Article such as this are having an increasing effect on the stock price.
10 Common Sense Reasons Why You Should Not Have LASIK.
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After years of dealing with the hassle of spectacles and contact lenses, you’ve decided to
reward yourself by having Lasik. You’ve read the glowing reports in the media about the
wonders of this "state of the art" procedure and your ophthalmologist has just pronounced
you "a perfect candidate."
It is at this time, more than at any other time in your life, that you must pause, stand back
from the excitement of the moment, and reflect deeply on what you are about to do. Lasik will
permanently alter the optics and physiology of your eyes. Most likely things will go well. But
there is a significant chance, much greater than many ophthalmologists realize or will publicly
admit, that your eyes will be irreversibly damaged. The results could be devastating.
One needs to take a practical approach prior to having any elective surgery and ask if the
benefits truly outweigh the risks involved. You’ve heard a lot about the benefits, no doubt
from the surgeon who stands to benefit financially by operating on your eyes. But you owe it
to yourself to take a few minutes to read the rest of this document in order to become better
informed about the risks of Lasik. Once you understand these risks, you may conclude that
the prudent course of action is to avoid the Lasik fad until the procedure as fully matured,
withstood the test of time, and been proven safe. After all, we’re talking about your eyes.
1. The True Degree of Risk is Unknown, and Where Known is Being Downplayed.
Before surgery, patients are typically told that the risk of long-term complications from
Lasik is 1%, and even lower in the hands of an experienced surgeon (such as the one
trying to sell you the procedure). For starters, one must realize that the risk being referred
to is for each eye, so the combined risk that permanent damage will occur to at least one
eye is, by these figures, actually 2%. Doesn’t sound so good anymore? Read on ...
At the 1997 Association for Research in Vision and Ophthalmology meeting in Fort
Lauderdale, Florida, researchers reported that up to 21% of patients who undergo laser
correction complain of night-vision problems stemming from reduced contrast sensitivity,
glare, and halos. (1) According to another study, at one year postoperatively 12% of Lasik
patients complained of visual disturbances at night. The figure for PRK patients was, by
comparison, “only” 6%.2 A more recent study presented in the Review of Optometry 3
summarized surgical (as opposed to optical) complication rates following Lasik as follows:
Interoperative Flap Complications - 2.7%
Postoperative Flap Complications - 4%
Epithelial Ingrowth (Farah) - 14.7%
Epithelial Ingrowth (Wilson) - 4.3%
Epithelial Defects - 5%
Interface Debris - 6.8%
Flap Wrinkles - 5.9%
These complications often produce vision-distorting irregular astigmatism. Unlike regular
astigmatism, which is correctable with glasses, irregular astigmatism cannot be corrected with
glasses.
New laser techniques are being developed to treat irregular astigmatism, but they are
yielding mixed results. Some ophthalmologists believe that lasers will never be precise
enough to correct irregular astigmatism.
Many top ophthalmologists remain in willful ignorance of Lasik’s true risks, often preferring
to avoid patients with post-LASIK complications because it is much less economical to
treat such a patient than to operate on a fresh candidate. These doctors therefore never
gain an accurate awareness of the extent of damage that is being done by LASIK. Their
ignorance is compounded by their unfamiliarity with websites such as SurgicalEyes.org,
which are dedicated to providing emotional and informational support to those suffering
from post-LASIK complications.
(1) See James J. Salz, M.D., Night Vision and the Excimer Laser: How to Ensure Patient
Satisfaction, EYEWORLD, Nov. 1997.
eyeworld.org
(2) PRK, LASIK, Neck and Neck in Controlled, Matched Study, OPHTH TIMES, Feb 15, 1999.
(3) See Paul M. Karpecki, O.D. and Steven Linn, O.D., What You Should Look for When LASIK
Goes Astray, REV OPTOMETRY, May 1999.
2. LASIK Technology Continues to Improve.
The refractive surgical community depends financially on the average individual’s
tendency to get swept up by fads and trends. This natural human tendency provides
refractive surgeons and medical device manufacturers with large numbers of patients
on whom they can continue to refine their surgical techniques and devices.
At present, for example, there is no consensus on what kind of excimer laser provides
optimal results. {snip}'s single beam laser follows a very different approach to ablating
corneal tissue from that of {snip}'s broadbeam laser, yet both are touted as being “state
of the art.” Many surgeons cut the LASIK flap from side to side with the {snip} microkeratome,
while other surgeons pronounce themselves experts in using the {snip} microkeratome,
which cuts a supposedly superior “up-down” flap.
The field of refractive surgery is still so new that many ophthalmologists develop and
market their own surgical instruments to perform various procedures, such as cutting,
lifting, or irrigating flaps. Perhaps their enthusiasm for LASIK stems partly from the goal
of “creating rapid profits by promulgating sales of surgical equipment and adopting new
surgical techniques,” as one eminent refractive surgeon has speculated. (4)
In the field of marketing there is a type of consumer known as the “early adopter,” who
enjoys buying the latest products and technology. No harm done when one is dealing
with a Palm Pilot or laptop computer. But does it make sense when we’re talking about an
irreversible surgical procedure on one’s eyes? Dr. George Waring, Editor-in-Chief of the
Journal of Refractive Surgery, answers this question best when he writes that “…we proceed
with active teaching of hundreds or thousands of ophthalmologists to use a technique that
we are simultaneously figuring out how to do -- including the identification of complications
and statistical outcomes. Is it not safer for patients and more rational for the profession to
proceed in a graduated manner, refining the techniques and improving the results on smaller
numbers of patients (or in the laboratory), and saving our mass education for the time when
we have worked the bugs out of the technique and have acquired reasonably quantitative
descriptions of safety and efficacy?” (5)
(4) See George O. Waring III, MD, FRCOphth, A Cautionary Tale of Innovation in Refractive
Surgery, ARCH OPHTH, Vol. 117, No. 8, Aug. 1999.
http//archopht.ama-assn.org/issues/v117n8/full/esa81001.html
(5) George O. Waring, III, MD, FACS, FRCOphth, Editorial, J REFRACT SURG, Vol. 12, No. 3,
Other leading refractive surgeons concur that the LASIK procedure has not yet been
perfected, writing: “As the technology and techniques improve, we should develop a
better understanding of the importance of laser-tissue interactions, corneal wound
healing, and the role of pharmacologic agents in modulating refractive outcomes.
These advances should allow PRK and LASIK to become more predictable with
fewer complications.” (6)
Do you want your eyes to be the ones to help these doctors learn how to perform
LASIK more safely and successfully?
3. Optical Aberrations Induced by LASIK are Poorly Understood by Ophthalmologists.
Refractive surgery focuses on eliminating spherical and cylindrical defocus, the most
important optical aberrations to correct. However, such an approach ignores the fact
that the eye has significant higher-order aberrations. According to Dr. Raymond Applegate
of the Department of Ophthalmogy of the University of Texas Health Science Center, these
naturally occurring higher-order aberrations, combined with large increases in the eye’s
higher-order aberrations induced by refractive surgery, can decrease visual performance
despite the elimination of spherocylindrical errors. Surgically-induced higher-order
aberrations have received less attention than the correction of defocus errors despite
their importance to optimal visual performance.(7)
(6) Edward E. Manche, Jonathan D. Carr, WeldonW. Haw, Peter S. Hersh, Excimer Laser
Refractive Surgery, WESTERN J MED, Jul. 1,1998, Vol. 169, No.1.
(7) See Raymond A. Applegate, OD, PhD & Howard Howland, PhD, Refractive Surgery,
Optical Aberrations, and Visual Performance, J REFRACT SURG, Vol. 13, May/Jun. 1997.
Moreover, the normal cornea is relatively trouble-free whereas the post-refractive cornea
frequently has a more aberrated optical performance. It is often unstable and its optical
performance deteriorates at night or in patients with larger-than-average pupils. Contact lenses
and spectacles do not permanently alter the physiologic optics of the eye. Refractive surgery
does. According to Dr. Leo Maguire of the Mayo Clinic, “When one alters irreversibly the
most trouble-free component of the human visual system, one runs the risk of compounding the
visual aberration caused by components of the visual system that characteristically show
dysfunction with age (the lens and macula).” (8) Dr. Maguire worries about how many refractive
patients who can compensate for their aberrate cornea will be able to do so when the lens and
macula develop age-related changes? How much sooner will they require cataract surgery or
visual aids for macular degeneration? (9)
Another reason why the eye’s optics are degraded by LASIKis that excimer lasers were
designed by engineers who assumed that the cornea is spherical rather than prolate.
According to Dr. Jack Holladay, McNeese Professor of Ophthalmology at the University
of Texas Medical School, these engineers further assumed that their job was to reshape
a steep sphere into a flat sphere, rather than to reshape a steep prolate into a flatter prolate.
As a result, excimer lasers reshape prolate corneas into oblate ones, a shape that is
optically worse because now peripheral rays are bent more powerfully, causing more
pronounced spherical aberrations when the pupil dilates. This problem affects every
patient who undergoes an excimer laser procedure to some extent. (10)
(8) See Leo J. Maguire, Mayo Clinic, Keratorefractive Surgery, Success, and the
Public Health, AM J OPHTH, Vol. 117, No. 3, March 1994.
(9) See id.
(10) See Jack Holladay, MD, MSEE, FACS, What We Should Really Tell LASIK Patients, REV
OPHTH, May 1999.
A final optical ramification of LASIK that is poorly understood by most ophthalmologists is
that following LASIK the eyes must focus and converge entirely unaided. However, after
years of adaptation to the prismatic effect of glasses, many eyes will have difficulty working
together. This problem can be compounded if either eye experiences even a slight
decrease in vision due to a post-LASIK complication. If the eyes are unable to adapt
after LASIK, the post-refractive patient will have difficulty reading and will experience
constant eye strain. Dr. Holladay concludes by writing that “We are actually reducing
the optics of the eye when we perform LASIK. That's fine when the pupil is small, but
as it gets larger, such as in nighttime conditions, this becomes a problem.” (11)
4. Contrast Sensitivity is Inevitably Reduced Following Refractive Surgery.
Most people will never know what contrast sensitivity is until they lose it as the result of
LASIK. An example of loss of contrast sensitivity is that when someone is walking towards
you in a situation where he is lit from behind, he appears merely as a dark silhouette,
whereas previously you would have been easily able to identify his facial features.
{That is, after LASIK, the patients discussed may have trouble distinguishing between
Bush and Gore in the dark. This thought may surely alarm some readers. - Geir}
Alternatively, seeing a white rabbit against the snow would also become more difficult.
Loss of contrast sensitivity is permanent and will to varying degrees affect everybody
who undergoes Lasik. A recent follow-up study performed for the London Centre for
Refractive Surgery of patients 2 to 7 years after refractive surgery determined that 58%
failed a contrast sensitivity test for night driving.12 These results have been supported
by an even larger study at Germany's Tubingen University, where more than 70% of
patients failed a night vision test -- a requirement in Germany for receiving a driver's
license. (13)
Another study by the U.K. Transportation Research Laboratory of myopic people who
had laser surgery concluded that as a result of loss of contrast sensitivity, 80% couldn’t
see a traffic sign at 55 meters, and 40% still couldn’t see the sign at 15 meters. (14) The
Canadian Medical Association has added laser eye surgery to a list of risk factors for
unsafe driving, after finding a decrease of night vision in between 30 and 60% of laser
eye patients. (15)
(11) Eye on Technology: New Procedure, Product Refines Lasik, INTL SOC REFRACT
SURG -EYE2EYE, Jul. 2000, p. 6.
(12) See Carol Hilton, Studies Show Compromised Night Vision an Undetected
Complication of Laser Eye Surgery, THE MED POST, Jun. 6, 2000 (citing research
performed by Dr. William Jory, Consultant Surgeon for the London Centre for
Refractive Surgery).
(13) See Louise Elliott, Canadian Medical Association Says Laser Eye Surgery Can
Pose Driving Risk, CANADIAN PRESS, Aug. 27, 2000.
(14) See id.
(15) See Elliott, supra note 12.
Why does this happen? One hypothesis is that some of the laser’s energy goes beneath
the targeted ablation to the corneal stroma and disturbs the fibrils. (16) However, there
are other hypotheses and no clear answers.
Perhaps you are wondering why this side effect of LASIK has gone largely unnoticed in the
United States. The reason is that, although contrast sensitivity tests are easy to administer
both pre- and post-operatively, they consume more time than most ophthalmologists are
willing to spend with their patients, and time is money. If refractive surgeons were to spend the
time to perform all the recommended diagnostic tests, they would be spending several
hours with each patient and the procedure would quickly become uneconomical for them.
Therefore, refractive surgeons generally only spend about one or two hours giving their
patients a “stripped-down” pre-operative evaluation. Issues such as the effect of LASIK
on contrast sensitivity get lost in the rush to put more patients through the LASIK mill. (17)
5. LASIK Reduces the Cornea’s Structural Stability.
Recent studies have indicated that people who undergo LASIK are at significantly greater
risk of developing Iatrogenic Keratectasia (Ectasia) due to the thinning of the cornea. This
weakens the cornea’s structural stability and can cause the cornea to bulge forward, resulting
in distorted vision, return of myopia, and fluctuating vision. It can affect even patients
with low degrees of myopia. (18)
The long-term weakening of the cornea has been well documented in other cases of corneal
refractive surgery, including radial and arcuate keratotomy. Although the mechanism of
weakening is different in incisional surgery, it may be even more profound in excisional
surgery, such as LASIK. (19)
Weakening of the cornea following LASIK is poorly understood. According to one renowned
refractive surgeon, “We have failed to ask some fundamental questions about the stability
of refraction of the human eye.” (20)
(16) See id. See also, Maxine Lipner, Inside LASIK-- First on the Endothelial Cell Block,
EYEWORLD, Sep. 2000
eyeworld.org
(noting recent studies indicating endothelial cell damage resulting from excimer laser radiation).
(17) For example, a recent advertisement by the Hillside PlusCare Network, {snip}, was entitled
“What do You Feed a Hungry Laser? Patients!”
(18) See S. Percy Amoils, Mark Deist, Petrus Gous, Philippa Amoils, Iatrogenic Keratectasia
after Laser In-Situ Keratomileusis for Less Than -4.0 to -7.0 Diopters of Myopia, J CATARACT
REFRACT SURG 2000, Vol. 26, No. 7, Jul. 2000, pp. 967-977.
(19) See Richard E. Damiano, M.D., Late Onset Regression After Myopic Keratomileusis --
Letter to the Editor, J REFRACT SURG, Vol. 15, Mar./Apr. 1999. See also Theo Seiler, M.D.,
Iatrogenic Keratectasia: Academic Anxiety or Serious Risk?, J CATARACT REFRACT
SURG., Vol. 25, No. 10, Oct. 1999
(20) See Chris Glenn, REV OPHTH, Apr. 2000 (quoting Dr. Daniel Z. Reinstein, MD, MA,
FRCSC, Professor of Ophthalmology at the University of Paris, Associate Professor at
Cornell University, and National Medical Director for {snip}
6. Photophobia is a Frequent Side Effect of LASIK.
Photophobia is the painful sensitivity to light that often results from LASIK. Though the
exact causes of post-LASIK photophobia are unknown, some surgeons hypothesize that
light scatter and glare resulting from post-LASIK corneal surface irregularities are the
culprits. Others believe that low-grade inflammation secondary to the Lasik procedure
is the true cause of the problem. Whatever the cause of photophobia following LASIK,
the result is that whereas one used to be able to walk down the street on a nice day
without sunglasses, now sunglasses are a constant necessity. It is a grim paradox that
while people undergo LASIK in order to reduce their dependency on glasses, now many
will have increased dependency on sunglasses.
7. Myopia Will Eventually Be Your Friend.
Have you ever wondered why most refractive surgeons do not have LASIK performed
on themselves? One reason is that they recognize that with refractive surgery they will
be simply be gaining distance vision at the expense of near vision.
In one’s later years, myopia reduces and can even eliminate the need for reading glasses,
which compensate for the lens’s greater rigidity with age. This rigidity reduces the lens’s
ability to accommodate in order to focus on near objects. Thus myopia is actually your
friend in later years -- to read you simply remove your glasses, or at worst wear bifocals,
which are lighter than normal glasses because the reading lens has a lighter prescription
than the lens used for distance vision. Lenses for myopia also produce an effect called
“image minification,” which further reduces the need for reading glasses by making it
more comfortable for the eye to see close-up objects. Eliminate the need for glasses
by having LASIK at the age of, say, 30, and within little more than a decade you will start
having to deal with the inconvenience of carrying reading glasses with you at all times in
order to read, use the computer, or do any other close-up work.
8. Steroid Drops, the Standard Treatment to Reduce Inflammation After LASIK,
Hasten the Onset of Cataracts.
Steroid medications such as {snip} (21) have been proven to induce cataracts, particularly
posterior subcapsular cataracts, if taken for prolonged periods. (22) The production of
cataracts varies based on individual susceptibility. Though prolonged use of steroids is
usually not necessary following LASIK, there are several complications (e.g., corneal
abrasion, infection, haze) that require treatment using steroid drops, which in turn
increases the risk of cataract formation.
9. Drier Eyes are Inevitable After LASIK.
The process of cutting the LASIK flap and then ablating the cornea with the laser damages
many of the nerves that signal to the eye the need to produce tears. (23) This is called
"de-enervation." The LASIK patient will typically experience dry eyes for at least two months
after LASIK surgery. Eye drops must constantly be applied, and the individual will often wake
up in the middle of the night with severely dry, scratchy eyes that need to be lubricated again.
For some, this uncomfortable and often painful dry eye condition persists indefinitely because
the nerves never completely heal. They must use expensive eye drops for the rest of their
lives, and may even need to have punctum plugs inserted into their eyes’ drainage ducts in
order to reduce the outflow of the few precious tears they have left. (24)
(21) PDR OPHTH, 1999, p. 244. See also, Flurometholone-Induced Cataract After PRK,
OPHTHALMOLOGICA 1997, pp. 394-96 (noting the case of a 24 year old woman who
developed cataracts after using FML 4-7 times per day for 4 months).
(22) Lens and Cataract, § 11, BASIC AND CLINICAL SCIENCE COURSE, AM ACAD
OPHTH (noting that 50% of patients developed catarac
23) See At Issue: Tears Versus Plugs in Post-Lasik Patients, OCULAR SURG NEWS,
Jun. 1, 2000.
(24) The recent proliferation of artifical tear brands such as Theratears, Genteal, and
Refresh is more than coincidental with the increase in refractive surgical procedures.
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{What a windfall for eyedrop companies. Some of the eyedrop companies also sell the
microkeratomes and excimer lasers that cause the dry eye. What a strange coincidence !
- Geir}
An RN's notes on dry eye following LASIK, from a conference at the Mayo Clinic
carlsbadnm.com
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According to one study, corneal sensitivity does not recover to the preoperative level by
6 months after LASIK, suggesting that cutting of the cornea during LASIK impairs corneal
sensitivity and that the depth of the corneal ablation affects the extent of corneal sensitivity
loss and recovery. One possible explanation is that in LASIK, because the corneal stroma is
ablated after a corneal flap is created, damage is caused to deeper corneal tissue. There
is also risk of damaging nerve fibers in forming a flap. Moreover, because there is a
temporary gap between the corneal flap and the bed, the transfer of cells and other materials
may be impeded. Such diffusion barriers affect the recovery of nerve cells and corneal
tissues. (25)
(25) See Wan-Soo Kim, MD, PhD, Jeong-Sam Kim, MD, Change in Corneal Sensitivity
Following LASIK, J CATARACT REFRACT SURG, Vol. 25, Mar. 1999.
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10. The Long Term Risks of LASIK are Unknown
By ophthalmologists’ own admission, the long-term risks of LASIK are completely
unknown. Peruse the medical literature of the refractive surgical community and you
will quickly see how much is being learned about the long-term optical and physiological
consequences of LASIK. Most of it isn’t positive.
Conclusion
Each of these ten points should be enough to give pause to anyone considering LASIK.
Taken as a whole, they raise serious concerns about the safety of this procedure. These
concerns have been raised by ophthalmologists themselves, but have been largely
disregarded by refractive surgeons and the excimer laser industry, which seem more
interested in maximizing profits from the LASIK fad rather than looking out for the
long-term health of their patients.
Eyeglasses have been giving people good eyesight for nearly a thousand years. Contact
lenses have been widely used for four decades, and, when cleaned and used properly, have
proven themselves to be safe. LASIK has been performed for less than five years. Does it
make sense to risk your eyes on such a new procedure? |
