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Cataract Surgery after LASIK
Like the general population, LASIK patients will develop cataracts
later in life. The altered corneal surface following LASIK prevents
accurate measurement of intraocular lens power for cataract surgery.
This may result in a "refractive surprise" for LASIK patients
following cataract surgery and exposes them to increased risk of repeat
surgeries.

LASIK Results in Loss of Near Vision
Patients are routinely misinformed that they will require reading
glasses after the age of 40 whether they have LASIK or not. Nearsighted
patients who do not have refractive surgery actually retain the ability
to see up close naturally after the age of 40 simply by removing their
glasses. LASIK increases the need for reading glasses by changing the
eye's focus from near to distance. The loss of near vision after
myopic-LASIK affects many daily activities, not just reading. LASIK
patients over the age of 40 may discover they have simply traded one
pair of glasses for another.

VII. PATIENT SATISFACTION

LASIK success is measured by the LASIK industry as uncorrected visual
acuity under bright illumination. Patients seeking vision correction
are most concerned with elimination of glasses or contact lenses, and
are unaware what it means to lose visual quality. Patient surveys
typically show a high level of satisfaction with LASIK. However, an
alarming number of 'satisfied' patients also report symptoms such
as visual disturbances in dim light and dry eye.

In May, 2001, results from a questionnaire completed by PRK and LASIK
patients revealed that 19.5% reported a worsening in functioning, 27.1%
a worsening in symptoms, 34.9% a worsening in optical problems, 33.7% a
worsening in glare, and 41.5% a worsening in driving.27

In one report, researchers suggest that factors such as the Hawthorne
effect and cognitive dissonance may play a role in patient satisfaction
following LASIK.28 The Hawthorne effect favorably influences
patients' survey responses merely because patients are aware that
they are enrolled in a study. Cognitive dissonance is a change in
one's attitude or beliefs to eliminate internal conflict with
negative consequences of an irreversible action.

VIII. NEWER TECHNOLOGIES

Wavefront-guided and wavefront-optimized LASIK
Newer laser technologies were designed to reduce induction of new
aberrations and prevent night vision disturbances. As complications
from current technologies generate bad publicity, pressures to develop
and market alternative technologies emerge. "Real" complication
rates are openly discussed, not when a procedure is popular, but rather
when providers push newer, "improved" technology. The LASIK
industry and LASIK surgeons aggressively promote new technologies as
"safer and more effective", blaming older technologies for past
complications. Although the introduction of wavefront-LASIK was
surrounded by hype, studies have shown that wavefront-guided and
wavefront-optimized LASIK actually increase, not decrease, higher order
aberrations, reducing visual quality in previously untreated eyes.29,30
A recently published review of literature on wavefront-guided LASIK
concludes that evidence does not support claims that wavefront
outperforms conventional LASIK.31 Wavefront, like previous forms of
refractive surgery, fails to deliver on its promises.

Femtosecond laser flap creation (Intralase-LASIK)
Mechanical blade microkeratomes have been linked to flap complications
and damage to the epithelium. The femtosecond laser keratome is
currently promoted as a safer alternative. Studies have shown that the
femtosecond laser produces flaps with smaller deviations from planned
thickness than mechanical microkeratomes. However, it does not reduce
most complications associated with the LASIK procedure and has been
linked to extreme light sensitivity,32 a new complication of this
technology. Femtosecond laser flaps are more difficult to lift than
flaps created with a blade, which may result in a higher incidence of
torn flaps.

The femtosecond laser keratome currently requires longer suction on the
eye than blade microkeratomes to create the LASIK flap. The incidence
of posterior vitreous detachment with blade microkeratomes is high, at
13% overall and 24% for patients with high myopia.33 Increased suction
ring exposure associated with use of femtosecond lasers likely induces
posterior vitreous detachment at even higher rates as well as other
serious complications such as retinal detachment, macular hemorrhage,
retinal vein occlusion, and optic nerve damage following LASIK.

A search of peer-reviewed literature reveals problems associated with
the femtosecond laser such as slipped flaps, interface inflammation,
flap folds, infectious keratitis, corneal stromal inflammation, delayed
wound healing, macular hemorrhage, and gas bubbles in the anterior
chamber after surgery.34-40 The FDA medical device adverse events
database (http://www.fda.gov/cdrh/maude.html) contains numerous reports
involving femtosecond laser keratomes.

IX. CONCLUSION

Patients are denied the whole truth about the negative effects of
LASIK; therefore they are unable to give informed consent. The LASIK
industry has been unresponsive to results of medical research, which
should have resulted in a higher standard of care. Instead, LASIK
surgeons have resisted raising the standard of care in order to
maintain the potential pool of candidates and to protect themselves
from liability.

The American Medical Association endorses certain principles of medical
ethics. One principle states that: "A physician shall uphold the
standards of professionalism, be honest in all professional
interactions, and strive to report physicians deficient in character or
competence, or engaging in fraud or deception, to appropriate
entities." (http://www.ama-assn.org/ama/pub/category/2512.html). The
white wall of silence called for by Dr. McDonald in 1999 violates this
principle.

There has been and continues to be a pattern within the refractive
surgery industry placing patients' interests secondary to financial
interests. Medical doctors are ethically bound to put the best
interests of patients first. LASIK is an unnecessary surgical procedure
that permanently damages the eyes of every patient; therefore it is a
violation of a primary principle of medicine, "First, Do No Harm". As
such, the practice of LASIK should be discontinued.

References

1. Sugar A, Rapuano CJ, Culbertson WW, Huang D, Varley GA, Agapitos PJ,
de Luise VP, Koch DD. Laser in situ keratomileusis for myopia and
astigmatism: Safety and efficacy. A report by the American Academy of
Ophthlamology. Ophthalmology. 2002 Jan;109(1):175-87.

2. Hovanesian JA, Shah SS, Maloney RK. Symptoms of dry eye and
recurrent erosion syndrome after refractive surgery. J Cataract Refract
Surg. 2001 Apr;27(4):577-84.

3. Calvillo MP, McLaren JW, Hodge DO, Bourne WM. Corneal reinnervation
after LASIK: prospective 3-year longitudinal study. Invest Ophthalmol
Vis Sci. 2004 Nov;45(11):3991-6.

4. De Paiva CS, Chen Z, Koch DD, Hamill MB, Manuel FK, Hassan SS,
Wilhelmus KR, Pflugfelder SC. The incidence and risk factors for
developing dry eye after myopic LASIK. Am J Ophthalmol. 2006 Mar;
141(3):438-45.

5. Schwiegerling J, Snyder RW. Corneal ablation patterns to correct for
spherical aberration in photorefractive keratectomy. J Cataract Refract
Surg. 2000 Feb;26(2):214-21.

6. Hersh PS, Fry K, Blaker JW. Spherical aberration after laser in situ
keratomileusis and photorefractive keratectomy. Clinical results and
theoretical models of etiology. J Cataract Refract Surg. 2003
Nov;29(11):2096-104.

7. Mrochen M, Donitzky C, Wullner C, Loffler J. Wavefront optimized
ablation profiles. Theoretical background. J Cataract Refract Surg.
2004 Apr;30(4):775-85.

8. Netto MV, Ambrosio R Jr, Wilson SE. Pupil size in refractive surgery
candidates. J of Refract Surg. 2004 Jul-Aug;20(4):337-42.

9. Hjortdal JO, Olsen H, Ehlers N. Prospective randomised study of
corneal aberrations 1 year after radial keratotomy or photorefractive
keratectomy. J Refract Surg. 2002 Jan-Feb;18(1):23-9.

10. Maguire LJ. Keratorefractive surgery, success, and the public
health. Am J Ophthalmol. 1994 Mar 15;117(3):394-8.

11. Uozato H, Guyton DL. Centering Corneal Surgical Procedures. Amer J
Ophthal. 1987 Mar 15;103(3 Pt 1):264-75.

12. Roberts CW, Koester CJ. Optical zone diameters for photorefractive
corneal surgery. Invest Ophthalmol Vis Sci. 1993 Jun;34(7):2275-81.

13. Alster Y, Loewenstein A, Baumwald T, Lipshits I, Lazar M.
Dapiprazole for patients with night haloes after excimer keratectomy.
Graefes Arch Clin Exp Ophthalmol. 1996 Aug;234 Suppl 1:S139-41.

14. Oliver KM, Hemenger RP, Corbett MC, O'Brart DP, Verma S, Marshall
J, Tomlinson A. Corneal optical aberrations induced by photorefractive
keratectomy. J Refract Surg. 1997 May-Jun;13(3):246-54.

15. Martinez CE, Applegate RA, Klyce SD, McDonald MB, Medina JP,
Howland HC. Effect of pupillary dilation on corneal optical aberrations
after photorefractive keratectomy. Arch Ophthalmol. 1998
Aug;116(8):1053-62.

16. Holladay JT, Dudeja DR, Chang J. Functional vision and corneal
changes after laser in situ keratomileusis determined by contrast
sensitivity, glare testing, and corneal topography. J Cataract Refract
Surg. 1999 May;25(5):663-9.

17. Seiler T, Kaemmerer M, Mierdel P, Krinke HE. Ocular optical
aberrations after photorefractive keratectomy for myopia and myopic
astigmatism. Arch Ophthalmol. 2000 Jan;118(1):17-21.

18. Schwiegerling J, Snyder RW. Corneal ablation patterns to correct
for spherical aberration in photorefractive keratectomy. J Cataract
Refract Surg. 2000 Feb;26(2):214-21.

19. Fan-Paul NI, Li J, Miller JS, Florakis GJ. Night vision
disturbances after corneal refractive surgery. Surv Ophthalmol. 2002
Nov-Dec;47(6):533-46.

20. Miyata K, Tokunaga T, Nakahara M, Ohtani S, Nejima R, Kiuchi T,
Kaji Y, Oshika T. R. Residual bed thickness and corneal forward shift
after laser in situ keratomileusis. J Cataract Refract Surg. 2004
May;30(5):1067-72.

21. Pallikaris IG, Kymionis GD, Astyrakakis NI. Corneal ectasia induced
by laser in situ keratomileusis. J Cataract Refract Surg. 2001
Nov;27(11):1796-802.

22. Flanagan GW, Binder PS. Precision of flap measurements for laser in
situ keratomileusis in 4428 eyes. J Refract Surg. 2003
Mar-Apr;19(2):113-23.

23. Lifshitz T, Levy J, Klemperer I, Levinger S. Late bilateral
keratectasia after LASIK in a low myopic patient. J Refract Surg. 2005
Sep-Oct;21(5):494-6.

24. Kramer TR, Chuckpaiwong V, Dawson DG, L'Hernault N, Grossniklaus
HE, Edelhauser HF. Pathologic findings in postmortem corneas after
successful laser in situ keratomileusis. Cornea. 2005 Jan;24(1):92-102.

25. Schmack I, Dawson DG, McCarey BE, Waring GO 3rd, Grossniklaus HE,
Edelhauser HF. Cohesive tensile strength of human LASIK wounds with
histologic, ultrastructural, and clinical correlations.
J Refract Surg. 2005 Sep-Oct;21(5):433-45.

26. Cheng AC, Rao SK, Leung GY, Young AL, Lam DS. Late traumatic flap
dislocations after LASIK. J Refract Surg. 2006 May;22(5):500-4.

27. Schein OD, Vitale S, Cassard SD, Steinberg EP. Patient outcomes of
refractive surgery. The refractive status and vision profile. J
Cataract Refract Surg. 2001 May;27(5):665-73.

28. Garamendi E, Pesudovs K, Elliott DB. Changes in quality of life
after laser in situ keratomileusis for myopia. J Cataract Refract Surg.
2005 Aug;31(8):1537-43.

29. Kohnen T, Buhren J, Kuhne C, Mirshahi A. Wavefront-guided LASIK
with the Zyoptix 3.1 system for the correction of myopia and compound
myopic astigmatism with 1-year followup: clinical outcome and change in
higher order aberrations. Ophthalmology. 2004;111:2175-2185.

30. Brint SF. Higher order aberrations after LASIK for myopia with
Alcon and Wavelight lasers: a prospective randomized trial. J Refract
Surg. 2005 Nov-Dec;21(6):S799-803.

31. Netto MV, Dupps W Jr, Wilson SE. Wavefront-guided ablation:
evidence for efficacy compared to traditional ablation. Am J
Ophthalmol. 2006 Feb;141(2):360-368.

32. Stonecipher KG, Dishler JG, Ignacio TS, Binder PS. Transient light
sensitivity after femtosecond laser flap creation: clinical findings
and management. J Cataract Refract Surg. 2006 Jan;32(1):91-4.

33. Luna JD, Artal MN, Reviglio VE, Pelizzari M, Diaz H, Juarez CP.
Vitreoretinal alterations following laser in situ keratomileusis:
clinical and experimental studies. Graefes Arch Clin Exp Ophthalmol.
2001 Jul;239(6):416-23.

34. Binder PS. Flap dimensions created with the IntraLase FS laser. J
Cataract Refract Surg. 2004 Jan;30(1):26-32.

35. Biser SA, Bloom AH, Donnenfeld ED, Perry HD, Solomon R, Doshi S.
Flap folds after femtosecond LASIK. Eye Contact Lens. 2003
Oct;29(4):252-4.

36. Chung SH, Roh MI, Park MS, Kong YT, Lee HK, Kim EK. Mycobacterium
abscessus keratitis after LASIK with IntraLase femtosecond laser.
Ophthalmologica. 2006;220(4):277-80.

37. Kim JY, Kim MJ, Kim TI, Choi HJ, Pak JH, Tchah H. A femtosecond
laser creates a stronger flap than a mechanical microkeratome. Invest
Ophthalmol Vis Sci. 2006 Feb;47(2):599-604.

38. Ratkay-Traub I, Ferincz IE, Juhasz T, Kurtz RM, Krueger RR. First
clinical results with the femtosecond neodynium-glass laser in
refractive surgery. J Refract Surg. 2003 Mar-Apr;19(2):94-103.

39. Principe AH, Lin DY, Small KW, Aldave AJ. Macular hemorrhage after
laser in situ keratomileusis (LASIK) with femtosecond laser flap
creation. Am J Ophthalmol. 2004 Oct;138(4):657-9.

40. Lifshitz T, Levy J, Klemperer I, Levinger S. Anterior chamber gas
bubbles after corneal flap creation with a femtosecond laser. J
Cataract Refract Surg. 2005 Nov;31(11):2227-9.