How
many on this chat line feel as I do that so called plaintiffs medical experts
are often "medical whores" and are a disgrace. I say this with the
knowledge that some feel that prostitution should be legalized.
Robert I. Schnipper, M.D.
Jacksonville Eye Center
2001 College St.
Jacksonville, Fl. 32204
800 223 3038
rismd@attbi.com
From: kenneth lipstock <kdloph@yahoo.com>
Subject: Laser vision correction public relations ISRS.net
Why doesn`t an organization such as ISRS get the various competing excimer laser
manufacturers together (or at least those that might be able to afford it) to
start a PR campaign in favor of laser vision correction. It could be something
like the dairy industry has done with the Got Milk? ads. I think most of us
would agree that the penetration of lvc in the general population could and
should be way higher. We all could list lots of reasons why it isn`t, but I`d
just like to know what you all think about this suggestion? I personally feel
that lvc is very affordable and extremely safe when performed by a skilled and
conscientious surgeon; I think a "non-partisan" ad campaign could help
to clarify an incredible amount of misinformation out there. Ken Lipstock Richard
Foulkes MD <foulkes52@mac.com> wrote:
Randy is the patient symptomatic of the displacement? With the softness of
the placement of the IOL in this deep myope that is sulcus fixed and yaged
you may be after your tail! If they were not symtomatic the simple and
perhaps safest fix would be the use of your 217. If you were squimish
about the keratome do PRK. My experience here has been excellent. Rick
Foulkes
---
You are currently subscribed to isrsnet as: kdloph@yahoo.com
Subject:
[isrsnet] Re: Good and Bad lawyers
To: "ISRSNet" <isrsnet@list.isrs.org>
I agree that until recently, I had a very good opinion of plaintiff's attornies.
The ones whom I had run into up to that point in time would only takes cases
that had damage that they could realisticly prove was due to treatment by a
doctor outside of the standard of care. In the past, I have received phone
called or memos from attornies telling me that they had reviewed a patient of
mine with an honest expert and found no fault with my care. Needless I was
please with the lawyers.
Such experiencec had given me a very respectful opinion of lawyers in general,
despite what was being said about them by others. . But I'm afraid that I came
to the attention of a single "rogue lawyer" who apparently believes
that he will build a career as a sort of King of Torts at my expense.I now know
that all lawsyers are not decent. This one has dogged me for the past 1 1/2
years , with newspaper and radio AS WELL AS INTERNET ADS SEEKING PATIENTS OF DR
DELLO RUSSO WHO HAVE HAD " BAD LASIK RESULTS" Placed an article in our
main paper with totally false allegations about an ophthalmologist who I was
helping to regain his medical license in association with the licensing board,
as well as the NY Post and News radio 880 am. ( Dr Guyton, pay attention ).
I didn't mean to go on about with my troubles with a specific lawyer, but we can
never lose sight that there are good lawyers and there are bad ones. Also I will
admit that a high profile laser surgeon must be willing to take the good with
the bad, so I am totally responsible for for tempting the bad lawyers.
Needless to say these bad lawyers are able to find the bad doctors who are
failed in their chosen profession and are anxiuos to help to pull down the
" successfull" surgeon. Rogue lawyers and expert whores ! a bad duo.
Speaking of whores, I have seen many ,many patients who have been injured 's by
surgeons and have yet to point a finger despite what a plaintiff's attorney
offers. even concerning doctors who have been unkind to me ( Dr C Silverman and
the late Dr Burke ). It is not only not in my nature to bad mouth others but I
also feel that my obligation is to help the patient as though they werre not
looking for my reprot to a lawyer. No laeyer gets a useful report from me, not
even for Dr C Silverman.
Why help foster a law suite that will not help the patient's eye condition ? In
reality , I feel that I am saving the patient at leasthree years of obsessing
about the wrong that was done to them and save them from being crushed when they
lose a frivolous case.
Another effect of so much attention by the bad guys is that it makes a surgeon
less desirable to a malpractice carrier. When I began to respond to the doctor
who feels that all lawyers are not rogues, I did not intend to bare all my warts
in cyberspace, but that is the way the real world does work for some surgeons
deemed to be " public figures" Are you still paying attention Dr
Guyton ? If we we choose to live by the sword , then we must be prepared to die
by the sword.
I think that I have covered about all important aspercts of malpractice, for
those who are young and unaware of all the various effects of being sued
frivolously. You become a part of the legal system in an arena controled
entirely by lawyers. You have no rights. You're a victim .I invite rwesponses.
Joe Dello Russo ---
Date:
Sat, 5 Oct 2002 01:45:07 EDT
Subject: [isrsnet] Re: lift or cut
Just today we lifted a flap created for ALK in 1992. We have lifted one made
13 years previously(my sister). Lifting a previous flap is almost always less
risky than cutting a new one. We would almost never cut a new flap unless
there was a problem with the original one.
Dave Dulaney
Phoenix, AZ
Subject:
[isrsnet] Re: lift or cut
To: "ISRSNet"
In a message dated 10/4/2002 2:49:55 PM Eastern Standard Time,
pannulaserinstt@msn.com writes:
i have cut and made ribbons of the previous flap.i have lifted and put
buttonholes.however now my choice is lifting.i use my laser microscope to
mark the edge of the flap with a sinsky hook and start lifting the flap with
a jewelers forcepsand finish with sinsky hook.i have lifted flaps upto 7
years after surgery.i do grade my flaps at the initial surgery to help me
decide what iwill do the next time.singh pannu.
Because of occurrences like Dr. Pannu described, I do not lift or recut. I do
Lasek enhancements of Lasik cases.
Johnny Gayton ---
Date:
Thu, 10 Oct 2002 19:07:03 -0700
To: "ISRSNet"
From: "Michael T. Furlong, MD" <mfurlong@furlong.org>
Subject: [isrsnet] Re: lift or cut
Johnny,
I'm interested in your technique when using LASEK over LASIK for enhancements.
I'm not sure if you used a superior hinge keratome, but when using the microhoe,
don't you have to sweep the loosened epithelium centrally, then superiorly? I'd
be concerned that the flap would likely shift/ develop wrinkles/ or at least
you'd see some DLK postop. How does your technique account for this?
Also, any cases of haze?
Mike
At 08:19 AM 10/10/02 -0400, you wrote:
In a message dated 10/4/2002 2:49:55 PM Eastern Standard Time,
pannulaserinstt@msn.com writes:
i have cut and made ribbons of the previous flap.i have lifted and put
buttonholes.however now my choice is lifting.i use my laser microscope to
mark the edge of the flap with a sinsky hook and start lifting the flap with
a jewelers forcepsand finish with sinsky hook.i have lifted flaps upto 7
years after surgery.i do grade my flaps at the initial surgery to help me
decide what iwill do the next time.singh pannu.
Because of occurrences like Dr. Pannu described, I do not lift or recut. I do
Lasek enhancements of Lasik cases.
Johnny Gayton ---
Date:
Wed, 02 Oct 2002 20:19:23 -0700
To: "ISRSNet"
From: "Michael T. Furlong, MD" <mfurlong@furlong.org>
This certainly is a dilemma. On one hand, it is "ethical" to give an
expert opinion to a plaintiff's attorney when the question of malpractice is
raised. On the other, it can certainly strain relationships between
ophthalmologists.
I have a question, though. For those of you out there that routinely agree to
review charts and give expert opinions do you:
1) do this only in defense?
2) do this only for plaintiffs?
3) do this for both?
At 12:58 PM 10/2/02 +1000, you wrote:
I
note that one of our members understands it is not the ligitation lawyer who is
the only major culprit generating plaintiff ligitation. Each action requires a
plaintiff expert MDto work with the attorney and ...who is willing to dump on
colleague
Kim
Frumar
Northern Laser Vision Centre
Suites #206-207
13 Spring St
Chatswood NSW 2067 Australia
Phone :+61-2-9410-1011
FAX:+61-2-9415-2314
e-mail: info@nlvc.com.au ----- Original
Message ----- From: NCCaro@aol.com To: ISRSNet
Sent: Friday, September 27, 2002 9:09 AM Subject: [isrsnet] Re: malpractice
insurance
It
is better and cheaper to go self-insured.. Over time all carriers will pull out
of the refractive field due to the high litigation rate.
It is the big shots at the Academy that are the major experts against refractive
surgeons--trying to garnish a living on us and trying to eliminate us as
competition.
What these ediots don't understand is that they too will not find insurance.
By-BY to the LASIK grravytrain.
---
From:
Jayne Weiss jweiss@med.wayne.edu
Subject: [isrsnet] Re: malpractice insurance
Date: Fri, 4 Oct 2002 12:25:17 -0400
Let's be honest. We all know there is malpractice and have cared for patients
who have been its victims. Why don't these patients deserve an adequate defense?
Why shouldn't those who are doing things they shouldn't and harming patients in
the process have to account for their actions.
HOWEVER, what we all agree on is: we would like to eliminate the frivolous
lawsuit and the paid testimony of the plaintiff's "expert" when the
patient had a good result but was not satisfied or when there was no negligence
but a known potential complication occurred anyway.
JSW
-----Original Message-----
From: Michael T. Furlong, MD [mailto:mfurlong@furlong.org]
Sent: Wed 10/2/2002 11:19 PM
To: ISRSNet
Cc:
Subject: [isrsnet] Re: malpractice insurance
This certainly is a dilemma. On one hand, it is "ethical" to give an
expert opinion to a plaintiff's attorney when the question of malpractice is
raised. On the other, it can certainly strain relationships between
ophthalmologists.
I have a question, though. For those of you out there that routinely agree to
review charts and give expert opinions do you:
1) do this only in defense?
2) do this only for plaintiffs?
3) do this for both?
At 12:58 PM 10/2/02 +1000, you wrote:
I note that one of our members understands it is not the ligitation lawyer who
is the only major culprit generating plaintiff ligitation. Each action requires
a plaintiff expert MDto work with the attorney and ...who is willing to dump on
colleague
Kim Frumar
Northern Laser Vision Centre
Suites #206-207
13 Spring St
Chatswood NSW 2067 Australia
Phone :+61-2-9410-1011
FAX:+61-2-9415-2314
e-mail: info@nlvc.com.au
----- Original Message -----
From: NCCaro@aol.com
To: ISRSNet <mailto:isrsnet@sand.lyris.net>
Sent: Friday, September 27, 2002 9:09 AM
Subject: [isrsnet] Re: malpractice insurance
It is better and cheaper to go self-insured.. Over time all carriers will pull
out of the refractive field due to the high litigation rate.
It is the big shots at the Academy that are the major experts against refractive
surgeons--trying to garnish a living on us and trying to eliminate us as
competition.
What these ediots don't understand is that they too will not find insurance.
By-BY to the LASIK grravytrain. ---
From: DLong911@aol.com
Date: Sat, 5 Oct 2002 13:38:09 EDT
Subject: [isrsnet] Re: malpractice insurance
To: "ISRSNet"
Tort reform will be very slow to evolve until there are 30-40 doctors in
Congress and 10 doctors in the Senate, enough to have a voting block that the
party leaders must please. It's time to stop whining and financially support
the doctor candidates across the country, especially the 4 ophthalmologists
running for office right now. A $1000 contribution would be a good
investment if we could get this malpractice mess under better control. All 4
candidates are struggling financially with 1 month to go. It is time for us
all to help them and help ourselves.
From:
"Weiss, Jayne" <jweiss@med.wayne.edu>
Subject: [isrsnet] RE: SKBM recall - Be sure to look at the New Amadeus -
Bursting...
Date: Tue, 10 Dec 2002 13:30:48 -0500
I
disagree with your statement "the FDA approves a device an state that it is
safe". The Panel on Ophthalmic Devices votes on whether a device shows
REASONABLE safety and efficacy. We all know that nothing is risk free and the
process of FDA approval includes these considerations.
Jayne
S Weiss MD
Chair,
Panel of Ophthalmic Devices
-----Original
Message-----
From: JoeDelloRussoMD@aol.com [mailto:JoeDelloRussoMD@aol.com]
Sent: Wednesday, November 27, 2002 12:34 AM
To: ISRSNet
Subject: [isrsnet] RE: SKBM recall - Be sure to look at the New Amadeus -
Bursting...
WE ALL KNOW THAT THERE IS NO RISK-FREE PROCEEDURE. THERE IS VARIOUS DEGREES OF
SAFETY. THE FDA APPROVES OF A DEVICE AND STATES "THAT IT IS SAFE".
WELL WE ALL KNOW THAT IS NOT LITERALLY TRUE . THAT WHAT THE FDA MEANS IS THAT
THE DEVICE IS ": SAFE ENOUGH", RECOGNIZING AN ACCEPTABLE PERCENTAGE OF
SIDE EFFECTS AND COMPLICATIONS.
IF I REMEMBER ENOUGH GRAMMER, THE WORD "SAFEST" IS SIMPLY A
COMPARATIVE TERM. IT IS NOT AN ABSOLUTE TERM . IT IS NOT THE SAME AS
"SAFE" THAT WOULD IMPLY 100 % SAFE. SO REMEMBER IF A SURGEON FEELS
THAT THE TECHNOLOGY IS THE "SAFEST" , HE IS ALLOWING FOR RISK, JUST
LESS THAN THE STANDARD WHATEVER.IN HIS OPINION. I FEEL WITHOUT A DOUBT THAT
INTRALASE IS THE SAFEST KERATOME AND WILL BECOME THE GOLD STANDARD . REGARDLESS
OF THE PRICING , INTRALASE IS NOT GOING AWAY. LIKE EVERY NEW ADVANCE THAT WE ARE
NOT PERESONALLY USING, THERE HAS TO BE SOME DOUBT ABOUT THE CLAIMS THAT ARE
BEING MADE ABOUT IT'S SUPERIORITY (COMPARATIVE TERM ) TO WHAT WE ARE DOING.
I SAY IT IS SAFEST BECAUSE IT IS IN MY EXPERIENCE., AFTER TWO DAYS OF USING THE
LASER, I REFUSED TO USE A BLADE AGAIN. I STILL HAVE ONE MORE HANSATOME FOR SALE
( FOR ANYONE NEEDING ONE - 201 538 3846 AND ASK FOR MIKE).
MY FELLOW LEARNED HOW TO USE THE INTRALASE ALONG WITH ME. HE WAS HAPPY TO GIVE
UP THE BLADE.HE HAS MADE SEVERAL PRESENTATIONS ON INTRALASIK . HE SAYS THAT THE
TALK THAT HE HEARS ABOUT BLADE KERATOMES IS LIKE LISTENING TO DISCUSSIONS ABOUT
WHICH BUGGY WHIP IS BETTER.
MY SON JOINED MY PRACTICE IN JULY. HE DOES NOT KNOW HOW TO USE A BLADE . ONE
MIGHT SAY THAT HE SHOULD , BUT WHY PUT PATIENTS AT RISK SO HE CAN LEARN A
TECHNIQUE THAT I NO LONGER USE.MYSELF.
SOMEONE WROTE THAT I USED A INFLAMMATORY WORDS IN MY "BURSTING THE BUBBLE
" E-MAIL. I WOULD RATHER THINK THE STATEMENT TO BE RATHER COLORFUL BUT
HONEST.
PEOPLE SHOULD START TO ACCEPT THAT INTRALASE IS HERE. IT IS NOT GOING AWAY AND
THERE WILL BE SOMEONE USING IT IN YOUR REGION WITHIN THE YEAR AND YOU WILL HAVE
TO CONSIDER WHEN NOT WHTHER YOU WILL LEARN HOW TO USE IT AND HOW TO GET ACCESS
TO ONE.
HAVEN'T WE BEEN DOWN THIS ROAD WITH EVERY ADVANCE IN OPHTHALMOLOGY ?.THERE ARE
EARLY ADAPTERS AND THE LATER ONES. WEREPEAT THE SAME STATEMENTS ON EITHER SIDE
OF THE ISSUE ABOUT THE ADVANCE . ONLY THE NAMES OF THE SPEAKERS ARE DIFFERENT
AND IT IS LATER IN TIME.
THAT'S ENOUGH PONTIFICATING FOR NOW. I'M SURE THAT SOMEONE WILL RESPOND TO THIS
E-PMAIL AND OBJECT TO IT'S CONTENT, RUDE PRESENTATION, OR SIMPLY THE
IMPOLITENESS OF USING ALL CAPS.
JOE ---
From:
kenneth lipstock <kdloph@yahoo.com>
Subject: [isrsnet] Re: metallic foreign body after lasik
To: "ISRSNet" <isrsnet@list.isrs.org>
Johann, have you (or any other online participants) any experience removing a
rusty foreign body from a flap? How would or did you do it. What would a foreign
body drill do to a flap? If you did nothing and left the rust there what could
the infiltrate lead to? Fortunately in my case a few days later the rust was
gone (spontaneously came out without a hint of rust and the local stromal edema
with no infiltrate is slowly resolving...lucky for the patient (and me!). Ken Dr
Johann Kruger <drkruger@iafrica.com> wrote:
Dear Colleague
The
foreign body may lead to a localised late onset lamellar keratitis. This seems
to be the case. Removing the foreign body and antibiotic and local steroids
should solve the problem.
Regards
Dr
Johann Kruger
-----
Original Message -----
From: kenneth lipstock
To: ISRSNet
Sent: Saturday, December 21, 2002 4:25 AM
Subject: [isrsnet] metallic foreign body after lasik
4 month post-op routine lasik patient noted a FB sensation and blurriness
in one eye 3 wks ago, and it gradually resolved over 2 wks. Now he is 20/15 and
comfortable in that eye and has about a .3mm rusty fb just outside the pupillary
center; there is a surrounding .75mm area of stromal edema (full flap thickness)
with no infiltrate; it has reepithelized and has only trace staining late. I
chose to leave it alone. What would you do especially if it had an active toxic
infiltrate and or a persistent epithelial defect? Anyone tried to remove a
foreign body off a flap? Thanks, Ken "Eugenio Cabrera G." <ecg@saludnet.com.co>
wrote:
Mark, if the patients topography and pachymetry are fine, I guess LASIK is a
godd option. Eugenio
---------- Original Message ----------------------------------
From: Mark Ozog
Reply-To: "ISRSNet"
Date: Fri, 13 Dec 2002 16:24:31 -0700
>I am seeing a patient who had PRK elsewhere 8 yrs ago who need
>additional surgery. He is was about a -6 before his PRK to his best
>guess and now he needs -3.50 tune up in one of his eyes. No sign of
>haze. My question is do I do a PRK or Lasik? He prefers lasik for he
>was uncomfortable during his PRK. Any input? Mark Ozog
>
>
>---
>You are currently subscribed to isrsnet as: ecg@saludnet.com.co
>*******************************
>DISCLAIMER: The contents of this message and all messages posted to the
ISRS Listserve ("Content") is to be considered the i Yahoo!
Mail Plus - Powerful. Affordable. Sign
up now --- You are currently subscribed to isrsnet as: drkruger@iafrica.com
******************************* DISCLAIMER: The contents of this message and
all messages posted to the ISRS Listserve ("Content") is to be
considered the individual opinion of the contributor and is for informational
purposes only. Content is provided based on the understanding that ISRS is not
engaged in rendering medical or professional services or advice. Content is
not intended to constitute professional medical advice, diagnosis, or
treatment. ISRS does not recommend, endorse or verify any specific tests,
products, procedures, opinions, or other information that may be mentioned on
the ISRS Listserve. Content does not necessarily represent accepted medical
standards of care. Reliance on any information provided by ISRS, ISRS
employees, others contributing to the ISRS Listserve at the invitation of ISRS,
or other visitors to the ISRS Listserve is solely at your own risk. Neither
ISRS or its agents or representatives can be held liable for any loss or
damage resulting from the use or misuse of any informatio n contained on this
si To unsubscribe send a blank email to %%email.unsub%%
In
a message dated 7/10/2002 6:22:05 AM Pacific Daylight Time, Whitman@keywhitman.com
writes:
Sounds like with a loose goggle fit--the force of the rushing air could have
lifted a weak flap edge and forced air/debris under the flap. I would lift as
soon as possible and debride--even if you can't see much and see what happens.
Jeffrey Whitman, M.D. Dallas, Tx
-----Original Message-----
From: Alan Leahey [mailto:acornea@ix.netcom.com]
Sent: Wednesday, July 10, 2002 6:03 AM
To: ISRSNet
Subject: [isrsnet] Skydiving and acute refractive change
44
yo male was -3.25 sph OD and -3.75 sph OS pre-op. Pre op pach was 582 OD and 565
OS and had normal topography by orbscan. Bilateral LASIK with good result.
Uncorrected Va was 20/20- OD and 20/20 OS. MR was + 0.25 sph OD for 20/20 and
plano + 0.25 X 30 for 20/20 OS at 2 weeks with mild dryness OU. His flaps were
in excellent position and no interface debris. He missed his 4 week follow up
because of travel, but reported doing well.
At 7 weeks out he went skydiving. On the drop down, he noticed his goggles on
the right were not fitting correctly and noticed vision getting worse OD during
the fall. When he landed, and removed goggles, he noticed vision was very blurry
OD. He described it as looking thru the bottom of a coke bottle. OS was fine. He
was seen the next day by one of my partners and his VA uncorrected OD was 20/40.
He said the vision had improved from when he first landed. Exam revealed a 3mm
ring of ? airbubbles in the central interface, with some paracentral
debris.(described by our oculoplastics partner). The flap was secure and no
epidefect. This was on Saturday, and he returned yesterday on Monday to see me.
The vision had dropped to 20/100 uncorrected OD. The flap looked normal, but
inferior .5mm area of debris vs early epithelial cells(but no nests). Nothing in
flap or interface that would account for poor vision by exam.
MR was -3.00 + 3.00 X 007 for 20/80. HCL BC 43.0 over refraction was 20/20- OD.
Orbscan and regular topo showed steepening inferior nasal in a pellucid like
pattern. Topo in OS normal po appearance. Residual corneal thickness 474 OD and
504 OS by orbscan. Patient had 180 flaps with hansatome.
I have not seen anything like this or read about anything similar. Does anyone
have any theories about what happened and the possible management other than
observation for now. Will lifting the flap, irrigating and replacing it help
when there are no folds or irregularities within the cap? Did the force during
free fall cause some change in the flap stromal interface bond?
Alan Leahey, MD
From: "Weiss, Jayne" <jweiss@med.wayne.edu>
I actually think that case proves my point as it sounds like it never was
malpractice.
-----Original Message-----
From: st gee [mailto:stephen2gee@yahoo.com]
Sent: Friday, October 04, 2002 2:35 PM
To: ISRSNet
Subject: [isrsnet] Re: malpractice insurance
Yeah,
well I only think for you to look at the former TLC
head who we all know - now has attempted to retract
his expert testimony in the arizona case.
You get kinda cynical about it - especially if you
knew the surgeron (which I did he was a resident
behind me).
aloha,
stephen
--- "Weiss, Jayne" <jweiss@med.wayne.edu>
wrote:
> Let's be honest. We all know there is malpractice
> and have cared for patients who have been its
> victims. Why don't these patients deserve an
> adequate defense? Why shouldn't those who are doing
> things they shouldn't and harming patients in the
> process have to account for their actions.
> HOWEVER, what we all agree on is: we would like to
> eliminate the frivolous lawsuit and the paid
> testimony of the plaintiff's "expert" when the
> patient had a good result but was not satisfied or
> when there was no negligence but a known potential
> complication occurred anyway.
> JSW
>
> -----Original Message-----
> From: Michael T. Furlong, MD
> [mailto:mfurlong@furlong.org]
> Sent: Wed 10/2/2002 11:19 PM
> To: ISRSNet
> Cc:
> Subject: [isrsnet] Re: malpractice insurance
>
>
>
> This certainly is a dilemma. On one hand, it is
> "ethical" to give an expert opinion to a plaintiff's
> attorney when the question of malpractice is raised.
> On the other, it can certainly strain relationships
> between ophthalmologists.
>
> I have a question, though. For those of you out
> there that routinely agree to review charts and give
> expert opinions do you:
>
> 1) do this only in defense?
> 2) do this only for plaintiffs?
> 3) do this for both?
>
>
>
> At 12:58 PM 10/2/02 +1000, you wrote:
>
>
> I note that one of our members understands it
> is not the ligitation lawyer who is the only major
> culprit generating plaintiff ligitation. Each action
> requires a plaintiff expert MDto work with the
> attorney and ...who is willing to dump on colleague
> Kim Frumar
>
> Northern Laser Vision Centre
> Suites #206-207
> 13 Spring St
> Chatswood NSW 2067 Australia
> Phone :+61-2-9410-1011
> FAX:+61-2-9415-2314
> e-mail: info@nlvc.com.au
>
> ----- Original Message -----
> From: NCCaro@aol.com
> To: ISRSNet <mailto:isrsnet@sand.lyris.net>
> Sent: Friday, September 27, 2002 9:09 AM
> Subject: [isrsnet] Re: malpractice insurance
>
>
> It is better and cheaper to go self-insured..
> Over time all carriers will pull out of the
> refractive field due to the high litigation rate.
>
>
> It is the big shots at the Academy that are the
> major experts against refractive surgeons--trying
> to garnish a living on us and trying to eliminate us
> as competition.
>
>
> What these ediots don't understand is that they
> too will not find insurance.
>
>
> By-BY to the LASIK grravytrain. ---
> You are currently subscribed to isrsnet as:
> info@nlvc.com.au
>
What
is the group's consensus for maximal steepining that would be allowed after
hyperopic lasik. 48? 49? 50?
The case:
31 year old woman with hyperopic astigmatism
UCVA OD 20/60 OS 20/50
Manifest OD +4.24 +1.00 x80 20/20
OS +3.75 +1.25 x 80
Cycloplegic OD +4.75 +1.00 x80
OS +4.00 +1.25 x 80
CCT OD 45.94x 47.43 @90
OS 44.79x 46.85 @80
If one assumes a diopter of steepening for each diopter of hyperopia treated
than I will be steepening her past 50 OD which will possibly/probably decrease
visual quality-pseudokeratoconus.
Any suggestions from this august body?
Jayne S Weiss MD
Kresge Eye Institute
Detroit
-----Original Message-----
From: Richard L. Lindstrom [mailto:rllindstrom@mneye.com]
Sent: Tuesday, March 12, 2002 4:26 PM
To: ISRSNet
Subject: [isrsnet] RE: pupil size Re: peer reviewed modern data
Osama: Thank you for the additional reference. It will help the defense of
the Ophthalmologist I am consulting for. Best. Dick Lindstrom
-----Original Message-----
From: osama omar [mailto:omar_eye@yahoo.com]
Sent: Tuesday, March 12, 2002 7:59 AM
To: ISRSNet
Cc: kera-net@ucdavis.edu
Subject: [isrsnet] RE: pupil size Re: peer reviewed modern data
Dr. Lindstrom let me add one additonal study to Dr.
Schallhorn's. Dr. Trattler please note this is a peer
reviewed article not a citation from the VISX users
manual.
Sam Omar MD
Effect of preoperative pupil measurements on glare,
halos, and visual function after photoastigmatic
refractive keratectomy.
Haw WW, Manche EE.
Department of Ophthalmology, Stanford University
School of Medicine, Stanford, California 94305, USA.
PURPOSE: To prospectively assess the effect of
preoperative variables such as pupil size on glare,
halos, and visual function after photoastigmatic
refractive keratectomy (PARK). SETTING: Department of
Ophthalmology, Stanford University School of Medicine,
Stanford, California, USA. METHODS: Ninety-three eyes
had PARK for primary compound myopic astigmatism.
Preoperative pupil diameters were measured under
scotopic and photopic illuminance conditions.
Postoperatively, patients were evaluated at 1, 3, 6,
9, 12, 18, and 24 months. A regression model was
performed to evaluate the predictive value of
assessing preoperative variables such as pupil
diameter on the development of glare and halos,
contrast sensitivity, and best spectacle-corrected
visual acuity (BSCVA) under scotopic, photopic, and
glare conditions. RESULTS: The greater magnitude loss
of BSCVA under scotopic conditions in the early
postoperative period as well as the slower recovery to
preoperative levels in eyes with larger scotopic pupil
diameters were not statistically significant (P >.05).
An increase in symptoms of glare was related more to
the attempted level of spherical equivalent (SE)
correction than to the pupil size during the first 12
postoperative months (P <.01). The photoablation
dimensions as determined by the attempted level of
astigmatic correction may result in decreases in the
glare BSCVA up to 12 months after PARK (P =.03). At
the 2 year follow-up, pupil diameter under both
scotopic and photopic illuminance conditions was not
predictive of any of the measured outcomes variables.
CONCLUSIONS: An assessment of preoperative pupil size
and the attempted level of both SE and astigmatic
correction may be useful in identifying patients at
risk of developing symptoms or declines in visual
performance after PARK. However, follow-up studies are
indicated to identify variables predictive of poor
visual outcomes following excimer laser refractive
surgery
--- "Richard L. Lindstrom" <rllindstrom@mneye.com>
wrote:
> I have a similar case. Jim Salz provided me with a
> group of references that
> support pupil size as important. You can contact him
> for those references.
> Steve Schallhorn of the Navy just completed an
> objective study that
> concludes pupil size is of minimal importance in
> patient dissatisfaction and
> visual complaints.. His study will be in OSN USA
> edition soon and you can
> reach him in San Diego. This area is a can of worms.
> It is likely not really
> pupil to ablation diameter that really matters but
> the fact that higher
> order aberrations, especially spherical aberration
> go up significantly with
> a larger pupil and with correction of higher
> refractive errors.Dick
> Lindstrom
>
> -----Original Message-----
> From: gmack50 [mailto:gmack50@cox.net]
> Sent: Sunday, March 10, 2002 10:41 PM
> To: ISRSNet
> Subject: [isrsnet] pupil size
>
>
> Anyone who can give me some recent citations/studies
> on pupil size and =
> night
> glare would be appreciated. I am going to be deposed
> as an expert =
> witness in
> a case where the pupil is "supposedly" larger than
> the ablation zone. =
> The
> patient cannot work at night, and will not or has
> refused to try =
> alphagan,
> pilo, glasses and is a contact lens failure patient.
> The plaintiff is
> blaming all symptoms on the pupil/ablation
> disparity. I agree with all =
> these
> comments that pupil size is only one, and possibly
> not the most =
> important
> contributor to night problems, but I need some hard
> studies or something =
> for
> the deposition/trial to back that up. Any info
> anyone has will be
> appreciated. By the way- in this case, there were no
> problems, the day
> vision is 20/20, flap looks fine- the only problem
> is the night vision. =
> It
> is simply a case of "poor result" being labeled as
> malpractice which we =
> will
> be seeing more of, and we must defend against these
> cases!
> Gary Mackman MD
> ---
> You are currently subscribed to isrsnet as:
> rllindstrom@mneye.com
From:
Waynecrewebrown@aol.com
Date: Fri, 1 Nov 2002 23:46:00 EST
Subject: [isrsnet] Re: late flap cut
Thankyou Matthew and David Kent for a logical explanation for what happened
in this case. I had a similar case several months back where I achieved a
very small superficial "flap" well above the visual axis and could not
explain it at the time. Our patient underwent repeat LASIK after 12 weeks and
had an uneventful flap second time around, which supports this theory of an
impropely engaged blade the first time. I had another case where the blade
did not engage or oscillate at all, passing across the entire cornea without
even as much as an abrasion! Needless to say, no matter how good my scrub
nurse is, I now check for blade oscillation before every keratome pass.
Wayne Crewe-Brown
Boots Laser Eye Clinics
U.K.