September 14, 1999

Mr. Brent Hanson
2007 Teasley Lane #118
Denton, Texas 76205

Dear Mr. Hanson,

I received your letter and follow-up from Dr. Foley with respect to your left eye. In your letter you stated that you wished to have a letter on file that gave you blanket coverage for future technology and corrections at TLC. I cannot offer you this as I had told you in my original letter, I am not prepared to live up to the personal statements made by Dr. Ray Stein. Even today, with the technology that I have available, I would never make such a statement to any patient who had the severity of astigmatism that you originally had.

This is especially true since you had PRK on a repeated basis in that eye as well. As I stated, I would do my very best to try and maximize your potential with what we had available and that is what we have done. You started off with approximately 6 diopters of astigmatism in your left eye with 9 diopters of total myopia, both in the most severe 1% of the world. Your astigmatism is in fact in the most severe 1% of the most severe 1% of the world. This is like being 7 feet tall and therefore such blanket statements are really looked down upon by surgeons such as myself.

While we have certainly continued to care for you at no charge and I had performed a mixed astigmatism LASIK enhancement again at no charge, we have been able to bring you to a very mild degree of astigmatism of 1 diopter. We were also fortunate not to have any complications with any loss of best corrected vision. Furthermore, your uncorrected vision is better than 20/30 at present, however, it is entirely dependent upon your healing process as to whether you remain stable or whether you encounter problems with your healing. As I stated, one of the risks of performing LASIK, which was your only alternative for a correction of a PRK problem, is that one may reactivate haze and you have been followed for this. I have sent Dr. Foley further directions with respect to placing you on drops should PRK haze begin to develop.

As I told you, Dr. Stein had written to the College of Physicians and Surgeons of Ontario stating that he wanted to be the surgeon of record and continue care for his patients. Clearly, this is not the case. I had asked you to write a letter to the College stating that he was not prepared to continue your care.

Dr. Stein, in all of his advertisements, has stated that he is a world-renowned expert who has performed thousands of LASIK and PRK procedures and has completely up to date technology available to him, certainly everything I have available to me in Canada. He has also authored textbooks and I know him to be a good person on a personal level. If you are looking for him to continue to offer his services on an endless basis for repeated surgery to achieve results that are 20/20 that he originally guaranteed you, then you will have to go back to him.

You are certainly seeing better than 90% at the present moment in time and this would be considered a superb result by any standards, including those of the FDA. While this may not be exactly what you hoped for, I would be extremely reluctant to treat you further and I would absolutely not be able to provide you vath a letter stating what you had desired.

Once again, I hope you understand my position. I think that you would agree that everyone at TLC is certainly trying to please you and make you happy which is our ultimate goal. Once again, I would ask you to either write a letter to the College of Physicians and Surgeons or contact Dr. Stein directly and ask him to live up to his personal pledge to you. We will certainly continue to follow you at TLC Arlington and do our best.

I hope this meets with your satisfaction.

Warmest personal regards,

Jeffery J. Machat, MD FRCSC DABO
TLC Medical Director

CC:      Dr. Foley - TLC Arlington
            Dr. Kerzner - TLC York Mills

            College of Physicians and Surgeons of Ontario 80 College Street
            Toronto, Ontario Canada M5G 2E2