A little survey about halo in LASIK

I don't know if this is going to get reliable results, but I'll try anyway.
I do hope that there will be many truthful and accurate answers.

If you had LASIK (or other refractive surgery, but mention about it if it's
other than LASIK), you are most welcome to participate in this survey. This
is just for informative purposes.

1. How long since you had the (first) surgery?

2. Do you see distortion of any kind, in daylight or in dark? If you answer
No, you can stop the survey here, but add a comment about your vision (be
critical, show that you do pay attention to visual quality).

3. Do you see disturbing starburst around small/distant lamps at dark?

4. Do you see disturbing halos around bigger/closer lamps at dark?

5. Does the starburst/halo size around lamps change when the pupil size
changes? If yes, does the halo reduce to zero or practically almost zero
(you can test this for example by looking out a window at night and then
constricting the pupils by the use light, eg. flash light)?

6. Has your starburst/halo size or brightness changed after surgery? If yes,
please tell how did you measure this (looking at the same lamps month after
month from the same spot can be a good test).

7. Do you see a less blurred image if you look through "finger binoculars"?
Roll your index fingers and look through the small holes formed. Look at
something in room illumination with high contrast, for example a black
poster with white text or a white object on black background.

8. Do you have difficulties recognizing faces if the person is standing in
front of a bright window -- or do you see everything more or less foggy in
room illumination?

9. Your happiness about the result (0-100%), where
- 100% = aquity is 20/20 or better, there are no side-effects
and any distortion is totally non-disturbing
- 50% = some disturbing side-effects, you don't have to
worry about glasses anymore, but the vision is far from perfect
- 0% = major difficulties at reading and recognizing faces,
driving a car at dark is hazardous (or other complications).

10. Your pre-operative prescription, dilated pupil size, perfect correction
optical zone size and transition zone size (if you know them). And your age,
if you wish.

X. If you have something else to comment about your vision, please add it
here.

Thank you very much for your time and effort!

Here are my own responses to the survey.

1. How long since you had the (first) surgery?

3 months.

2. Do you see distortion of any kind, in daylight or in dark?

Yes, in dark. Bright daylight is better than pre-op with spectacles.

3. Do you see disturbing starburst around small/distant lamps at dark?

Yes.

4. Do you see disturbing halos around bigger/closer lamps at dark?

Yes.

5. Does the starburst/halo size around lamps change when the pupil size
changes?

Yes. It reduces to almost zero when the pupil is about 5.0mm or so. The
maximum starburst diameter is quite big and it's very bright too (covering
cars behind it etc.).

6. Has your starburst/halo size or brightness changed after surgery?

Not at all (since two days after surgery my vision has remained the same).
I've measured my distortions for example by looking out of my room window at
two lamps. Their starburst max. diameter is now the same as it was before
surgery without glasses (the two starbursts are just touching eachother when
they're at maximum).

7. Do you see a less blurred image if you look through "finger binoculars"?

Yes, I see a very sharp and stable image by looking that way.

8. Do you have difficulties recognizing faces...

Yes.

9. Your happiness about the result (0-100%)

50%.

10. Your pre-operative prescription, dilated pupil size, perfect correction
optical zone size and transition zone size (if you know them). And your age,
if you wish.

-4.75 both eyes (-0.25 astigmatism), 7.66mm (horizontal), 6.0mm and with
transition zone about 8.2mm. Age is 26.

X. If you have something else to comment about your vision, please add it
here.

I don't have any severe complications or side-effects other than this
starburst/fog problem. I use eye drops very rarely anymore (dryness is not
severe anymore). I can't see as near as I could anymore, the limit is about
10cm now.

Pauli's survey will undoubtedly be interesting, but is under no
circumstances going to be representative of reality. A voluntary
survey without any controls in an unmoderated newsgroup is not likely
to accurately represent the actual reality of all refractive surgery
patients or carry much statistical merit. I guess it is time to post
again my....

LURKERS, SEARCHERS, and HAPPY CAMPERS

How about a statistical fact:

98% of all pedestrian vs. auto accidents occur when the pedestrian is
within the crosswalk.

Now a statistical analysis:

Crosswalks are the most dangerous place for pedestrians to cross the
street.


If you conclude by the posts on the refractive surgery related
bulletin boards and newsgroups that this industry has nothing but
problems, you are making the same mistake as assuming crosswalks are
the most dangerous place for a pedestrian.

People posting on bulletin boards tend to be one of three kinds of
researchers.

One group is researching before making a decision about refractive
surgery. The information this person needs is readily available if
they read enough posts. They may never post a message. These are the
Lurkers. BTW, Lurker is not a derogatory term.

Another type of group using bulletin boards and newsgroups is looking
for answers to unresolved problems. They post very specific items and
watch the board closely, looking for someone who also has their
problem that may have found relief. These people are dissatisfied
with the results of their surgery and may even feel they have been
wronged. Often they will post warnings to others who may be unaware
of the potential for problems like the ones they suffer. These are the
Searchers.

The last group using bulletin boards and newsgroups are delighted with
their refractive surgery and other than "thanks" don't have much to
say. These people may even feel a little guilty about posting their
satisfactory results amongst so many people who are experiencing
difficulty. These are the Happy Campers.

This presents a skewed representation of the refractive surgery
public.

Our organization has determined from multiple sources that about 3% of
refractive surgery patients (all types of surgery, all types of
refractive error) have an unresolved complication at six months
postop. About 0.5% have a serious complication that requires
extensive maintenance or invasive treatment to resolve/maintain.

The posts on these boards are almost exactly the opposite - around 97%
about problems and around 3% about successes.

The information about problems relating to refractive surgery is very
important and all possibilities must be considered. It is also
important not to draw the wrong conclusion when adding up the quantity
of information about problems and the quantity of information about
successes.

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.

In article <(E-Mail Removed)>,
Glenn - USAEyes.org <(E-Mail Removed)> wrote:

> Pauli's survey will undoubtedly be interesting, but is under no
> circumstances going to be representative of reality. A voluntary
> survey without any controls in an unmoderated newsgroup is not likely
> to accurately represent the actual reality of all refractive surgery
> patients or carry much statistical merit.

I totally agree with that.

> Our organization has determined from multiple sources that about 3% of
> refractive surgery patients (all types of surgery, all types of
> refractive error) have an unresolved complication at six months
> postop. About 0.5% have a serious complication that requires
> extensive maintenance or invasive treatment to resolve/maintain.

And I disagree with that one. Inherent in your organization's
presentation of the numbers are two issues:

1. you have a vested interest in promoting refractive surgery. I will
add that unlike some similar groups, you do indeed present both sides of
the issues and do so with patient's best interest as a real concern, an
admirable quality.

2. It is also well known that refractive surgery patients with less than
stellar results, as in Paul's case, are more likely to "hide" their
complaints. They do this as a psychological protection against the
unresolvable depression or regret they feel having altered their body
with negative outcome.

That being said, do we really know the actual number of patients that
have life-altering issues following refractive surgery?

--LB, O..D.

Actually, if anything, Glenn reflects a negative view of LASIK. His
3% number needs to be revised and lowered. I don't understand why the
anti-lasik people attack him so much. They aren't going to ever get
someone else to give a seemingly credible negative view of lasik.
His infomration is extensive and right on. but his statistics are
skewed, and his personal opinions are off the mark. One way to read
his posts is to think of them as the most negative slant you could put
on real facts. The opposite of that would be the sleazy marketers who
put the most rosy, positive slant on the facts without being blatantly
false.

On Mon, 16 May 2005 17:31:49 GMT, LarryDoc <(E-Mail Removed)>
wrote:

>In article <(E-Mail Removed)>,
> Glenn - USAEyes.org <(E-Mail Removed)> wrote:
>
>> Pauli's survey will undoubtedly be interesting, but is under no
>> circumstances going to be representative of reality. A voluntary
>> survey without any controls in an unmoderated newsgroup is not likely
>> to accurately represent the actual reality of all refractive surgery
>> patients or carry much statistical merit.
>
>I totally agree with that.
>
>> Our organization has determined from multiple sources that about 3% of
>> refractive surgery patients (all types of surgery, all types of
>> refractive error) have an unresolved complication at six months
>> postop. About 0.5% have a serious complication that requires
>> extensive maintenance or invasive treatment to resolve/maintain.
>
>And I disagree with that one. Inherent in your organization's
>presentation of the numbers are two issues:
>
>1. you have a vested interest in promoting refractive surgery. I will
>add that unlike some similar groups, you do indeed present both sides of
>the issues and do so with patient's best interest as a real concern, an
>admirable quality.
>
>2. It is also well known that refractive surgery patients with less than
>stellar results, as in Paul's case, are more likely to "hide" their
>complaints. They do this as a psychological protection against the
>unresolvable depression or regret they feel having altered their body
>with negative outcome.
>
>That being said, do we really know the actual number of patients that
>have life-altering issues following refractive surgery?
>
>--LB, O..D.

Thank you Glenn for your good analysis on the message board behaviour. I
agree (and I have thought about this before). It is a difficult thing to
make accurate statistics, even for an honest doctor who is making statistics
of his patients. Most of the patients do not know how to accurately describe
or measure their problems (but with proper methods it should and must be
possible to make accurate statistics!).

With this survey, which I hope even some people could take the time to
answer, success rate statistics will not be accurate. But, as you might have
guessed, my topmost interest is actually the healing process: is it true or
is it a myth. With the information delivered within the questionnaire
answers I hope to understand the healing process better. And it would be
interesting to find out if new relations of things would occur. But that
would require hundreds of answers which is of course utopia. For example, it
seems that the older you get, the smaller the scotopic pupil will be - does
the age of the patient affect halo occurances?

>And I disagree with that one. Inherent in your organization's
>presentation of the numbers are two issues:
>
>1. you have a vested interest in promoting refractive surgery.

There is one very important difference: Our organization has no
financial incentive for anyone in particular to have or not to have
refractive surgery. The doctors we certify certainly do, but we don't
make anything if someone does or does not have surgery with a
USAEyes.org certified doctor or anyone else.

So long as refractive surgery exists in one form or another, the
information and services we provide will be in demand.

That said, I'm sure that some of the doctors we have certified would
not be so interested if they did not reasonably believe that our
certification got them more patients. To be very frank and honest,
I'm delighted if someone selects a USAEyes.org certified doctor. That
means they are selecting someone who is at least independently
evaluated. I'm pretty happy when someone uses our 50 Tough Questions
For Your Doctor too.

In comparison, the ASCRS LASIK guidelines has a very troubling "less
than one percent" complication rate statement. But then ASCRS is an
ophthalmology trade organization.

>I will
>add that unlike some similar groups, you do indeed present both sides of
>the issues and do so with patient's best interest as a real concern, an
>admirable quality.

Thanks for the (very) limited endorsement. I'll graciously accept
whatever I can get. 8^)

>2. It is also well known that refractive surgery patients with less than
>stellar results, as in Paul's case, are more likely to "hide" their
>complaints. They do this as a psychological protection against the
>unresolvable depression or regret they feel having altered their body
>with negative outcome.
>
>That being said, do we really know the actual number of patients that
>have life-altering issues following refractive surgery?

I don't think there is much anyone can do about people who don't
report their outcomes truthfully. But wouldn't you say that goes both
ways? For those who over-report problems as well as those who
under-report them.

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.

In article <(E-Mail Removed)>,
Glenn - USAEyes.org <(E-Mail Removed)> wrote:

> Thanks for the (very) limited endorsement. I'll graciously accept
> whatever I can get. 8^)

It's not *that* limited. I really do believe that your replies are well
thought out, well written and provide a degree of honest presentation
that is, at least in these part, very, very lacking in the RS business.

It really bothers me to hear day after day radio ads promoting this or
that doctor as the "premier surgeon" "now with blah blah laser that can
give you better than 20/20, even better that 20/15!" and you know the
rest of BS come-ons.

> I don't think there is much anyone can do about people who don't
> report their outcomes truthfully. But wouldn't you say that goes both
> ways? For those who over-report problems as well as those who
> under-report them.

Sure. But the real issue for me is people who had RS and live a life of
constantly looking for a fix to their problems, or have problems that
seriously disrupt the quality of their lives. Or, as for one person I
know, loose their job as a direct result of LASIK. But equally
important is the problem of potential RS patients having an unrealistic
view of what will be. And, of course, the scams and doctors with less
than stellar ethics.

I'm glad that you are trying to deal with those issues. So thanks for
that. Nevertheless, there remains an industry-wide problem and one that
causes far too many people to live with a life long (hopefully not!)
disability.

--LB, OD

Ragnar wrote:
> Actually, if anything, Glenn reflects a negative view of LASIK. His
> 3% number needs to be revised and lowered.

I disagree. I think the true value is somewhat higher. There are a lot
of post lasik people out there who don't complain because they see so
much better without lenses than they did without lenses pre-operatively,
they feel sheepish even mentioning their little "problems".

For example, a common case would be a 4 D. myope.

20/400 unaided before surgery (20/15 with glasses or contacts).

Post LASIK:

Unaided acuity
R 20/20-
L 20/25+

Now refracts as plano O.U., and 20/15 is now not possible.

So the guy/gal is now able to drive without glasses/contacts, and is by
the numbers a success, one of the 97%, right?

Wrong.

This person will never again see 20/15. He/she won't complain, or if
so, will be told that the numbers are great. Better than expected. This
person may even believe that they have a great result.

Sorry, but I like 20/15, and I like not having to strain to read it.

w.stacy, o.d.

No one has survived long enough post-lasik to know that, Pauli.