.


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 Post subject:
PostPosted: Sat Feb 16, 2008 2:33 am 
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Location: California
Also please consider John 12:24 which is an asterisimo I think...asterisimos I believe are super super important (the amen amen according to catholic confraternity text)

Amen amen I say to you, unless the grain of wheat falls into the ground and dies, it remains alone. But if it dies, it brings forth much fruit. HE WHO LOVES HIS LIFE, LOSES IT;AND HE WHO HATES HIS LIFE IN THIS WORLD, KEEPS IT UNTO LIFE EVERLASTING.


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 Post subject:
PostPosted: Sat Feb 16, 2008 1:43 pm 
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Location: Iowa
In John 12:24, Jesus is preparing His disciples for His subsequent sacrifice. He was setting the stage and letting us know that our life here isn't the ultimate prize. Good example.

I cannot seem to corroborate the term "asterisimos," especially as it relates to Catholocism. Can you provide a link or more detail?

Anyway, thanks for the support. It is more important now than ever to keep my (our) physical struggles in context.

_________________
Didn't think it could happen to me.


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 Post subject: Re: Wish we were meeting under different circumstances
PostPosted: Sat Feb 16, 2008 2:37 pm 
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Joined: Wed Jul 11, 2007 11:33 am
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Location: Iowa
BE,

Thanks for your detailed response. I always appreciate the time and effort that you seem to put into your postings. It reflects the fact that you really do care.

Broken Eyes wrote:
Which laser, exactly, were you treated with? Who said you needed custom -- a technician, OD or surgeon?


I am embarrased to say that I don't know the exact laser that was used in my treatment. Can I get that from the laser report? On the report, there are several lines of information. One of them is "Calibration Table:." Past that point, there are some numbers and then "Star S4 US Lasik PRK, PRKH Astig." I thought that I had read something on this board or another about the Star S4 laser. I am guessing that is what was used.

I was told by everyone I met throughout the process that I needed the custom treatment. The technicians and ODs I visited pre-operatively were all consistent in referring to the custom treatment. You know, now that I think about it, I don't ever remember the surgeon talking about custom. But, in my case, I got to see the surgeon for about 5 minutes total. Not a whole lot of time to talk about anything.

Broken Eyes wrote:
Always my first question is, what is your current refraction? This is very important.


My current refraction is OD -1.00+0.50X115, OS -0.75+0.25X150. I have visited three well respected ODs post. This prescription is from a corneal specialist at the University of Iowa Hospital.

Broken Eyes wrote:
My sister had a co-worker who had floaters so badly after LASIK that while he was working he subconsciously fanned his eyes, as if he were batting at gnats. I developed a huge, curtain-like floater after LASIK. There are many, many reports of floaters after LASIK. We believe this is due to the effects of the suction ring...

http://www.lasikcomplications.com/vitre ... damage.htm


I visited a Retinal specialist once I developed the floaters and began to realize what they were. I was afraid that I may have some Retinal damage or internal bleeding. Thankfully, there doesn't seem to be any damage to the Retina or bleeding. However, there is certainly damage to the vitreous. I asked one of ths assistant Retinal specialists I visited with about the connections between LASIK and floaters. He was adament that several studies had been done that showed NO CONNECTION between LASIK and floaters. I knew better from my time on this board, but I also knew that arguing with this guy wasn't going to help me. I just couldn't believe that these kinds of lies were still being perveyed. I mean, this is a guy who has been through several years of school and is paid handsomely to know everything there is to know about the Retina and vitreous, and he is telling patients that LASIK doesn't lead to floaters. Wow. How do we compete with that?

Broken Eyes wrote:
This means that after LASIK your lower order aberrations were reduced by LASIK (as they should be) and apparently your higher order aberrations were increased. Just a decrease in the lower order will cause a higher percentage for higher order, but most likely your higher order increased a lot. The numbers to look for are the numerical values for the spherical aberration and coma before and after surgery. And it's important to know the scan diameter.


So, how can I use my wavefront scan information? What is the most useful information on the page? How can I understand the information better in order to communicate more effectively and prevent any future doctors from lying again? I am looking at some of my scans right now, and see that most of them, even taken one after another, weren't done at the same diameter. Does that reduce their value? If I were to get more wavefront scans taken, should I request a certain diameter or at least that they be consistent in diameter? Is the scan diameter something that the machine "auto" determines?

Broken Eyes wrote:
That's what this site is for -- to educate. Unfortunately your best option is probably going to be hard contact lenses. I wear SynergEyes PS. My vision is much improved with them. My extremely dry eyes are another matter and it makes it hard to wear the lenses. It's the LASIK catch-22.


So, you went to see Dr. Boshnick in Miami? Do the lenses reduce your HOAs? When you say that your vision is much improved, are you just talking in an overall sense or are there one or two things that are spectacularly better?

I also have dry eyes. I mentioned in my first post that I struggled with contacts before surgery because of my eye dryness. I can't imagine I am going to be any better off now. Are there some type of drops that you use to make things more manageable?

Broken Eyes wrote:
If you are interested in surgical alternatives... well, don't get your hopes up too high. First things first. You need to know precisely what your residual stromal bed thickness is before ever considering more surgery. Unless your surgeon performed intraoperative pachymetry (not likely), you may not know unless you have a special test performed. Instruments that can measure your residual stromal bed after LASIK are not common in most eye doctors' offices. We can do a guesstimate, but I would never ever plan a surgery with a guesstimate. I'd need your records to do the guesstimate. Also the records will answer several other questions that I have about your surgery.


I am not in any state right now to consider further surgical options. I have talked to Dr. Wang in Nashville by email. Of course, his message is hopeful, but I know the truth thanks to this board. I have also talked to others that have found new hope with Dr. Stojanovic in Norway. I spoke with Dr. Stojanovic by email as well. It sounds like he is so busy with his work and helping people like us that he wouldn't take the time to review my records unless I was willing to pay him $500/hour. I hope that technology can further advance and we can all have new hope for a surgery that actually works.

As far as my residual corneal thickness, I have two post op measurements, but none of them, of course, are broken down into flap vs. bed. My pre-operative thickness was between 600 and 650 microns. The laser reports say that they burned 56 microns out of one eye and 40 out of the other. I have been told post op that I have "plenty" of cornea to have further treatments if I so desire. Thanks to this board, I know that having enough total thickness doesn't tell the whole story. Eventually, I will visit Dr. Wang or someone closer to me that has an Artemis, and get a better picture of what is really going on between the flap and bed.

Broken Eyes wrote:
Firstly, based on what you said above, you do not have large pupils. You said your pupils are 6+mm. It's possible they were measured inaccurately as mine were. "Large" is typically 7mm or larger. Conventional (non-custom) LASIK generally has up to a 6.5mm optical zone. With some lasers the optical zone is reduced when treating astigmatism. If you can scan and email me your operative report I can tell you exactly what your optical zone size is.


Yes, there is certainly a possibility that my pupils were measured inaccurately. If I remember right, I was told they were 6.14mm. I suppose that is one of my two eyes, as they can't be perfecly the same. I have all of files scanned. What would you be most interested in seeing? I would send you everything, but the total file size is 26 MB zipped.

Broken Eyes wrote:
"Optical zone" and "effective optical zone" are different. The optical zone is the area that is intended to receive the full correction. The effective optical zone is the actual diameter of the cornea after LASIK that was fully corrected. Contrary to what patients are told by LASIK surgeons, the laser does not precisely sculpt the cornea like it does a flat piece of plastic or a dead human hair. One surgeon stated that it's like trying to precisely sculpt jell-o. The cornea contains water and there are biomechanics and healing responses that come into play, as well as the "cosine effect".

A color topography will usually show the effective optical zone.


This is very interesting information. I believe I have read the report that you refer to where the doctor equates cornea shapping to jell-o. Again, a report I should have read before hand.

Broken Eyes wrote:
Fraud for sure. On all of us. Be sure to file a MedWatch report with the FDA. That's another way you can help. Before you do you'll need to know the exact laser used.

I know an attorney in Chicago that's helping another LASIK patient and would be happy to give you his name.


Once I am able to confirm the laser with you, I will file the MedWatch report right away.

I would be grateful to find an attorney that would evaluate my case. Please feel free to PM me if you feel that is most appropriate. I would also ask anyone else out there with legal advice or suggestions for legal council to please speak up. I can't possibly imagine that having the wrong surgery doesn't constitute negligence to the point of malpractice, or at least, fraud.

Thank you

_________________
Didn't think it could happen to me.


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 Post subject:
PostPosted: Sat Feb 16, 2008 3:22 pm 
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only found one book which really explained asterisimos and also polyptoton(he who has ears to hear let him hear) and do not know where it it now..so just using my memory . But both terms are so very very important as used in the bible.


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 Post subject: Re: Wish we were meeting under different circumstances
PostPosted: Sat Feb 16, 2008 4:14 pm 
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TheEyesHaveIt wrote:
I am embarrased to say that I don't know the exact laser that was used in my treatment. Can I get that from the laser report? On the report, there are several lines of information. One of them is "Calibration Table:." Past that point, there are some numbers and then "Star S4 US Lasik PRK, PRKH Astig." I thought that I had read something on this board or another about the Star S4 laser. I am guessing that is what was used.


I'm not sure you're looking at the "operative report". Recently I was assisting a patient who had asked for all of his records but the operative report was not with the other records, and he had to request records a 2nd time to get his operative report. Somewhere on the report it should have the optical zone diameter and number of laser pulses -- does it? The VISX Star S4 may or may not have been "custom". I can't tell without seeing the report.

TheEyesHaveIt wrote:
My current refraction is OD -1.00+0.50X115, OS -0.75+0.25X150. I have visited three well respected ODs post. This prescription is from a corneal specialist at the University of Iowa Hospital.


Next important question... are you current wearing lenses to correct for this? Free tip: Go with the experienced ODs refraction, not with the "corneal specialists' ".

TheEyesHaveIt wrote:
I visited a Retinal specialist once I developed the floaters and began to realize what they were. I was afraid that I may have some Retinal damage or internal bleeding. Thankfully, there doesn't seem to be any damage to the Retina or bleeding. However, there is certainly damage to the vitreous. I asked one of ths assistant Retinal specialists I visited with about the connections between LASIK and floaters. He was adament that several studies had been done that showed NO CONNECTION between LASIK and floaters. I knew better from my time on this board, but I also knew that arguing with this guy wasn't going to help me. I just couldn't believe that these kinds of lies were still being perveyed. I mean, this is a guy who has been through several years of school and is paid handsomely to know everything there is to know about the Retina and vitreous, and he is telling patients that LASIK doesn't lead to floaters. Wow. How do we compete with that?


This is a common experience for post-LASIK patients. It's what we've come to expect from eye doctors, sadly. Sometimes I'm not sure if they are just stupid, or if they know they're lying, or if they are in denial.

TheEyesHaveIt wrote:
So, how can I use my wavefront scan information? What is the most useful information on the page? How can I understand the information better in order to communicate more effectively and prevent any future doctors from lying again? I am looking at some of my scans right now, and see that most of them, even taken one after another, weren't done at the same diameter. Does that reduce their value? If I were to get more wavefront scans taken, should I request a certain diameter or at least that they be consistent in diameter? Is the scan diameter something that the machine "auto" determines?


Here's the deal... the scan needs to be taken at the diameter of your pupils when dark-adapted. If your pupils measure 6mm in the dark, then the scan needs to be taken at 6mm. If the scan diameter is smaller, then it doesn't tell you anything about your vision at night. If your problems are worse at night, this is probably important to you. Somewhere on the wavefront report it should have the values for higher order aberrations expressed in microns. That's the important number -- that, and the scan diameter. Yes, the scan size is extremely important. You can't compare a pre-op scan taken at 6mm to a post-op scan taken at 4.5 or 5 (that's one of their dirty little tricks). Yes, if you have more scans taken, insist that they be taken at the same diameter of your pupils in the dark. Good luck with that! An eye doctor will NOT want to comply with such a request because it proves how badly your vision was impaired by LASIK. The tech doing the scan has control over the scan diameter up to a point, meaning that the machine may have an upper limit, and that's a big problem for patients with large pupils. The other limiting factor is your pupil size when the scan is taken -- if they have you sitting in a brightly lit room, your pupils will be small. In order to get a large scan they can dilate your eyes or do the scan in a dark room controlling for any stray light sources. Just remember, what you want to know is the values of the HOA at the diameter of your pupils in the dark.

TheEyesHaveIt wrote:
So, you went to see Dr. Boshnick in Miami? Do the lenses reduce your HOAs? When you say that your vision is much improved, are you just talking in an overall sense or are there one or two things that are spectacularly better?


No, actually my local OD fits SynergEyes PS. They are now commerically available. Yes, my lenses reduce my HOAs. They correct both, my myopia and astigmatism and my HOA to a large extent. Glasses improve my refractive error but they do nothing for my visual quality (HOAs). If I try to drive at night with glasses I am ovewhelmed by starbursts and halos and everything is still blurry. With my lenses I feel safe to drive -- the starbusts and halos are almost gone. But I do see shooting arcs when my pupils dilate larger than the optical zone of the lenses -- this is only a problem for patients like me with enormous pupils (8mm).

TheEyesHaveIt wrote:
I also have dry eyes. I mentioned in my first post that I struggled with contacts before surgery because of my eye dryness. I can't imagine I am going to be any better off now. Are there some type of drops that you use to make things more manageable?


Yeah, I struggled with contacts before LASIK, too, which is one reason I thought LASIK was a good idea. :roll: Little did I know that contact lens intolerance is a sign of dry eyes. Not that it would have mattered because I was not tested for, or warned about dry eyes. My regimen includes eye washes twice a day with cold Unisol4, preservative-free Theratears PRN, and frequent rewetting drops when wearing my lenses. I never go anywhere wearing my lenses without rewetting drops. I left the house a few days ago and forgot my rewetting drops -- what a nightmare. I was miserable. I always make a mad dash for the bathroom to remove my lenses as soon as I return home. I'm used to stumbling around in blurryland at home.

TheEyesHaveIt wrote:
I am not in any state right now to consider further surgical options. I have talked to Dr. Wang in Nashville by email. Of course, his message is hopeful,


Of course. He's a surgeon. If you ask a surgeon for an opinion, the opinion is "surgery".

TheEyesHaveIt wrote:
but I know the truth thanks to this board. I have also talked to others that have found new hope with Dr. Stojanovic in Norway. I spoke with Dr. Stojanovic by email as well. It sounds like he is so busy with his work and helping people like us that he wouldn't take the time to review my records unless I was willing to pay him $500/hour. I hope that technology can further advance and we can all have new hope for a surgery that actually works.


I personally believe that having a surface treatment on top of a LASIK flap is a really bad idea!!! And I do NOT believe that any new technology will ever change the fact that the cornea is NOT a piece of plastic. Retreatments are very risky. I know several people that have had them and most of them did not turn out well. Dr. S in Norway will likely use a toxic substance called MMC on your cornea. I have read some scary things about MMC -- possible long-term damage to the eye. Do some research here on lasik-flap about MMC or mitomycin C. Any doctor who is doing surface treatments on top of a LASIK flap uses MMC to prevent haze. That stuff is never coming near my eyes if I can help it.

TheEyesHaveIt wrote:
As far as my residual corneal thickness, I have two post op measurements, but none of them, of course, are broken down into flap vs. bed. My pre-operative thickness was between 600 and 650 microns.


Wow, you had thick corneas! You probably have good RST.

TheEyesHaveIt wrote:
Yes, there is certainly a possibility that my pupils were measured inaccurately. If I remember right, I was told they were 6.14mm. I suppose that is one of my two eyes, as they can't be perfecly the same. I have all of files scanned. What would you be most interested in seeing? I would send you everything, but the total file size is 26 MB zipped.


Send me the operative report if you have it, the post-op wavefront scans, and the post-op color topography.

TheEyesHaveIt wrote:
I would be grateful to find an attorney that would evaluate my case. Please feel free to PM me if you feel that is most appropriate. I would also ask anyone else out there with legal advice or suggestions for legal council to please speak up. I can't possibly imagine that having the wrong surgery doesn't constitute negligence to the point of malpractice, or at least, fraud.


The important thing (legally) here may not be whether or not you had the "wrong" surgery (custom v conventional). The reason I'm interested in knowing the exact laser model that was used is so I can check to see if the FDA approved it to treat your level of refractive error and astigmatism. The FDA's definition of "mixed astigmatism" is on page one of the following letter:

http://www.fda.gov/cdrh/pdf/p930016S020a.pdf

You may have a legal case... I don't know. I'll PM you the attorney's information.

Were you given a Patient Information Booklet, as mandated by FDA?

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 Post subject:
PostPosted: Sat Feb 16, 2008 4:34 pm 
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This might have been the system that the techs and ODs were referring to.

http://www.fda.gov/cdrh/pdf/P930016s020c.pdf

The Patient Information Booklet begins on page 89 (penciled in at the bottom right corner).

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 Post subject: Re: Wish we were meeting under different circumstances
PostPosted: Sat Feb 16, 2008 5:08 pm 
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Broken Eyes wrote:
I'm not sure you're looking at the "operative report". Recently I was assisting a patient who had asked for all of his records but the operative report was not with the other records, and he had to request records a 2nd time to get his operative report. Somewhere on the report it should have the optical zone diameter and number of laser pulses -- does it? The VISX Star S4 may or may not have been "custom". I can't tell without seeing the report.


Yes, this report (these reports, actually, one for each eye) has the pulse count. OD - 184 pulses and OS - 255 pulses. The optical zone diameter information looks to be OD 6.0mm X 4.6mm and OS 6.0mm X 5.2mm. Does that make sense? I will send the reports.

Broken Eyes wrote:
Next important question... are you current wearing lenses to correct for this? Free tip: Go with the experienced ODs refraction, not with the "corneal specialists' ".


No, I am not currently wearing lenses to correct for any of my issues. I have a "standard" pair of -1.00 glasses that I am wearing to help reduce some of my issues at night. They just help to "take the edge off" in a way.

Interesting, your comments about the OD vs. specialist. I don't have as recent a refraction from an OD. One conducted last March, only a couple of months after surgery, was "OD -1.00+0.50X071 and OS -0.50 sphere."

Broken Eyes wrote:
Here's the deal... the scan needs to be taken at the diameter of your pupils when dark-adapted. If your pupils measure 6mm in the dark, then the scan needs to be taken at 6mm. If the scan diameter is smaller, then it doesn't tell you anything about your vision at night. If your problems are worse at night, this is probably important to you. Somewhere on the wavefront report it should have the values for higher order aberrations expressed in microns. That's the important number -- that, and the scan diameter. Yes, the scan size is extremely important. You can't compare a pre-op scan taken at 6mm to a post-op scan taken at 4.5 or 5 (that's one of their dirty little tricks). Yes, if you have more scans taken, insist that they be taken at the same diameter of your pupils in the dark. Good luck with that! An eye doctor will NOT want to comply with such a request because it proves how badly your vision was impaired by LASIK. The tech doing the scan has control over the scan diameter up to a point, meaning that the machine may have an upper limit, and that's a big problem for patients with large pupils. The other limiting factor is your pupil size when the scan is taken -- if they have you sitting in a brightly lit room, your pupils will be small. In order to get a large scan they can dilate your eyes or do the scan in a dark room controlling for any stray light sources. Just remember, what you want to know is the values of the HOA at the diameter of your pupils in the dark.


Okay, so, I need to have my pupils dialated and then accurately measured. What is the most accurate way to measure pupils? Then, while dialated, I need to have the wavefront scans taken at the same diameter as my pupil measurement. Got it. I have scans taken post-op with dialated pupils, but the scan diameters are different (7.25mm vs. 6.00mm.) I will send you the scans.

Broken Eyes wrote:
No, actually my local OD fits SynergEyes PS. They are now commerically available. Yes, my lenses reduce my HOAs. They correct both, my myopia and astigmatism and my HOA to a large extent. Glasses improve my refractive error but they do nothing for my visual quality (HOAs). If I try to drive at night with glasses I am ovewhelmed by starbursts and halos and everything is still blurry. With my lenses I feel safe to drive -- the starbusts and halos are almost gone. But I do see shooting arcs when my pupils dilate larger than the optical zone of the lenses -- this is only a problem for patients like me with enormous pupils (8mm).


These lenses sound like something that I need to look into more closely. Would you be willing to comment on their cost?

Broken Eyes wrote:
Yeah, I struggled with contacts before LASIK, too, which is one reason I thought LASIK was a good idea. :roll: Little did I know that contact lens intolerance is a sign of dry eyes. Not that it would have mattered because I was not tested for, or warned about dry eyes. My regimen includes eye washes twice a day with cold Unisol4, preservative-free Theratears PRN, and frequent rewetting drops when wearing my lenses. I never go anywhere wearing my lenses without rewetting drops. I left the house a few days ago and forgot my rewetting drops -- what a nightmare. I was miserable. I always make a mad dash for the bathroom to remove my lenses as soon as I return home. I'm used to stumbling around in blurryland at home.


Boy, I hear ya on that one. Contacts won't work, so just go for the home run. Well, something got hit out of the park, that is for sure. Thank you for sharing your dry eye care regimen. I will see if some of your steps will help me.

Broken Eyes wrote:
I personally believe that having a surface treatment on top of a LASIK flap is a really bad idea!!! And I do NOT believe that any new technology will ever change the fact that the cornea is NOT a piece of plastic. Retreatments are very risky. I know several people that have had them and most of them did not turn out well. Dr. S in Norway will likely use a toxic substance called MMC on your cornea. I have read some scary things about MMC -- possible long-term damage to the eye. Do some research here on lasik-flap about MMC or mitomycin C. Any doctor who is doing surface treatments on top of a LASIK flap uses MMC to prevent haze. That stuff is never coming near my eyes if I can help it.


I am only starting the process of compiling my list of options. It has been suggested that PRK on top of my LASIK treatment might be the best option. Of course, I am extremely gun shy of ever letting anyone touch my eyes again, no matter what they are promising. I will have to do some research on this MMC.

One more complicating detail of my situation of which you should be aware is the free cap I have on my right eye. My right eye was the first one chopped. They chopped off the flap completely. Luckily, they didn't lose it. They did throw it in a dirty petri dish, and now I have several pieces of debris trapped between the flap and bed. Anyway, the ODs I have seen since have differed in opinion on the proper way to burn up my corneas again. One had no problem re-lifting the flap, another was very hesitant about lifting the flap and was suggesting PRK, and the last was undecided and said that further evaluation would be required before he would make a decision.

Broken Eyes wrote:
Wow, you had thick corneas! You probably have good RST.


I had thick corneas, and little did I know it, but I had very nice corneas. I thought they were somehow "imperfect" because they were a little of of shape. Ha. Now I know what imperfect is. In the process, I managed to get my vitreous ruined as well.

Broken Eyes wrote:
Send me the operative report if you have it, the post-op wavefront scans, and the post-op color topography.


I will try to trim the files to the most meaningful, re-zip them, and send them. Thanks for your willingness to take a look. Would you prefer that I remove my name from the reports?

Broken Eyes wrote:
The important thing (legally) here may not be whether or not you had the "wrong" surgery (custom v conventional). The reason I'm interested in knowing the exact laser model that was used is so I can check to see if the FDA approved it to treat your level of refractive error and astigmatism. The FDA's definition of "mixed astigmatism" is on page one of the following letter:

http://www.fda.gov/cdrh/pdf/p930016S020a.pdf

You may have a legal case... I don't know. I'll PM you the attorney's information.


Thanks for the information. One thing that I did just notice is that my pre-operative refractive error and the "desired correction" in the laser reports don't seem to match. That can't be right, can it?

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 Post subject:
PostPosted: Sat Feb 16, 2008 5:15 pm 
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Broken Eyes wrote:
This might have been the system that the techs and ODs were referring to.

http://www.fda.gov/cdrh/pdf/P930016s020c.pdf

The Patient Information Booklet begins on page 89 (penciled in at the bottom right corner).


That has to be it. Now, how does the non-custom treatment differ from the one described? I have just perused the material. I plan to read it in more detail.

Interesting that I was never shown this booklet prior to surgery? :shock:

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 Post subject: Re: Wish we were meeting under different circumstances
PostPosted: Sat Feb 16, 2008 7:19 pm 
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TheEyesHaveIt wrote:
Yes, this report (these reports, actually, one for each eye) has the pulse count. OD - 184 pulses and OS - 255 pulses. The optical zone diameter information looks to be OD 6.0mm X 4.6mm and OS 6.0mm X 5.2mm. Does that make sense? I will send the reports.


That's what I was looking for. So there you have it -- your optical zone is too small for your pupils. Man, that pisses me off! You should have been warned about that.

TheEyesHaveIt wrote:
No, I am not currently wearing lenses to correct for any of my issues. I have a "standard" pair of -1.00 glasses that I am wearing to help reduce some of my issues at night. They just help to "take the edge off" in a way.


You should be wearing prescription glasses based on your refraction. Some issues will be improved just by wearing the correct script.

TheEyesHaveIt wrote:
Interesting, your comments about the OD vs. specialist. I don't have as recent a refraction from an OD. One conducted last March, only a couple of months after surgery, was "OD -1.00+0.50X071 and OS -0.50 sphere."


I would suggest you get refracted by a good OD and get some glasses. I'd never get by without corrective lenses. I'd be running into walls. That reminds me of another thing that really ticks me off about LASIK surgeons -- they never tell patiens that they need to be wearing glasses, even if they really do. They don't want anyone seeing their LASIK patients in glasses -- they'd rather they be running around in blurryland so they can say your surgery was a success! :roll:

TheEyesHaveIt wrote:
Okay, so, I need to have my pupils dialated and then accurately measured.


No, no, no. Two things -- first you should probably have your pupils measured again in the dark with a pupillometer just to be sure the original measurement was correct. This has to be done with no dilating drops! You need to know your natural dark-adapted pupil size. Secondly, knowing your true natural dark-adapted pupil size, you need to have a wavefront scan taken at that diameter. It's ok if you are dilated for this exam (some will argue that point), but it's much better if you can get the tech to do the exam in a dark room and control any stray light and take the scan at your natural dark-adapted pupil diameter -- but this can be tricky and getting them to do it might be impossible. The point is to get the scan diameter as large as your natural dark pupil size. Keep in mind some aberrometers are not capable of taking a very large scan. But if your pupils really are not much larger than 6mm, that won't be a problem for you.

TheEyesHaveIt wrote:
What is the most accurate way to measure pupils? Then, while dialated, I need to have the wavefront scans taken at the same diameter as my pupil measurement. Got it. I have scans taken post-op with dialated pupils, but the scan diameters are different (7.25mm vs. 6.00mm.) I will send you the scans.


Infrared pupillometer in a dark room is the most common and should be reasonably accurate -- unless there's a moron on the other side of the device. There's a little more to it. You might find this helpful:

http://www.lasermyeye.org/keratoscoop/c ... n2003.html

Remember, no dilating drops for the pupillometer! Dilating drops are ok (some will argue) for the wavefront scan. The scan diameter needs to be set by the tech for your natural dark pupil size. If the scan is larger, the device should still be able to provide a report at any smaller size.

TheEyesHaveIt wrote:
These lenses sound like something that I need to look into more closely. Would you be willing to comment on their cost?


I had a complete exam (except dilated fundus) including lens fitting which was over $800. I believe the cost of the lenses themselves was $660.00. That's two pair. Each pair lasts six months. I highly recommend these lenses. I would be very surprised if they did not dramatically improve your vision.

TheEyesHaveIt wrote:
Boy, I hear ya on that one. Contacts won't work, so just go for the home run. Well, something got hit out of the park, that is for sure. Thank you for sharing your dry eye care regimen. I will see if some of your steps will help me.


TheEyesHaveIt wrote:
I am only starting the process of compiling my list of options. It has been suggested that PRK on top of my LASIK treatment might be the best option. Of course, I am extremely gun shy of ever letting anyone touch my eyes again, no matter what they are promising. I will have to do some research on this MMC.


At least now you can be informed first.

TheEyesHaveIt wrote:
One more complicating detail of my situation of which you should be aware is the free cap I have on my right eye. My right eye was the first one chopped. They chopped off the flap completely. Luckily, they didn't lose it. They did throw it in a dirty petri dish, and now I have several pieces of debris trapped between the flap and bed.


Holy cow! You didn't mention a free cap! Geez, I'm sorry to hear about that. Did you lose lines of best corrected vision, meaning, can you be refracted to read the 20/20 line with that eye?

TheEyesHaveIt wrote:
Anyway, the ODs I have seen since have differed in opinion on the proper way to burn up my corneas again. One had no problem re-lifting the flap, another was very hesitant about lifting the flap and was suggesting PRK, and the last was undecided and said that further evaluation would be required before he would make a decision.


No problem relifting a free cap?! Are you kidding? I never, ever heard of anyone relifting a free cap -- not that I know everything, I don't, but I will tell you this -- I'd never even consider a relift if it were me... then of course I'd never consider any additional surgery, period.

Proceed with extreme caution -- ask yourself if you can really trust them.

TheEyesHaveIt wrote:
I will try to trim the files to the most meaningful, re-zip them, and send them. Thanks for your willingness to take a look. Would you prefer that I remove my name from the reports?


Not unless you feel better removing your name. It actually helps me keep them straight. Many patients have sent me their reports and I usually hang onto them in case they have more questions. Your records are safe with me. But if you decide to remove your name, that's ok with me.

TheEyesHaveIt wrote:
Thanks for the information. One thing that I did just notice is that my pre-operative refractive error and the "desired correction" in the laser reports don't seem to match. That can't be right, can it?


Actually that's common. Don't read too much into that. Let me explain... let's say your surgeon had lasered 5 people who were -4.00 and all of them were overcorrected... he'd naturally back off a bit on the laser treatment to adjust for that the next time he treated a -4.00. Several factors come into play with a surgeon's nomograms. Now, if it were a misprogrammed treatment, that's another story. That's probably not the case, but you should be able to tell by the other information on your reports.

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 Post subject:
PostPosted: Sat Feb 16, 2008 7:42 pm 
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TheEyesHaveIt wrote:

That has to be it. Now, how does the non-custom treatment differ from the one described? I have just perused the material. I plan to read it in more detail.

Interesting that I was never shown this booklet prior to surgery? :shock:


Typical. How they get away with this is a mystery to me.

Here's all the information for the last version of the VISX Star prior to custom wavefront -- there's a lot of material here:

http://www.fda.gov/cdrh/pdf/P930016S014.html

The "Patient Labeling" is the same thing as the "Patient Information Booklet" which they are required to give you PRIOR to LASIK.

This webpage has more information about the patient information booklet requirement, about halfway down the page:

http://www.lasikcomplications.com/fda.htm

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 Post subject:
PostPosted: Sat Feb 16, 2008 7:47 pm 
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Why don't you just ask them, point blank, "which version/model (exactly) of the VISX Star S4 was I treated with?" There are several...

http://www.fda.gov/cdrh/pdf/P930016S010.html

http://www.fda.gov/cdrh/pdf/p930016s012.html

http://www.fda.gov/cdrh/pdf/P930016S014.html

http://www.fda.gov/cdrh/pdf/P930016S016.html

http://www.fda.gov/cdrh/pdf/p930016s017.html

http://www.fda.gov/cdrh/pdf/p930016s020.html

http://www.fda.gov/cdrh/pdf/p930016s021.html

Monovision
http://www.fda.gov/cdrh/pdf/p930016s025.html

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