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Guest
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 Posted: Fri May 20, 2005 9:57 pm Post subject:
Have requirements changed for lasik?
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Doctors, do you think that restrictions for lasik have been tightened
in the last 5 years or so? I'd be interested in your discussion.
One example that I notice now is that the upper limit for lasik may be
lower than it was several years ago. I used to read about "taking up
to -13......." I don't see that as often now.
Do you think the MD's and OD's check more carefully for pupil size and
possible problems? It "almost" seems obvious what the answer should
be.
When I present my problems as a post-op (lasik) high myope to a new
doctor, sometimes I get the idea that "they have never heard of such a
thing." I really like to think that we know a lot more now than we did
way back.
Thanks, pknapp |
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paqsanchez@hotmail.com
medicine forum beginner
Joined: 21 May 2005
Posts: 3
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Glenn - USAEyes.org
medicine forum Guru Wannabe
Joined: 05 May 2005
Posts: 129
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| Posted: Sat May 21, 2005 3:48 am Post subject:
Re: Have requirements changed for lasik?
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Phyllis,
As you know, I am not a doctor, but I observe closely the refractive
surgery industry.
It is clear to me that the decrease in the most serious complications
and the increase in patients achieving visual acuity at or better than
their acuity before surgery with glasses is the combination of two
effects.
One is the continued advancement of the technology and techniques
employed by refractive surgeons. This includes surgeon experience.
The other is a much tighter process by which "ideal" candidates are
defined. This includes evaluations that did not exist in the early
years, and the application of evaluations that were not understood to
be necessary in the beginning.
Glenn Hagele
Executive Director
USAEyes.org
"Consider and Choose With Confidence"
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor. |
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Dr. Leukoma
medicine forum Guru
Joined: 30 Apr 2005
Posts: 1283
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| Posted: Sat May 21, 2005 9:50 am Post subject:
Re: Have requirements changed for lasik?
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Glenn - USAEyes.org wrote:
| Quote: | Phyllis,
As you know, I am not a doctor, but I observe closely the refractive
surgery industry.
It is clear to me that the decrease in the most serious complications
and the increase in patients achieving visual acuity at or better
than
their acuity before surgery with glasses is the combination of two
effects.
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Of course, common sense says that this should be the case, but I
haven't yet seen any large studies showing this to be true. In fact, I
haven't seen any large studies on the safety and efficacy of LASIK,
period. At least with contact lenses we have population studies
involving thousands of patients.
| Quote: |
One is the continued advancement of the technology and techniques
employed by refractive surgeons. This includes surgeon experience.
The other is a much tighter process by which "ideal" candidates are
defined. This includes evaluations that did not exist in the early
years, and the application of evaluations that were not understood to
be necessary in the beginning.
It's interesting to go back and look at the old VISX manual for PRK |
circa 1997. It would make an interesting discussion over dinner. You
would be amazed at how many absolute contraindications and relative
contraindications are contained in that document. It even contains a
novel idea of doing one eye at a time, just like cataract surgery and
other intraocular surgeries. I would say that about the only
evaluation performed now that wasn't performed then was a standardized
pupil measurement with a Colvard or similar device.
DrG |
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Dr. Leukoma
medicine forum Guru
Joined: 30 Apr 2005
Posts: 1283
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| Posted: Sat May 21, 2005 1:17 pm Post subject:
Re: Have requirements changed for lasik?
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I just think that standards relaxed, and that some relative
contraindications became ignored along with unilateral surgeries.
DrG |
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Glenn - USAEyes.org
medicine forum Guru Wannabe
Joined: 05 May 2005
Posts: 129
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| Posted: Sat May 21, 2005 4:43 pm Post subject:
Re: Have requirements changed for lasik?
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I suppose there is much interpretation as to what would be meant by
"large scale". No, there have not been many studies involving
thousands of patients. Also, there have not been many studies that
compare results of ten years ago to results of today, but one can look
at ten year old studies and compare them with studies of today. In
fact, you can just go over to the FDA's website and look at the
outcomes for the laser approvals to see that outcomes have most
certainly improved.
Infrared pupil size measurement is one evaluation that was not done
way back when, but wavefront diagnosis didn't exist in 1997. Few
doctors actually did TBU and Shirmer tests then, many do now.
Pachemetry has improved. The Orbscan II now provides a better
diagnostic tool for keratoconus.
Keep in mind, in 1997 doctors were still discussing if a 5.0mm optical
ablation zone without transition really needed to be larger and if a
transition zone was necessary.
Glenn Hagele
Executive Director
USAEyes.org
"Consider and Choose With Confidence"
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor. |
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