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Medical Forum / General / Vision / May 2005Have requirements changed for lasik?
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 i think i saw something about this in http://fridaghitis.blogspot.com/ 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. > Phyllis, > [quoted text clipped - 5 lines] > their acuity before surgery with glasses is the combination of two > effects. 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. > One is the continued advancement of the technology and techniques > employed by refractive surgeons. This includes surgeon experience. [quoted text clipped - 3 lines] > 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 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. I just think that standards relaxed, and that some relative contraindications became ignored along with unilateral surgeries. DrG |
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