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Thread: Since Shwing started it...:-)

  1. #1
    Bad address email on file Darris Chambless's Avatar
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    Hello everyone,

    After reading Shwings posting with the article about the pitfalls of LASIK I felt compelled to write down some things that I see happening now with the procedure as well as some future outcomes. Also I will put in some of my own predictions just to make people mad at me for being right sometime down the road :-)

    First, the question has been posed several times about how LASIK will affect opticians and the optical industry. The answer is: Temporarily only. In a nutshell ;-)

    Now let's talk procedure outcome shall we :-) After running the hacksaw blade...er...Keratome through a layer of the cornea and ripping it...er...folding it back gently in order to get to the soft underbelly beneath the doctor then torches the living flesh underneath to create a refractive improvement (maybe ;-) While this all sounds like a really good idea to some, it just strikes me as well self mutilation as an attention getter :-)

    Technical stuff: When incising the cornea one must penetrate Bowmans membrane. So?!?! Bowmans membrane is made up of cells that do not regenerate and therefore has to build a web type or honeycomb system of cellular tissue to bind (hopefully) the incised tissue. That "The visions great but there's just something...." something is the web like tissue. This cellular mass is the same medium that infection can develop in a small percentage of patients that have the procedure done (approximately 0.2%) because of its sponge like effect on moisture not to mention the perfect breeding ground for infection (Mmmmm, Yummy!)do to exposure and cellular make up. That "just something..." is the defusing effect of light through this molecular structure underneath the corneal flap. Defusing light in low light situations or no light situations compounds the effect of lightlessness (Imagine that. :-)

    I have a whole lot more but I must be off to Austin where I will meet with a good friend of mine and basically get plowed for the weekend :-) TTFN.

    Darris "Always thinking" Chambless

  2. #2
    Master OptiBoarder Shwing's Avatar
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    Redhot Jumper

    Hello, Mr. Chambless. How are you?

    I wish to make things clear (through my -8.50D eyes).

    I have never said that LASIK, PRK, RK, Ortho-keratology, In-Tacts, or big blunt scissors are a poor choice to correct an ametropic eye.

    I think that it a wonderful advancement in medicine (as opposed to optics) to be able to make a -8.00D into a -1.50, or even -0.50D.

    The issue I have, is the way the correction is presented, and the possible ramifications. I have been saying this since about '90.

    In Calgary, there are 2 or 3 of the most innovative forward-thinking ophthalmologists in North America.

    Yes, If I decided to Steve Austinize my eyes, I have a preferrence. Even so, I have Zero intention of doing so for the fore-seeable future.

    Quite frankly, knowing what I know about the various surgeries available, and where the technology will be in 7 years, I am more comfortable sleeping in my Acuvues than zapping my eyes. (And, I'll have you know that any vascular growth I have was caused by a poor lens choice by my practitioner 7 years ago. Since I have started to wear Acuvue(not a plug, just an observation), my vasc is looping, and the start of ghost vessels = happy eyes...)

    It is a personal thing. Ford or GM? Boxers or briefs? Yankees or Mets?

    You are given a once in a lifetime choice: Take a for sure $50,000 now, or wait 5 years and have a 40% chance of $1,000,000.

    Those are my thoughts, not yours.

    ------------------
    Shwing;-}

    [This message has been edited by Shwing (edited 07-20-2000).]

  3. #3
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    I saw an ad in last week's paper that offered LASIK for $499 per eye. Scary! I'm also hearing "20/20 or your money back". I have never recommended this procedure to anyone I know. But, at a party over 4th of July, 5 out of 12 people in the room, had it done! All were "short term happy" and unconcerned about long term results. Amazing.

  4. #4
    Master OptiBoarder OptiBoard Gold Supporter Judy Canty's Avatar
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    Redhot Jumper

    In my opinion, and I could be wrong, there's 20/20 in the controlled environment of an exam lane and there's 20/20 in the real world of glaring headlights, rain-covered streets, bright sunlight and all those other annoying little inconveniences that play havoc with good clear vision. Guarantee 20/20 when? In the exam chair only or every day they want to see? I still have serious misgivings about taking a perfectly healthy eyeball and "fixing" it. A dear friend of mine was almost convinced by his Ophthalmologist that Lasik would be appropriate knowing full well my friend has kerataconus and macular degeneration. Almost convinced until I suggested that he do a LOT more research on the subject. Money wasn't even the issue here, they are both Naval Officers. Just because the procedure can be done, doesn't mean it should be done!

  5. #5
    Optical Curmudgeon EyeManFla's Avatar
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    Redhot Jumper

    Let's look at it this way, for as many years as we have been in this business, how many of you would trust the MDs you know to do a slice and dice on YOUR eyes...........

  6. #6
    Master OptiBoarder
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    Never. I do not trust some one with this much control that does not do a through history. This is what I am hearing everywhere. I also have experienced it in the exam room personally.

  7. #7
    Master OptiBoarder BobV's Avatar
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    When I saw a physician refract after LASIK, and the patient could faintly see one letter on the 20/20 line, this patient was declared to have "20/20" vision. IT'S A MIRACLE!!!!

    Price wars for LASIK. Step right up...it's only money. If we goof it up, well, we'll refund your $1000. No problem. You can still see with this new Rx for EYEGLASSES.

    Bob V.

  8. #8
    sub specie aeternitatis Pete Hanlin's Avatar
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    I've come to the conclusion that y'all must know a different set of folks than I do... We've had dozens of patients who have had LASIK and are extremely pleased with their results...

    I can only speak personally for one of them (myself). I read the 20/10 line off our charts with ease (which I could do with my glasses before the surgery). I was worried about dry eye post-surgery, but I find my eyes actually experience less discomfort now than before LASIK.

    About the only side effect I've noticed is a slight increase in light sensitivity and halos at night (which have decreased and continue to decrease over time).

    Perhaps if I were to meet all of these people who have had terrible, horrible experiences with LASIK I would be of a different opinion... I suppose till I meet such individuals, I'll continue to have a relatively positive opinion of the procedure... Considering the number of people I've seen with soft CL complications, I'll continue to have a relatively negative opinion of that mode of vision correction.

    Pete "Speaking from personal experience... I'll take LASIK over disposable cls anyday" Hanlin

  9. #9
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    Pete, thank God you have had a positive experience. If no one ever did, LASIK would have died out years ago. But the risks are still there. There are stories all over the country, not necessarily in Tallahassee, that indicate caution. As for contact lens over wear problems, those are the result of the same mentality...lack of respect for one's eyes and a desire for a quick fix. Viva la eyeglasses!

  10. #10
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    Hello everyone,

    Without sounding too obnoxious, I have to admit that I am totally grossed out by LASIK, clear lens extraction or any other invasive procedure. (I feel the same way about cosmetic surgeries...not judgmental, just grossed out.)

    With that said, I try to keep my personal feelings about refractive surgeries out of the classroom. One person posted a failure ration of 30/'1000, or something like that...whatever the exact number, it was way too high in my opinion.

    As far as success rates: I told you guys before my husband is an OD who also had LASIK. He was -12.00 ou, -10.something with contact lenses. He was successful (THANK GOD!) I had many heart attacks and mental breakdowns in the process! It was life changing for him, and I am very happy for him. HOWEVER, he insists that he is 20/20 and I know for a fact he is not, because I'm 20/40 without glasses and he can't see things I can without specs. (I goof on him and say, you can't see that, Mr. LASIK man?!: ) Long story short, it is rare to be 20/20. long term after. Many patients will report 20/happy, but not full 20/20 (especially if you take contrast sensitivity into account).

    The scary part is, there are a ton of Docs in town who will do the procedure on risky candidates. The doc has to have the ethics to turn away patients with contraindications.

    My 2 cents...

    Laurie

  11. #11
    sub specie aeternitatis Pete Hanlin's Avatar
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    Good points, everyone...
    As CJ has stated, there are risks involved with LASIK that need to be considered. I dug up a prior issue of "Review of Optometry" for the article "When LASIK Goes Astray" (vol.136, no.5; May 15, 1999; pp. 98-107). This was one of the articles I researched before my operation on Oct. 6, 1999.

    According to the article, the incidence rate of complications associated with LASIK are as follows:
    • Intraoperative flap complications 2.7%
    • Post-Op flap complications 4%
    • Epithelial ingrowth 14.7% (only 1.7% of these cases required a procedure for resolution, however)
    • Epithelial defects 5%
    • Interface debris 6.8%
    • Flap wrinkles 5.9%


    Nearly all complications associated with LASIK can be tracked to the creation/healing of the flap. This is where, IMHO, the surgeon's skills/equipment are put to their greatest test (and presents the greatest argument against ODs performing LASIK).

    When all is said and done, the incidence of "notable" complications is about 5% (this rate varying with the amount of correction being resolved). Barring the formation of diffuse lamellar keratitis (aka, "Sands of the Sahara"), the likelihood of complications appearing more than two days post-op drops to below 1% (these figures were from a round table at Vision Expo East and were derived from TLC data).

    I think its great to be concerned, and the decision to undergo LASIK is certainly a personal one. However, assuming a patient is supplied with truthful information, I think its a procedure anyone with moderate to high amounts of myopia would want to at least investigate. I also think it does not serve us well to ignore the fact that the great, vast, overwhelming majority of people undergoing LASIK would recommend it to a friend (89%, compared to 71% for hip replacement surgery... just a stat thrown in from my research...).

    The comparison to cosmetic surgery is a fair one... albeit refractive surgery is a bit more functionally related than most cosmetic
    surgery (although I suppose an exotic dancer COULD posit that breast augmentation is a functional... ;) ). I had LASIK because I was tired of playing tennis in glasses, being blind when I'm in the water, and other instances where even the best eyewear products are debilitating to some degree.

    Pete

  12. #12
    Bad address email on file Darris Chambless's Avatar
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    Redhot Jumper

    Hello All,

    Well I had a great time in Austin. I actually didn't get plastered; however, I did get badly sunburned while playing 18 holes of golf (or as we like to call it "Goff" :-) My score, if you must know, was extremely bad since this is only the second time I've played. I have only been to a driving range twice and only hit maybe ten balls either time so I guess my score was to be expected. I do enjoy the game though and plan on actually taking it up when I get a chance.

    Let me start by saying that all of the responses are great and chalk full of info both pro and con (Pete's eyes will fall out one of these days though :-) BUT I think what is being missed here is a very important, in fact probably the most important thing of all; Long Term. I realize that there are very competent doctors out there and they know their stuff and can do procedures blind folded and never make a mistake, but they can't tell the future. They can make a decent educated guess but that is all that it is, a guess.

    As Pete said it is a personal decision to make but if someone should ask me how good this procedure is I have to tell them it is as good as the doctor performing the procedure. I also tell the patients that if having viable tissue removed for the sake of vision without glasses is what they want to do and have the money to do it then by all means.

    With all that said I can also hit a little below the belt with this one and it is my favorite :-) What are the risks/advantages to having LASIK done? Blindness or decent vision. Maybe even 20/20 if you're one of the lucky few. I finish it all up by saying "Even though the percentages of failure with this procedure are fairly low, the percentages don't mean squat if you're one of those few." ;-)

    You have to think of it this way, if 5% of patients develop problems that can be debilitating or at least a poor outcome after the procedure then just tell that 5% not to have the procedure done and your success rate would go up to 100% wouldn't it? So who has the list? You know the list of the 5% past, present and future that will have problems associated with the procedure? Let's start a mailing list and tell these people not to have the procedure done, okay? I'll pay for the postage :-)

    Again it is a personal decision to make but the question is more, would you recommend the procedure to the patients? Some will but I won't and will try to discourage it simply because I don't want any of my patients to become part of bad statistical numbers, even if it is only one patient. To me that's just too many and I don't want to be responsible in any way.

    Breast augmentation, although nice to look at, would still fall under the same category as LASIK. Personal decision and perhaps better quality of life (BARFFFF!!! :-), but was it necessary?

    For those of you out there that have had the procedure done and feel good about it I say congrats and hope the best for you for the future. For those that haven't had the procedure done but are thinking about it, remember that even a small risk of a poor outcome is a risk nonetheless. One of you, if not more, will have a bad experience and you can't go back and undo it at that point. Those that will never have the procedure done and aren't thinking about it at all will just have to suffer along with glasses or contacts.

    Keep in mind that I'm not trying to make anyone feel bad, feel stupid or feel superior. What I am trying to do is say that the risks are there, they are real and someone (but no one knows who until it happens) will end up with some serious problems. I am also saying that with as new as this procedure is there isn't enough long term information to be definitive about the outcome in later years (it is in theory only as to the long term effects of this procedure) I hope and pray that my good friends on this board that have had the procedure never have to experience an ill effect from having had the procedure done. I'm sure that the doctors that have and will perform the procedure are hoping and praying as well ;-)

    There is still more stuff that I will throw out there for all to chaw on, but I've gone on long enough for now.

    Talk to you later,

    Darris "Scalpel...forceps...Oops!" Chambless



  13. #13
    Master OptiBoarder Shwing's Avatar
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    Redhot Jumper

    "...I realize that there are very competent doctors out there and they know their stuff and can do procedures blind folded and never make a mistake, but they can't tell the future. They can make a decent educated guess but that is all that it is, a guess..." - Darris

    The same can be said of contacts. Polymacon was a wonderful material, resilient, breathable, easily produced.

    That was 15 years ago+. Technology moves on. When fitting contacts, Polymacon is about the last material I choose, though it represents about a quarter of all lens materials available.

    Polymacon was a great choice and innovation. I prefer Etafilcon A; Methafilcon B; and others. It comes down to modality.

    Seems to me that few fitters, and virtually zero patients realize this. Nothing wrong with say, Vifilcon A (if I have to pick on someone).

    I wore the Vifilcon A lens for 3 years on a continual basis. Didn't have vasc previously though...

    Since wearing Etafilcon A, vascularization is looping, same w.t....

    I can't tell you how many patients have overwear issues with Polymacon or Vifilcon A compared to Etafilcon A on the same wear schedule, solutions, and disposal rate(of my observations).

    Thus, as the practitioner, I provide the best lens for the patient, per their planned wear schedule and apparent ocular needs allow, based on past performance of a given lens modality.

    Sorry to go on, but it is like this: Guy came to me last week, had PRK 1 year ago, and is ****** (but acceptant) that he still needs specs for night:about -0.50-0.50x 180ish O.U. and an a/r for the halos. C'est la vie.

    Also had a couple in, she wearing big-assed ugly old fit overs, and they want the darkest lens possoble. She had LASIK a week previous, and light is intollerable. I showed my darkest grey polarized sunglass, but she said her eyes still hurt and water.

    B'bye.

    All I could think was 1)you volunteered for the surgery. 2)if light is that bad, why are you out of your house 'til things settle down??

    Sorry for rambling.



    ------------------
    Shwing;-}

  14. #14
    sub specie aeternitatis Pete Hanlin's Avatar
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    Darris said,
    "Again it is a personal decision to make but the question is more, would you recommend the procedure to the patients? Some will but I won't and will try to discourage it simply because I don't want any of my patients to become part of bad statistical numbers, even if it is only one patient. To me that's just too many and I don't want to be responsible in any way.
    Darris went on to say...
    "Those that will never have the procedure done and aren't thinking about it
    at all will just have to suffer along with glasses or contacts."
    The implication is that we should be wary of LASIK- remaining in the "safe" haven of spectacle and contact lens wear! I don't understand why we are all so concerned about the risks of LASIK- yet we ignore the ongoing risks of soft contact lens wear. I know I sound like a broken record, but here's a quote from "Contact Lens Spectrum" (July 2000 issue; "Diagnosing and Treating Contact Lens Complications," pp.25-32)...
    "Ulcerative keratitis is the most severe and sight threatening complication of contact lens wear. Poggio and Schein (1989) estimated the annual incidence of ulcerative keratitis to be 4.1 per 10,000 in soft daily wear conventional lens wearers and 20.9 per 10,000 in soft extended wear conventional lens users."
    If one is too many, than surely the nearly 21 per 10,000 extended wear users is too many. Use extended wear cls for 20 years, and your chances of an ulcer rise to 4.1% (in other words, one out of every 24 patients who use extended wear cls for 20 years will develop an ulcer). Ulcerative keratitis is a more severe condition than most of the complications associated with LASIK. That is why I believe LASIK may prove to be inherently less risky than prolonged contact lens use.

    In the end, all forms of eyesite correction come with inherent risks- with spectacle lens wear being undoubtably the safest. If we are going to bemoan the perils of LASIK, let's at least be honest with ourselves regarding the risks associated with contact lens wear. How many people have actually seen a patient who has had a tragic result with LASIK? Now, how many of us has seen a patient who had a severe complication associated with contact lens wear and/or abuse? Add to this the horror we profess over patients who are "uninformed" of the risks associated with LASIK. How many individuals who wear extended wear cls are uninformed about the risks associated with their modality of cl wear???

    Pete "Keeping things in perspective..." Hanlin

    [This message has been edited by Pete Hanlin (edited 07-25-2000).]

  15. #15
    Master OptiBoarder Shwing's Avatar
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    Thumbs down

    But Pete, As I was positing, I have (as the practitioner) provided (hopefully) the best invasive prosthetic ophthalmic device available based on the patients history, needs, etc.

    I simply cannot help it if the patient then decides to become non-compliant. Check the facts. Ulcers don't just happen. It is casued by wither over-wear, or improper care.

    In addition, I do regular follow-ups. C.Y.A.

    I am not boo-hooing LASIK et al. but it is simply not the be all and end all tht it is being touted as.

    ------------------
    Shwing;-}

  16. #16
    sub specie aeternitatis Pete Hanlin's Avatar
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    Hi Shwing,
    Of course ulcers don't just happen (just like hypoxia, neovascularization, GPC, etc. don't just happen). My point is: ask the typical extended wear patient if they are concerned about their risk of developing an ulcer (or any of the other cl complications) and they will say "Huh, what are you talking about?"

    Now, they may or may not have been informed about these risks... chances are, however, they are currently not aware of them. I am simply observing that, to some degree, patients are responsible for their own eyes and should decide for themselves whether a lifetime of cl wear or LASIK is the safest mode of correction for their eyes.

    I've watched the posts about LASIK compile on the board- and I've asked myself "Why are we soooo concerned about the chances of complications with LASIK when cl wearers have health issues related to their contact lens wear all the time that are often serious and sometimes sight threatening???"

    We have a satellite office located on the campus of Florida State University. We often participate in health fairs and such- where we offer free samples of cl cleaning supplies, etc. Without fail, we find the vast majority of students respond with statements like "Oh, I never clean my lenses, they're disposable..." and "Uh, I wear my contacts for about 2 months at a time before taking them out- is that bad for my eyes?" Perhaps these students have great practitioners who HAVE explained the risks of cl wear (and abuse). Obviously, however, they haven't "gotten it."

    I know LASIK scares a lot of us ("us" meaning Opticians, ODs, etc.)... but some of this fear is misplaced and should be more evenly distributed with soft cl wear. Also, we often fail to note that LASIK, when compared to other refractive surgeries (RK, PRK) is far superior in both results and impact on the eye.

    Pete
    PS- I'm not bashing contact lens wear. However, noncompliance (based on either ignorance or apathy) is so commonplace that it can almost be accepted as the norm. I'm sure Shwing and others here are great practitioners... in the end, however, soft cls still decrease oxygen to the cornea and decrease tear flow.

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