The LASIK industry & the FDA have conspired since LASIK's inception to purposely withhold information vital to the public in making a truly informed LASIK decision. With Lasikdecision.com, The hope is to show you what the industry and FDA would not and did not even think of doing until LASIK casualties started speaking out, and yet, they still did NOTHING.
Studies & Articles


TOP TEN REASONS NOT TO HAVE LASIK EYE SURGERY PDF Print E-mail
Sunday, 31 January 2010 00:00

Opinions By Damaged LASIK Patients For Those Considering LASIK

1. LASIK causes dry eye

Dry eye is the most common complication of LASIK. Corneal nerves that are responsible for tear production are severed when the flap is cut. Medical studies have shown that these severed nerves never return to normal densities. Symptoms of dry eye include pain, burning, foreign body sensation, and eyelid sticking to the eyeball. The FDA website warns that LASIK-induced dry eye may be permanent.

2. LASIK results in loss of visual quality

LASIK patients have more difficulty seeing detail in dim light (known as loss of contrast sensitivity), and also experience an increase in visual distortion at night (multiple images, halos, and starbursts). The FDA website warns that patients with large pupils may suffer from debilitating visual symptoms at night.

3. The cornea is incapable of complete wound healing after LASIK

Researchers found that the flap heals to only 2.4% of normal tensile strength. LASIK flaps can be surgically lifted or accidentally dislodged for the remainder of a patient’s life. For these reasons, the FDA website warns that patients who participate in contact sports are not good candidates for LASIK.

Collagen bands of the cornea provide its form and strength. LASIK severs these collagen bands and thins the cornea, resulting in permanent weakening. The thinner, weaker post-LASIK cornea is more susceptible to forward bulging due to normal intraocular pressure, which may progress to a condition known as keratectasia and corneal failure, requiring corneal transplant.

4. The true rate of LASIK complications is unknown

There is no clearinghouse for reporting of LASIK complications. Side effects occur frequently but are downplayed by LASIK surgeons. Moreover, there is no consensus among LASIK surgeons on the definition of a complication.

5. LASIK results in loss of near vision

Nearsighted patients who do not have LASIK retain the ability to see up close naturally after the age of 40 simply by removing their glasses. LASIK patients over the age of 40 may discover they have traded one pair of glasses for another.

6. There are long-term negative consequences of LASIK

LASIK affects the accuracy of intraocular pressure measurements, exposing patients to risk of blindness from undiagnosed glaucoma.

Like the general population, LASIK patients will develop cataracts later in life. Calculation of intraocular lens power for cataract surgery is inaccurate after LASIK. This may result in poor vision following cataract surgery and exposes patients to increased risk of repeat surgeries. Ironically, steroid drops routinely prescribed after LASIK hasten the onset of cataracts.

7. Bilateral simultaneous LASIK is not in patients’ best interest

In a 2003 survey of American Society of Cataract and Refractive Surgery (ASCRS) members, 91% of surgeons who responded did not offer patients the choice of having one eye done at a time. Performing LASIK on both eyes in the same day places patients at risk of vision loss in both eyes, and denies patients informed consent for the second eye.

8. Serious complications may emerge later

The medical literature is filled with reports of late onset LASIK complications such as loss of the cornea due to biomechanical instability, vision-threatening infection, inflammation resulting in corneal haze, flap dislocation, and retinal detachment. Complications may emerge weeks, months, or years after “successful” LASIK.

9. Rehabilitation options after LASIK are limited

LASIK is irreversible, and treatment options for complications are extremely limited. Hard contact lenses may provide visual improvement if the patient can obtain a good fit and tolerate lenses. The post-LASIK contact lens fitting process can be time consuming, costly and ultimately unsuccessful. Many patients eventually give up on hard contacts and struggle to function with impaired vision. In extreme cases, a corneal transplant is the last resort and does not always result in improved vision.

10. Safer alternatives to LASIK exist

Some leading surgeons have already abandoned LASIK for surface treatments, such as PRK, which do not involve cutting a corneal flap. It is important to remember that LASIK is elective surgery. There is no sound medical reason to risk vision loss from unnecessary surgery. Glasses and contact lenses are the safest alternatives.

 
Flap Studies & Articles PDF Print E-mail
Saturday, 30 January 2010 00:00

These quick-links will provide you faster access to the studies & articles provided: 

Accidental self-removal of a flap - a rare complication of LASIK surgery - - To report a rare complication in which the patient accidentally removed the LASIK corneal flap.

LASIK Flap Only 2.4% as strong as Normal Cornea - The human corneal stroma typically heals after LASIK in a limited and incomplete fashion; this results in a weak, central and paracentral hypocellular primitive stromal scar that averages 2.4% as strong as normal corneal stroma.

Traumatic corneal flap dislocation one to six years after LASIK in nine eyes with a favorable outcome - To report our experience treating eye trauma after LASIK refractive surgery.

Comparison of residual stromal bed and flap thickness in primary and repeat LASIK in myopic patients - To compare the change in residual stromal thickness and flap thickness between primary laser in situ keratomileusis (LASIK) and repeat LASIK in myopic patients.

Central Flap Necrosis After LASIK With Microkeratome and Femtosecond Laser Created Flaps - To report nine cases of severe central flap inflammation and necrosis after LASIK.

Flap Displacement during Vitrectomy 24 months after LASIK - “The LASIK flap never heals… the LASIK flap can be easily dislodged from simple contact with the eye such as a finger poke.”

Traumatic flap displacement and DLK after LASIK - Traumatic flap displacement and subsequent diffuse lamellar keratitis after laser in situ keratomileusis.

Late-onset flap folds and partial dehiscence of flap - Late-onset repetitive traumatic flap folds and partial dehiscence of flap edge after laser in situ keratomileusis.

Late traumatic dislocation of LASIK flaps  (1) - A case of traumatic flap displacement with a fingernail injury four years after LASIK is reported.

Late traumatic dislocation of LASIK flaps  (2) - The second patient had a blunt trauma that caused a dislocation of the flap.

Flap tearing during lift-flap LASIK retreatment - This report suggests that flaps with margins near the limbus or a corneal pannus may be prone to an earlier and stronger healing process at the edge that may lead to a flap tear during LASIK retreatment.

Precision of flap measurements for LASIK in 4428 eyes - Flap thickness varies significantly depending on the microkeratome used. Factors that influence flap thickness are primarily corneal thickness, patient age, preoperative keratometry, preoperative refraction including astigmatism, and corneal diameter.

Predictability of corneal flap thickness in LASIK using three different microkeratomes - Corneal flap thickness tended to be considerably thinner than expected on both eyes using the ACS and Hansatome.

Inaccurate Flap Cut - Here is a case report of a woman who developed ectasia following LASIK due to in accurate flap cut.

Late traumatic displacement of LASIK flaps - Laser in situ keratomileusis corneal flaps are vulnerable to traumatic dehiscence and dislocation, which can occur more than 2 years after the procedure.

Traumatic flap dislocation 4 years after LASIK - The patient was examined 5 days after being struck in the face and found to have a flap dislocation.

Mismatch between flap and stromal areas after LASIK as source of flap striae - Excess flap area may cause striae because of wrinkling.

Uveitis-associated flap edema and lamellar interface fluid collection after LASIK - To report two cases of corneal pathology associated with anterior uveitis after LASIK.

Noninflammatory flap edema after lasik associated with asymmetrical preoperative corneal pachymetry - To report persistent unilateral flap edema following LASIK in patients with asymmetrical central corneal thickness.

Evaluation of corneal flap dimensions and cut quality using the SKBM automated microkeratome - To evaluate flap dimensions and cut quality with repeated blade use of the automated Summit Krumeich-Barraquer microkeratome (SKBM [LadarVision])

Flap-related complications present challenges for surgeons

Surgeons review some common flap-related problems and how to handle them.

By Amar Agarwal, MS, FRCS, FRCOphth; Jairo Hoyos, MD; Melania Cigales, M

Flap-related problems after LASIK are a concern for any refractive surgeon. Common causative factors are inadequate suction, microkeratome malfunction and corneal curvature anomalies. This article reviews some common complications and ways to avoid or manage them.

Read the FULL ARTICLE

Microstriae

 

Quote:  Microstriae are very faint, small, disorganized, superficial wrinkles in the LASIK flap. Unlike macrostriae, which result from the flap’s slippage, microstriae are produced by the mechanical forces of a LASIK flap...

Traumatic late flap dehiscence and Enterobacter keratitis following LASIK - To report a case of traumatic flap dehiscence and Enterobacter keratitis 34 months after LASIK.

Flap interface particles are another finding whose clinical significance is undetermined.

A Finnish study found that particles of various sizes and reflectivity were clinically visible in 38.7% of eyes examined via slit lamp biomicroscopy, but apparent in 100% of eyes using confocal microscopy.

Some patients have reported large chunks of metal in their corneas after lasik.

Watch a video of a confocal exam of another LASIK patient with an extraordinary amount of metallic debris from the LASIK microkeratome blade.

LASIK Blade Leaves Metal Under Flap

LASIK flap disintegrates during lifting

Read more...
 
Dry Eye Studies & Articles PDF Print E-mail
Friday, 29 January 2010 00:00

Dry Eye After LASIK - The risk of chronic dry eye after LASIK was significantly higher in Asian eyes. Contributing factors could include racial differences in eyelid and orbital anatomy, tear film parameters and blinking dynamics and higher attempted refractive corrections in Asian eyes.

Chronic dry eye and regression after LASIK for myopia - The risk for refractive regression after LASIK was increased in patients with chronic dry eye.

The incidence and risk factors for developing dry eye after myopic LASIK - To determine the incidence and risk factors after myopic LASIK.

Autologous Serum Eye Drops for dry eye after LASIK - To evaluate the efficacy of these drops for dry eye after LASIK in a prospective, randomized study. 

Symptoms of dry eye and recurrent erosion syndrome after refractive surgery - These symptoms occurred commonly after excimer laser procedures but were significantly more common, more severe, and more prolonged after PRK.

Dealing With Dry Eye - An article written for FDA Consumer magazine.

Dry Eye and Corneal Sensitivity After High Myopic LASIK - To assess subjective symptoms and objective clinical signs of dry eye and investigate corneal sensitivity after high myopic LASIK.

 
Pupil Related Studies & Articles PDF Print E-mail
Thursday, 28 January 2010 00:00

Pupil measurement using the Colvard pupillometer and a standard pupil card with a cobalt blue filter penlight - To compare scotopic pupil measurements obtained with a Colvard pupillometer with measurements taken with a printed pupil gauge and penlight with a cobalt blue filter attachment in mesopic and scotopic luminance.

Influence of pupil and optical zone diameter on higher-order aberrations after wavefront-guided myopic LASIK - To investigate the influence of pupil and optical zone (OZ) diameter on higher-order aberrations (HOAs) after myopic wavefront-guided laser in situ keratomileusis (LASIK)

Pupillary Dilation

1) Pupillary dilation from 3 to 7 mm in post-refractive surgery patients found to cause 28- to 46-fold increase in aberrations! - Both photorefractive keratectomy and laser in situ keratomileusis increase the wavefront aberrations of the cornea and change the relative contribution of coma- and spherical-like aberrations.

2) Pupillary dilation from 3 to 7 mm in post - PRK patients found to cause 25-to 32-fold increase increase in aberrations! - After surgery, the same dilation resulted in a 25- to 32-fold increase in the photorefractive keratectomy group and a 28- to 46-fold increase in the laser in situ keratomileusis group.

Pupil Size

Pupil size and night vision disturbances after LASIK for myopia. - Large pupil size measured preoperatively is correlated with an increased frequency of subjectively experienced post-LASIK visual disturbances during scotopic conditions.

Large pupils lead to night vision problems, physicians suggest

SOURCE

 

EyeWorld

November, 2005

Excerpt:

While some studies have suggested pupil size has little to no effect on nighttime vision post-refractive surgery, some ophthalmologists point to new evidence that there is a correlation.

“If you compare patients of the same prescriptions, the larger the pupil size, the bigger the chance that they’re going to have more night vision problems,” said William B. Trattler, M.D., Center for Excellence in Eye Care, Miami.

To back up his assertion, Dr. Trattler performed his own studies, one of which included 119 myopic eyes that underwent LASEK or PRK with either a standard VISX (Advanced Medical Optics, Santa Ana, Calif.) Star S3 or S4 laser.

Using a Larson Glarometer, he found that the radius of starbursts was greater in patients with large pupils compared with those in patients with small ones. Dr. Trattler presentedthe results at the most recent ASCRS•ASOA Symposium & Congress. The Larson Glarometer does not have a corporate manufacturer yet. It was developed and is distributed by Bruce Larson, M.D., Hinsdale, Ill.

Meanwhile, James Salz, M.D., clinical professor of ophthalmology, University of Southern California, Los Angeles, also believes large pupils can lead to night vision complaints after refractive surgery.

“The larger the pupil size, the greater the aberrations will be,” said Dr. Salz.

Pupil diameter changes and reaction after posterior chamber phakic intraocular lens implantation - To compare the different aspects of pupil constriction before and after the implantation of an implantable contact lens (ICL).

Effect of pupil size on visual function under monocular and binocular conditions in LASIK and non-LASIK patients - To compare binocular and monocular vision in patients treated with laser in situ keratomileusis (LASIK) and in non-LASIK patients.

Read more...
 
Corneal Studies & Articles PDF Print E-mail
Wednesday, 27 January 2010 00:00

Wound healing in the cornea: a review of refractive surgery complications and new prospects for therapy - The corneal wound healing response is of particular relevance for refractive surgical procedures since it is a major determinant of efficacy and safety. The purpose of this review is to provide an overview of the healing response in refractive surgery procedures.

Long-term corneal keratoctye deficits after photorefractive keratectomy and LASIK - To measure changes in keratocyte density up to 5 years after photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK).

Estimation of true corneal power after keratorefractive surgery in eyes requiring cataract surgery: BESSt formula - To describe a new formula, BESSt, to estimate true corneal power after keratorefractive surgery in eyes requiring cataract surgery.

Considerations of glaucoma in patients undergoing corneal refractive surgery - Corneal thickness, which is modified during corneal refractive surgery, plays an important role in monitoring glaucoma patients because of its effect on the measured intraocular pressure.

Corneal Keratocyte Deficits After PRK and LASIK - To measure changes in keratocyte density up to 5 years after PRK and LASIK.

Effective corneal refractive diameter as a function of the object tangent angle in visual space - To determine whether the currently accepted method of selecting a minimum optical zone diameter for laser refractive surgery that is equal to or slightly greater than the dark-adapted pupil diameter provides a sufficient diameter of corneal surface to focus light arising from objects in the paracentral and peripheral visual field.

Evaluation of Corneal Sensitivity to Mechanical and Chemical Stimuli After LASIK: A Pilot Study - To evaluate the effect of laser in situ keratomileusis (LASIK) on corneal sensitivity, nerve morphology, and tear film characteristics.

Changes in corneal thickness and curvature after different excimer laser photorefractive procedures and their impact on intraocular pressure measurements - To analyze the changes in central corneal thickness (CCT) and curvature before and after different excimer laser photorefractive procedures and their possible impact on intraocular pressure (IOP) estimations with Goldmann applanation tonometry.

Effect of Corneal Curvature and Corneal Thickness on the Assessment of Intraocular Pressure Using Noncontact Tonometry in Patients After Myopic LASIK Surgery - To evaluate the effect of corneal curvature and corneal thickness on the assessment of intraocular pressure (IOP) using noncontact tonometry (NCT) in patients after myopic LASIK surgery.

Failed LASIK Depleting Supply Of Donor Corneas - Optometrist specializing in post-refractive surgery disaster claims that FAILED LASIK EYE SURGERY IS DEPLETING SUPPLY OF DONOR CORNEAS.

Epidemic of Corneal Weakening After Refractive Surgery - Here is an excerpt and link to a comment posted by Optometrist Dr. Greg Gemoules who specializes in the treatment of patients damaged by refractive surgery by fitting them with rigid gas permeable contact lenses.

Effect of Corneal Curvature and Corneal Thickness on the Assessment of Intraocular Pressure Using Noncontact Tonometry in Patients After Myopic LASIK Surgery -  Even if a residual corneal bed of 300 microm or thicker is preserved, anterior bulging of the cornea after LASIK can occur.

Structural Analysis of the Cornea Using Scanning-Slit Corneal Topography in Eyes Undergoing Excimer Laser Refractive Surgery - Myopic PRK and LASIK induce significant forward shifts of the cornea, which are not true corneal ectasia.

Permanent Disease Changes Present in all Post-LASIK Corneas! - Permanent pathologic changes were present in all post-LASIK corneas. These changes were most prevalent in the lamellar interface wound. These changes along with other pathologic alterations in post-LASIK corneas may change the functionality of the cornea after LASIK.

Corneal Nerve Damage Continues to Increase years 2-3 after LASIK - Both subbasal and stromal corneal nerves in LASIK flaps recover slowly and do not return to preoperative densities by 3 years after LASIK.

Critical thoughts on current laser surgery of the cornea (1995) - If we look at refractive surgery, especially laser photoablation, in the context of the needs for ophthalmic care of the whole world, then this type of surgery is out of proportion.

Theoretical Elastic Response of the Cornea to Refractive Surgery: Risk Factors for Keratectasia - "In particular, a forward shift and an increase in power of the posterior surface was predicted for myopic LASIK, in agreement with previous experimental findings." 

Cohesive tensile strength of human LASIK wounds with histologic, ultrastructural, and clinical correlations - The human corneal stroma typically heals after LASIK in a limited and incomplete fashion; this results in a weak, central and paracentral hypocellular primitive stromal scar that averages 2.4% as strong as normal coeneal stroma.

Pathologic findings in postmortem corneas after successful LASIK - Permanent pathologic changes were present in all post-LASIK corneas. These changes were most prevalent in the lamellar interface wound. These changes along with other pathologic alterations in post-LASIK corneas may change the functionality of the cornea after LASIK.

Ex vivo confocal microscopy of human LASIK corneas with histologic and ultrastructural correlation - Confocal microscopy, along with histologic and ultrastructural correlations, demonstrated that the most prevalent alterations in the centers of LASIK corneas were a slightly thickened epithelium caused by focal basal epithelial cell hypertrophic modifications, random undulations in Bowman's layer over the flap surface, and a variably thick hypocellular primitive stromal interface scar.

Corneal reinnervation after LASIK: prospective 3-year longitudinal study - Both subbasal and stromal corneal nerves in LASIK flaps recover slowly and do not return to preoperative densities by 3 years after LASIK.

Progression to end-stage glaucoma after LASIK - 2 patients, one a glaucoma suspect because of family history and the other with juvenile glaucoma.

Steroid-induced glaucoma after LASIK associated with interface fluid - To report the ocular manifestations and clinical course of eyes developing interface fluid after LASIK.

Biomechanical modeling of refractive corneal surgery - A biomechanical study before surgery is therefore very convenient to assess quantitatively the effect of each parameter on the optical outcome.

Confocal Microscopy of Corneal Flap Microfolds After LASIK - To describe the morphological characteristics of microfolds that appear at the corneal flap after LASIK, as seen under confocal microscopy.

Objective method to measure corneal clarity before and after LASIK - To develop, evaluate, and use an objective method to determine the effect of LASIK on corneal clarity.

Histopathology of corneal melting associated with diclofenac use after refractive surgery - To describe the histopathology of the cornea in 3 cases of corneal melting associated with diclofenac therapy after refractive surgery procedures.

Central corneal iron deposition after myopic LASIK - To describe central corneal iron deposition after myopic LASIK.

Corneal ectasia after LASIK in patients without apparent preoperative risk factors - To evaluate patients who developed ectasia with no apparent preoperative risk factors.

Interface Corneal Edema Secondary to Steroid-induced Elevation of Intraocular Pressure Simulating DLK - To describe interface corneal edema secondary to steroid-induced elevation of intraocular pressure (IOP) following LASIK.

Delayed Ectasia Following LASIK With No Risk Factors: Is a 300-µm Stromal Bed Enough? - To report a case of ectasia occurring >4 years following LASIK with no risk factors and a residual stromal bed >300 µm.

Steroid glaucoma after laser in situ keratomileusis - A steroid-induced glaucoma may develop after bilateral laser in situ keratomileusis (LASIK)  with normal intraocular pressure in applanation tonometry.

Keratocytes' Density Remains Low After Refractive Surgery  - According to a paper presented this month at the 6th International Congress on Advanced Surface Ablation and SBK, keratocytes' density decreases substantially in the anterior stroma of  refractive surgery patients during the first postoperative year and remains low for several years.

Risk Assessment for Ectasia after Corneal Refractive Surgery - To analyze the epidemiologic features of ectasia after excimer laser corneal refractive surgery, to identify risk factors for its development, and to devise a screening strategy to minimize its occurrence.

More on the cornea...

Read more...
 
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