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Medical Forum / General / Vision / June 2007Eureka!
I found him! I am back from my appointment with my new cataract surgeon and I am pleased beyond expectations. I was super-prepared, with a package for the doc that included a letter from a retina specialist, my own notes and and history report, OCTs from previous stages of my eye problems, and a list of my wishes concerning a cataract surgery. The doc was impressed, said that my report and notes were "professional" and my Wish List was reasonable and doable. He was friendly, pleasant, forthcoming and not rushing. He checked my 2 eyes thoroughly (including the retina), gave me a detailed explanation and information, willingly answered my questions, and even invited me to call him if I have additional questions or wish further discussion. He expressed several times his amazement and appreciation of my knowledge and said that he has never had such an educated patient. There were smiles and handshakes, and we set dates for measurements and surgery. Of course, a great part of my education is attributed to the wonderful people in this forum who helped me along the way. Many thanks! To sum up my present state, I am dilated and delighted! >I found him! I am back from my appointment with my new cataract >surgeon and I am pleased beyond expectations. I was super-prepared, [quoted text clipped - 12 lines] >patient. There were smiles and handshakes, and we set dates for >measurements and surgery. That is truly exceptionally good news. A "fit" between surgeon and patient is just not always so easy to find. The process of looking is emotionally draining (and expensive). As I've said, though, the /right/ doctor will be heartened and encouraged by your knowledge and thoughtful approach. The wrong doctor will be insecure, dismissive, and occasionally condescending. So ... when's the date?? Did he make any predictions about likely visual acuity post-operatively? What lens will he use? What's his goal for your refraction with the lens in place? I'm very happy that you'll get what you want, and from whom you want to get it. Congratulations, Brainy. I Am Very Happy For You. Good Luck. > >I found him! I am back from my appointment with my new cataract > >surgeon and I am pleased beyond expectations. > That is truly exceptionally good news. > A "fit" between surgeon and patient is just not always so easy to > find. The process of looking is emotionally draining (and expensive). > As I've said, though, the /right/ doctor will be heartened and > encouraged by your knowledge and thoughtful approach. The wrong > doctor will be insecure, dismissive, and occasionally condescending. In fairness to cataract surgeons, there are one million cataract surgeries done each year in the US. Most of them are fairly simple, unlike this one. Many people (not those on this forum) don't want to participate in deciding what to do. They want the doctor to make all the decisions and just do it. Forget the explanations, just do what the doctor thinks best. "Dan Abel" <dabel@sonic.net> wrote in message news:dabel- > In fairness to cataract surgeons, there are one million cataract > surgeries done each year in the US. Most of them are fairly simple, > unlike this one. Many people (not those on this forum) don't want to > participate in deciding what to do. They want the doctor to make all > the decisions and just do it. Forget the explanations, just do what the > doctor thinks best. I second that. I don't think a surgeon's bed side manner is as important as his surgical skills. In the end, what matters is the result. >"Dan Abel" <dabel@sonic.net> wrote in message news:dabel- > [quoted text clipped - 4 lines] >> the decisions and just do it. Forget the explanations, just do what the >> doctor thinks best. I'm not really sure that's true. What might be MORE true is that: - Many people don't recognize that there IS a need (or an upside) to participate in their own health care, - Many people don't feel competent to participate in their own health care I think there is still a tendency for many people to deify MDs, rather than look at them as fallible humans who =practice= medicine, and may or may not be up on the latest research. My only experience with a refractive surgeon (evaluation for implantable contact lens or clear lens extraction and intraocular lens implant) was with a world-renowned doc. He was =thrilled= at my understanding of risks, options, and likely outcomes. I knew enough to have realistic expectations about possible outcomes. If you look at the vast majority of "unanticipated surgical outcomes," I'd wager that the patient DID simply pay their money and leave everything to the doctor. >I second that. I don't think a surgeon's bed side manner is as important as >his surgical skills. In the end, what matters is the result. Though I, personally, would agree, I'm not sure that represents the feeling of the masses. I don't think that too many people are eager to have an SOB operate on them ... regardless of reputation. > I'm not really sure that's true. What might be MORE true is that: > [quoted text clipped - 3 lines] > - Many people don't feel competent to participate in their own > health care Sure, laypeople may not feel competent enough to make their own health decision, but there are enough intelligent people. I know several surgeons and they joked to me once, "The worst types of patients are professors, MDs and engineers because they ask too many Qs." >>I second that. I don't think a surgeon's bed side manner is as important >>as [quoted text clipped - 3 lines] > feeling of the masses. I don't think that too many people are eager > to have an SOB operate on them ... regardless of reputation. Sure, there are SOB surgeons, but it's important to know how patients judge surgeons' bed side manner. If a surgeon accomodate their requests, patients are likely to perceive him as a good one. If not, they will label him as a SOB surgeon. It's important to understand that each surgeon has his own tools of trade, and that s/he sticks to them because s/he has had the most success with those tools. > Sure, laypeople may not feel competent enough to make their own health > decision, but there are enough intelligent people. I know several surgeons > and they joked to me once, "The worst types of patients are professors, MDs > and engineers because they ask too many Qs." Well, accordingly I am in a very good crowd. >> Sure, laypeople may not feel competent enough to make their own health >> decision, but there are enough intelligent people. I know several [quoted text clipped - 4 lines] > > Well, accordingly I am in a very good crowd. I'm one of the worst types of patients...according to them. > "Dan Abel" <d...@sonic.net> wrote in message news:dabel- > > In fairness to cataract surgeons, there are one million cataract [quoted text clipped - 6 lines] > I second that. I don't think a surgeon's bed side manner is as important as > his surgical skills. In the end, what matters is the result. FKS, I believe you seconded your previous messages, not the one from Dan Abel. To the best of my understanding he did not recommend to "forget the explanations and just do what the doctor thinks best", but rather indicated that this is the attitude of most patients. Anyway, the patient's wish to understand or have a say in the decisions cannot justify rudeness, haste and lack of consideration from the doctor. And as for the "doctor knows best" attitude, the former 3 docs I have visited had 3 different opinions about certain issues. So who's right? And whose choice should it be? To be more specific, since you repeatedly accused me somewhat of misbehavin' with my former 3, in your opinion should I have allowed doc #1 to operate on my good eye also? (my retinologist and none of the other docs found it needed, and even recommended against it.) Or should I have allowed doc #2 to stick Crystalens in my eye? (2 others said that I am not a candidate for sunch lens, and the opinion of people in this NG is almost unanimous against it.) Or should I have allowed doc #3, who has dedicated a whole 3 minutes to me, including eye exam, to use injection for anesthetizing my eye instead of topical anesthesia? (3 others, and myself, were in favor of topical, and statistically there is higher risk in injection, in addition to my own fear.) > > "Dan Abel" <d...@sonic.net> wrote in message news:dabel- > > > In fairness to cataract surgeons, there are one million cataract [quoted text clipped - 11 lines] > "forget the explanations and just do what the doctor thinks best", but > rather indicated that this is the attitude of most patients. Some patients, anyway. And it isn't just one way or the other, there are degrees in between. Due to my past eye problems, I want to know a whole lot, not everything, but a lot. You are not having a routine cataract surgery, so you of course want to know a lot also. > eye exam, to use injection for anesthetizing my eye instead of topical > anesthesia? (3 others, and myself, were in favor of topical, and > statistically there is higher risk in injection, in addition to my own > fear.) I have had four eye surgeries, two for cataract and two to repair detached retinas. The first used general anesthesia. The surgeon assured me that I wouldn't want to be awake for three and a half hours while he did some major things. Afterwards I had some doubts, but will never (hopefully) know what it would have been like without the general. My second was with a local block. That went really well, during and afterward. Before the third one could happen, that doctor retired. I had already read that injections for cataract surgery were only done by older doctors. My third was topical. It was miserable. The doctor didn't believe in tranquilizers. It was the longest 20 minutes of my life, and it wasn't good for the doctor, since I was unable to stay still. My fourth was topical, and it went fine. The anesthesiologist assured me that they had tranquilizers and would use them. It was two hours on the table with me awake the whole time. Ms. Brainy, I certainly support your view concerning a patient's right to have a say in decisions related to his/her health care. After all, it's the patient (not the doctor) who must live with the results. The notion that the doctor knows best is totally outdated, as far as I'm concerned. I truly believe that you avoided potential disaster by rejecting the Crystalens. And why should you assume the risks of injectable anesthesia (which, by the way, tend to be higher for myopic eyes) when (safer) topical anesthesia can be used? My priorities apparently differ from yours in one aspect. In your place, I'd probably prefer to do surgery on my second eye sooner (rather than later) in order to have more comfortable binocular vision. But you have every right to find a doctor who respects your priorities about having a second procedure. Best wishes for successful surgery. > Ms. Brainy, I certainly support your view concerning a patient's right > to have a say in decisions related to his/her health care. After all, [quoted text clipped - 9 lines] > have every right to find a doctor who respects your priorities about > having a second procedure. Best wishes for successful surgery. Jane, I find your posts always intelligent and helpful. Thanks. My decision not to opertae on the good eye at this stage is based on the common wisdom of "if it ain't broke, don't fix it." It applies to eyes more than to anything else. Any surgery involves risks, and I don't want to place my one and only good eye at ANY risk unnecessarily. It ain't broke yet and I ain't gonna fix it yet. This is my decision regarding MY eyes. Somebody else might make a different decision. I will not let any doc to make this decision for me, unless it becomes necessary, i.e. the risk (or loss) from NOT fixing it is greater than the risk associated with fixing it. > >I found him! I am back from my appointment with my new cataract > >surgeon and I am pleased beyond expectations. I was super-prepared, [quoted text clipped - 14 lines] > > That is truly exceptionally good news. <snip> > So ... when's the date?? Surgery is scheduled to June 26. >Did he make any predictions about likely > visual acuity post-operatively? Probably 20/40 with glasses. Withou glasses is less important because the main goal is to make the 2 eyes work together without creating significant disparity between them. I will probably know more after they do the pre-surgery refraction. >What lens will he use? I don't know, we haven't discussed it. >What's his > goal for your refraction with the lens in place? -2D. > I'm very happy that you'll get what you want, and from whom you want > to get it.- Thanks! Your continuous support is highly appreciated. > I found him! I am back from my appointment with my new cataract > surgeon and I am pleased beyond expectations. I was super-prepared, [quoted text clipped - 17 lines] > > To sum up my present state, I am dilated and delighted! But hopefully not deluded or derailed Well done!  SignatureNicolaas. 2007 Pricelessware CD now available. 600Mb of the best of the best in Freeware. E-Mail me for details. ... It is preferable to be "over the hill" than under it. > On 31 May 2007 13:47:08 -0700, "Ms.Brainy" <mikabra...@gmail.com> wrote > > To sum up my present state, I am dilated and delighted! > > But hopefully not deluded or derailed Well done! No, my delight is not diluted nor deluded :-) >> On 31 May 2007 13:47:08 -0700, "Ms.Brainy" <mikabra...@gmail.com> wrote > [quoted text clipped - 3 lines] > > No, my delight is not diluted nor deluded :-) Delightful. Hopefully you will be deliriously happy. SignatureNicolaas. 2007 Pricelessware CD now available. 600Mb of the best of the best in Freeware. E-Mail me for details. ... When something you do turns out to be easier than it looked, you have overlooked something. > I found him! I am back from my appointment with my new cataract > surgeon and I am pleased beyond expectations. I was super-prepared, [quoted text clipped - 17 lines] > > To sum up my present state, I am dilated and delighted! ----------------- excellent! a portion of the battle is over and you have won! i'm sure you will keep us informed on the surgery and recovery. it is heartening that some people are able to get answers and support here on this forum. all the more reason that we should make an effort to keep it useful and on topic without allowing certain influences to lead us astray into unproductive discussions. all the more reason that we should make an effort > to keep it useful and on topic without allowing certain influences to > lead us astray into unproductive discussions. "Certain influences" ??, "Certain influences" !!! What is this shistola of "certain influences" !!!! Don W. > all the more reason that we should make an effort > [quoted text clipped - 5 lines] > > Don W. Don, Perhaps the word "influences" was not the best choice, but everybody here knows exactly what the writer meant. He is not the only one who has called on us to keep on topic and stay away from unproductive discussions. Just look at all the energy spent escently on arguing with some cookoos who chose to preach voodoo or just stir the pot here. This NG is outstanding and exceptional, let's keep it this way. There will be an occassional spam and repeated appearances of Otis, Revival et al, but those who are serious about vision and science will find here real value and great resources. >There will be an occassional spam and repeated appearances of Otis, Revival et al, ?? now Revival upset :( Revival not negative influence. Revival good. :) > >There will be an occassional spam and repeated appearances of Otis, Revival et al, > [quoted text clipped - 5 lines] > > Revival good. :) revival very good when he quiet Dear Revival, Subject: The majority-opinion wishes to DESTROY the preventive second-opnion. In subjects of this nature, and PClar's response, just remember this: What they do not UNDERSTAND, they seek to destroy. In general, long-standing methods (like the minus quick-fix) have little scientific support. But they are very easy to use, and impressive. Issues like Bates-prevention, (second-opinion) have yet to be developed. But we can understand that they must be started before a negative refractive STATE gets out-of-hand. And yes, you should ask if there are ODs who have "changed their mind" -- with respect to their own children. The answer is here: www.chinamyopia.org Best, Otis > >There will be an occassional spam and repeated appearances of Otis, Revival et al, > [quoted text clipped - 5 lines] > > Revival good. :) On Jun 2, 12:26 pm, "otisbr...@pa.net" <otisbr...@pa.net> wrote: > And yes, you should ask if there are ODs who > have "changed their mind" -- with respect to > their own children. The answer is here: > > www.chinamyopia.org ...a veritable revolution. DrG And yes, DrG, this is how the discovery of germs, and "washing your hands" became a "revolution". The "traditional" doctor did not understand (or believe) that he could INDUCE disease in a woman -- so he refused to wash his hands. And that because a revolution as "newer" doctors learned the wisdom of washing you hands to avoid inducing problems. Otis > On Jun 2, 12:26 pm, "otisbr...@pa.net" <otisbr...@pa.net> wrote: > [quoted text clipped - 7 lines] > > DrG On Jun 2, 11:03 am, "otisbr...@pa.net" <otisbr...@pa.net> wrote: > And yes, DrG, this is how the discovery of germs, > and "washing your hands" became a "revolution". [quoted text clipped - 6 lines] > learned the wisdom of washing you hands to > avoid inducing problems. Otis, Here you are hijacking a thread again. Why don't you start a new NG? I will come to lurk if I have nothing better to do. Actually I like you Otis. You are a man of conviction and I believe you believe in your message to humanity and see yourself as a prophet. I agree, you are a prophet, though false prophet. All you need now is a few followers... >On Jun 2, 11:03 am, "otisbr...@pa.net" <otisbr...@pa.net> wrote: >> And yes, DrG, this is how the discovery of germs, [quoted text clipped - 16 lines] >are a prophet, though false prophet. All you need now is a few >followers... He has them, but ... due to steadily worsening vision ... they can no longer operate their computers. >On Jun 2, 11:03 am, "otisbr...@pa.net" <otisbr...@pa.net> wrote: >> And yes, DrG, this is how the discovery of germs, [quoted text clipped - 11 lines] > >Here you are hijacking a thread again. Why don't you start a new NG? Such a newsgroup already exists! It is alt.med.vision.improve I think, from the naming, it is EXACTLY where Otis should be posting: - his posts are about vision-- check - his posts are about alternative thinking-- check - his posts have nothing to do with modern science, so posting here is not appropriate. An "alt" newsgroup is much more appropriate-- check - his posts relate to a theory, albeit without any supporting evidence, regarding vision "improvement" -- check So Otis, why not go there? Leave all us close-minded, boring, irrational,first opinion, non-engineers here to discuss medical issues and current research issues regarding vision. I won't come over to your newsgroup and hassle you, I promise. > see yourself as a prophet. I agree, you >are a prophet, And here Ms. Brainy is where you hit the proverbial nail on the head! Otis fancies himself as an unrequited prophet of the real truth. He fantacizes that someday he will be appreciated when the current state of thinking comes around to discovering he's been right all along! Otis Brown, engineer, is actually a head-case who lives in a fantasy world instead of reality. And again you are right about Otis' biggest problem being finding followers for his prophetic statements. When ask for a list of supporters he usually lists several dead people, long-retired optometrists who actually have never heard of him before, some wacko guy in Hong Kong who has a website, his nephew Keith (but not his neice Joy who is currently myopic despite following Otis' therapies throughout her childhood), and a dead guy named Raphaelson whom wrote a book that Otis read and waxes nostalgic about every 2-3 weeks or so. Flash-- Otis, start your own religion. The Church of the Biconvex Lens. You could hold sermons and meetings on the internet. Wow, think of the tax deductions. You've already got the concept of faith down pretty well. >And yes, DrG, this is how the discovery of germs, >and "washing your hands" became a "revolution". If your discovery is THAT revolutionary, then why is your poor niece, Joy Benson, still a myope? On Jun 2, 2:03 pm, "otisbr...@pa.net" <otisbr...@pa.net> wrote: > And yes, DrG, this is how the discovery of germs, > and "washing your hands" became a "revolution". [quoted text clipped - 20 lines] > > > DrG Otis -- answer the questions I posted to you. at least just answer one or two to get started! How come uncorrected hyperopes who strain all day and accommodate excessively 24/7 don't develop myopia (or at least diminished hyperopia) over time? If your overly simplistic model were correct, then they should. And how come over-minused patients, in a statistically-controlled studies, DID NOT develop accelerated myopia as you claim that should they should. Come on-- they were wearing the "wretched minus." Here are the references provided below. Please explain why your theory differs from these results, and why you won't reconsider your "theory" on the basis of this kind of data (as well as A LOT OF OTHER data the demonstrates you are wrong)? Otis' credo -- "My mind is made up. Don't confuse me with the facts." ========== 1. Goss, D. (1984) Overcorrection as a means of slowing myopic progression. Am J Optom Physiol Opt., Feb;61(2):85-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra ct&list_uids=6703013&query_hl=3 Thirty-six subjects (18 males and 18 females) ranging in ages from 7.38 to 15.82 years received an overcorrection of 0.75 D over the power required to correct their myopia exactly. These 36 experimental subjects were matched by control subjects selected at random from the files of the Indiana University Optometry Clinics. The criteria used in matching were sex, beginning age, beginning refractive error, and duration of time covered by the record. The mean rate of change of refractive error for the experimental group was (minus indicating increase of myopia) -0.49 D/year (range, +0.37 to -1.95 D/year) on retinoscopy and -0.52 D/year (range, +0.21 to -1.32 D/year) on subjective refraction. The mean rate of change for the control group was -0.47 D/year (range, +0.06 to -2.03 D/year) on retinoscopy and -0.47 D/year (range, +0.28 to -1.72 D/year) on subjective refraction. Rates for the experimental and control groups were not significantly different. The results of this study do not support the hypothesis that an overcorrected myope has a lower rate of increase of myopia than a myope wearing a conventional spectacle correction. ========================== 2. Arch Ophthalmol. 1999 May;117(5):638-42. Does overcorrecting minus lens therapy for intermittent exotropia cause myopia? Kushner BJ. Pediatric Eye and Adult Strabismus Clinic, Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, USA. bkushner@... http://archopht.ama-assn.org/cgi/content/abstract/117/5/638 RESULTS: At the time of initial examination, the mean (+/-SD) refractive error was 0.00 +/- 1.40 diopters (D) in the control group, 0.00 +/- 1.50 D in the study group, and -0.10 +/- 1.50 D in the 5-year study group, all of which were essentially identical. Five years after initial examination, the mean change in refractive error was -1.40 +/- 2.80 D in the control group, -1.52 +/- 1.80 D in the 6-month treatment group, and -1.54 +/- 1.80 D in the 5-year treatment group. These differences in the change in refractive error (myopic shift) were not statistically significant (t test), and the differences are clinically unimportant. CONCLUSION: Overcorrecting minus lens therapy for intermittent exotropia does not appear to cause myopia. > And yes, you should ask if there are ODs who > have "changed their mind" -- with respect to > their own children. The answer is here: And you should ask for evidence that show any of these techniques are effective. Y'know, simple t-tests, control groups, that sort of thing. Basic stuff. I couldn't find any of that at the site you recommended. -MT On Jun 2, 1:26 pm, "otisbr...@pa.net" <otisbr...@pa.net> wrote: > Dear Revival, > [quoted text clipped - 34 lines] > > > Revival good. :) Alright Don W-- this poster is a best example of the "certain influences" that can be a negative aspect of this forum. Otis shamelessly promotes his alternative-medicine "cure" for myopia even though it has been thoroughly analyzed and debunked decades ago by the scientific community. Here Otis. Instead just posting the same old crap, prove to everyone here how knowledgeable you are in the topic of myopia research by addressing these questions. Don't just disappear and not respond as if you haven't been asked a question, only to resurface a few days later offering people advice again. Either prove your case, or admit to everyone that they must accept what you say purely on faith since the scientific studies don't support it, or go away. Questions that Otis won't and can't answer: 1. What is your professional training, or professional experience, that allows you to give people advise on how to manage their vision and eyecare problems? What Optometry, Ophthalmology, or Optics training and/or experience do you have? 2. Why is it that many myopes who do not wear their minus lenses and are therefore walking around with net plus refractive power in their eye 24/7, do not become less myopic. This is optically the same as wearing plus lenses all the time. Why is it that they don't revert to emmetropia? Why is it that they oftentimes become even more myopic? Your "theory" predicts the opposite! 3. How come hyperopes (far-sighted people) who wear no correction do not become more myopic (=less hyperopic) over time? They are straining to see, in exactly the same way that others do who get very close to their reading material. And they do it 24/7. And it's optically the same as wearing glasses that are overminused. Your theory predicts their refraction should change, but it doesn't. Actually, they manifest even more hyperopia around age 40. How can that be Otis? Unless your theory is wrong! 4. How come, in a study published by Goss et al. (Am Jour Optom Physiol Opt. Feb; 61(2):85-93, 1984) children who were intentionally overminused did not become myopic any more than children who wore their proper spectacle prescription? Your "theory" predicts the opposite! You claim that the "wretched minus" would cause them to plunge deeper into the despair of myopia. Yet it doesn't seem to work that way. Why? 5. How come, when myopic patients were undercorrected so as to leave them slightly myopic even with their glasses on, they continued to develop myopia, and actually at an accelerated rate (Chung K, Mohidin N, O'Leary DJ. Undercorrection of myopia enhances rather than inhibits myopia progression. Vision Res. 2002, 42: 2555-9.) Your "theory" predicts the opposite! Since they would be walking around 24/7 with a net plus refractive error, shouldn't they get better? Or at least not worse-- if your theory were correct! 6. How come the Hong Kong Progressive Lens Myopia Control Study (Investigative Ophthalmology and Visual Science. 2002;43:2852-2858) concluded that using bifocal lenses on children has no effect on myopia progression? Your "theory" predicts the opposite! Why is it that science just keeps proving you wrong time and time again? We're waiting Otis. |
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