Custom veiw Lasik Overcorrection

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Custom veiw Lasik Overcorrection

Postby Rustystud » Thu Jul 13, 2006 3:56 am

I am a 49 years old male. I had progressed into bifoacals about 6 years ago. My close vision was still good enough without wearing glass to get along. My distant vision had just passed the point I had to wear glasses for driving even though I had been wearing them anyway.

Last December I had my right eye done(custom view lasik) and it is fine. 20/15 uncorrected for distant vision. I now have to wear reading glasses and I expected this.

In January I had my left eye done (custom Lasik). To make a long story short the eye was overcorrected. I have had it examined and tested three times and it is continuing to worsen but at a slower pace and it now has been 7 months.

The eye center I have been going to is a very large and prestegious university teaching facility. The doctor who did my surgery is the head of the deartment. He is held in the highest professional esteem by his peers and employer. The gosip in the waiting room was not so flattering.

He is quite arogent and his personality is all but void. He does not like answering my questions. I paid $5,400.00 and feel I deserve a little of his time. He and his staff are very closed mothed and will not talk about my case. He told me he does about 3,500 Lasik cases per year. He said he ends up doing about 14-15 enhancements for under correction. He said he only does about one correction per year for correcting overcorrections.I feel like a guinnie pig.

I am almost convinced he used the correction numbers for my right eye on my left eye's procedure. My left eye was not as bad as my right eye and the left eye was the one overcorrected. During my office visits my doctor has asked and said some of the dumbest things during my apointments. Which leads me to believe he does not read the patient files.

I have talked to and had consults with two other non related Lasik surgeons who both told me to go back to the surgeon who did the first procedures. It is difficult to go back with confidence when you got poor results earlier. And you suspect your surgeon screwed up the first surgery.

It is my understanding it is much easier and more precise going forward with lasik correction. That going backwward with lasik is almost a gamble whether the correction will be better or worse.

My far vision is uncorrected 20-40. It causes a noticeable degration of my biocular vision. My vision in my left eye is worse now both close and far than before the procedure.

My surgeon told me that my corneas were about 500 microns thick. He said the earlier surgery removed about a 36 microns thickness in the previous treatment. He says he will have to remove about 15 micron thick ring around my cornea to reshape it back to a corrected curvature. Will this much removal of the cornea cause me more or other problems down the road?

I have two question. If I were to get all the records including my cornea scans and digital maping before and after my lasik procedures could another physician tell if the first surgeon used the wrong numbers when he did the procedure?

The second question is can the overcorrection be corrected to as good as my other eye?

Third am I a fool to go back to the first surgeon if he indeed screwed up my eye?

If he was ethical he would admitt to me if he screwed up.

I was in his office for over two hours today. Seeing him for only 5 minutes or less. He jumped up saying he did not have time to discuss my case any more, that I needed to talk to his office manager about booking another lasik enhancement appointment. I was mad enough to just about grab him by the collar and sit him down in his seat and give him a piece of my mind.
I let better judgement prevail.

Your thoughts would be appreciated.
Rustystud
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Postby LasikExpert » Thu Jul 13, 2006 5:30 pm

I’m sorry to hear of all your difficulties. It is bad enough to have been overcorrected, but having an uncooperative surgeon is even worse.

There is a lot of ego in surgery. That really is not such a bad thing. After all, you want someone who is doing microsurgery on your eyes to be pretty darn sure of himself. The problem is when that ego crosses over into arrogance...or at least the appearance of arrogance. This may be a great surgeon, but that does not mean he is a great person. You need to ask yourself if you want a great surgeon or a great person. Like the other two doctors who you saw for additional opinions I think you will probably be best served by continuing your care with this doctor, however you may be better served if the environment is changed a bit.

I recommend that you attempt to remove yourself from the negativity of the environment as much as possible without losing access to a skilled surgeon. Request that another surgeon in the same ophthalmology department take over your preoperative and postoperative care. You may even consider having another surgeon do your enhancement surgery, if you ultimately decide to have surgery performed. If you stay with the same department at the same facility, it seems unlikely that there would be any additional cost or concern. Expect your surgeon to respond with a bruised ego, but I’m sure you are much more concerned about your eyes that about your surgeon’s ego. If you can get a cooperative doctor to go over the details, you may find that confidence in your primary surgeon is well placed, even if he has a poor chairside manner.

The kind of environment you have now is one that easily spirals downward into an adversarial situation, especially when a poor outcome occurred. It is a pity that your surgeon does not recognize this simple fact. His insensitivity and apparent arrogance is festering animosity in a person who may well consider the outcome to be malpractice (it probably is not, BTW). Do not expect the surgeon to act any differently than what you have already seen. Do not expect an acknowledgement that he screwed up (he may not have).

It is very doubtful that your custom Lasik was performed with data from the wrong eye. The Visx S4 CustomVue wavefront-guided laser uses an iris recognition technology that requires unique imagery to match the iris of they eye from which the data was derived to the eye for which the laser ablation is performed. Your overcorrection was undoubtedly not because of switched data, but was probably an artifact of custom ablation with low refractive error.

We have received several reports of unexpected overcorrection from myopia (nearsighted, shortsighted) vision into hyperopia (farsighted, longsighted) vision when custom ablation is used for a patient with low myopia. This seems to be a problem across all laser systems, not just the laser used for your surgery. The precise reason is not yet determined and this occurs so infrequently and inconsistently that it has thus far been impossible to know the exact cause. Your overcorrection may very likely have nothing to do with the surgeon. Fortunately, hyperopic Lasik - which is what your enhancement surgery would be - does not seem to have the same problem.

Although your surgeon may need to perform only one hyperopic Lasik enhancement surgery a year, that does not necessarily mean he is inexperienced. The only difference between primary hyperopic Lasik and hyperopic Lasik enhancement is that the surgeon does not need to create the Lasik flap for the enhancement. The existing flap will be lifted for the enhancement. Other than the flap, the surgery is the same and I’m sure that your doctor has performed more than one hyperopic Lasik a year.

The ring of tissue that will be removed from the outer edge of the cornea for hyperopic Lasik enhancement is not in the same area as where tissue was removed to correct myopia. Also, this tends to be a thicker portion of the cornea. It is not likely that the amount of untouched cornea will change much, if at all, and these calculations can be made before surgery.

Despite the negative environment, you will need to have the situation corrected in one manner or another. At the very least, you will need to wear a contact lens in the hyperopic eye. Having one eye hyperopic and one eye myopic can cause all sorts of problems including poor depth perception, vertigo, headaches, and nausea.

Last but not least, your surgeon may be the head of the ophthalmology department, but he is not head of the hospital and he is not the head of the university that is attached to that hospital. If you do not get a satisfactory response, go over his head. There is no reason for a patient to put up with inappropriate care.
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Thanks for your timely reply

Postby Rustystud » Thu Jul 13, 2006 8:15 pm

Glenn Hagele:

I hate to sound negative but every part of my Lasik experience has been less than desirable.

My regular eye surgeon does not do Lasik surgery. He makes referals to the surgeon who did my Lasik. I would say I have an above average relationship with my primary eye care physician.

My father and brother are physicians, I grew up in a medical family. I work with doctors in my job everyday.

I know there are both egotistical and humanistic clinicians.

It is reasuring that the custom Lasik computer does not rely on human input but scans and applies it's own algorithm.

My surgeon was so cocky and arrogant about the first procedure. I can remember his saying how well the the procedure went and "I would be getting perfect vision from the correction"

I am scheduled to go back Tuesday for an enhancement. The surgeon said I had a 4 percent chance of more problems.

My vision is very important in both my work and recreation.

If I knew then what I knew now I would not have had the procedures done. I now feel that I am stuck with at least trying to get the overcorrection corrected. It has been a bad 7 months with my left eye not focusing at either near or far distances.

As for your comment about malpractice, that does not get my vision back.

Rustystud
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Postby LasikExpert » Thu Jul 13, 2006 10:33 pm

You don't need to apologize for being negative. I think anyone in your situation would be negative.

With your background you probably know more than most what you are up against with an ego that appears to have run amok. It is probably even more frustrating because you know compassionate doctors and understand that the kind of behavior you report is as unnecessary as it is unacceptable.

It is a pity that you cannot have your care comanaged with your primary surgeon. If he does not do Lasik, he would probably not have the specialized equipment or practical knowledge to assist you.

I’m very curious how your surgeon would substantiate the 4% statement, including exactly what he considers a “problem”. Some doctors do not consider overcorrection that can be corrected with additional surgery as being a “problem”. Some patients would disagree.

Your vision in your left eye would be expected to be poor. The combination of hyperopia and presbyopia would very likely produce poor vision quality at all distances, whether it is natural or induced by surgery. Hopefully enhancement surgery will resolve the refractive error problem.

Don’t be surprised if your surgeon wants to slightly overcorrect you into more myopia than needed for your monovision target. Hyperopic correction (enhancement or primary) tends to regress. The doctor may overcorrect you to accommodate expected regression. That would mean that immediately after enhancement surgery your very near vision would be quite good, but mid and distance vision would not be great. As regression occurs your vision would stabilize and (hopefully) provide good distance vision in the right eye with good near vision in the left eye.

Also expect some difficulty with monovision adjustment. Your brain has been working around the imbalance problem for several months now. When you correct the problem, your brain will need to adjust to the new monovision and will probably be dealing with a moving target as your eye regresses after surgery. Expect the best, but don’t be surprised if it takes 2-6 weeks for you to gain the full benefits of monovision.

You are right that malpractice litigation does not get back one’s vision. I also get the impression that it would do nothing about your doctor’s apparent attitude problem.

Something that everyone reading this needs to understand is that the patient doctor match is as much about personalities as it is about quality. Nobody wants an inferior surgeon who happens to be likeable, but I believe that you can attest to the fact that nobody wants a superior surgeon who is unlikeable.
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Reply to your Reply

Postby Rustystud » Fri Jul 14, 2006 12:04 pm

Glenn Hagele:

My primary eye care physician is a personal family friend and does cases with my brother who is a plastic surgeon. Both graduated from the same teaching institution where my Lasik surgeon is the Medical Director. My Lasik surgeon has no clue what I do for a living. I prosecute medical providers(including physicians) in my job at the Justice Department. I have been intentionally vague with him and his office staff only saying I work in a government job when asked. I have been somewhat curt with him as I am not happy with his services. I would never let my personal and professional lives get mixed. I know the Medical Institutions CEO, President, and Vice Presidents on a first name basis. I have worked with them numerous times. They know me an I feel that I am well respected by them. When this matter is resolved as far as it can go, I plan to write a lengthy and detail letter to the CEO. I will be completely honest with my views. Maybe he will call the surgeon in and have a heart to heart with him. Yesterday, after spending over two hours in the waiting room I heard several other patients voiceing their complaints. I kept my mouth shut and listened, all were saying the same thing. The staff at the facility must have known some of what was going on as they shifted the people in the waiting room to another adjoining waiting room.
The bottom line is that physicians not only need to be good clinicians, they need to be able to honestly communicate with their patients. Patients need to have trust and confidence in their surgeons. The litigus atmospere has done a great disservice to the medical field. Physicians should hire a consultants to evaluate them and advise them on how to better serve their patients(not just financial consultants improving the bottom line). A little preemptive adjustment in their disposition might go a long way into improving their image and increase the bottom line as well. I go to trial all the time and cocky arrogent physicians are a prosecutors and tort lawyers best friend. Doctors don't seem to remember those jurors are not doctors like the medical board is during a diciplinary hearing.

I am going back Tuesday for an enhancement. I'll keep you posted.

Rustystud
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Postby LasikExpert » Fri Jul 14, 2006 4:53 pm

I must admit that as you described your work responsibilities, I laughed out loud. I'm not worried about you being buffaloed around by a pushy arrogant doctor. You obviously know how to handle him. I’m sure everyone reading this has had the unfortunate experience of an apparently uncaring arrogant doctor and would all like to see one get his comeuppance.

Do keep us informed of the medical side of things. I would especially be interested in the explanation for the overcorrection.
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Follow-up to yesterdays enhancement

Postby Rustystud » Wed Jul 19, 2006 4:02 pm

Yesterday:

I had my first enhancement to correct the overcorrection.

Though I want say it was fun. It was less uncomfortable than the first procedure.

The doctor says he feels good about the procedure.

Upon my return this a.m. The protective contact was removed. My vision is still a unclear 16 hours post surgery (20/40). But in the last couple of hours I have been seeing some improvement.

The surgeon said he may still need to do one more enhancement This was a little different procedure. I will have to wait another 6 months to know.


I go back next Monday p.m. for my next follow up.

I'll keep you posted.

Rustystud

I'll
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Postby LasikExpert » Wed Jul 19, 2006 4:57 pm

Please do keep us informed of your progress.
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Two 1/2 days post enhancement

Postby Rustystud » Fri Jul 21, 2006 1:29 pm

Day 1 after enhancement:

Still a bit sore and feeling like a grain of sand was in my eye. Vision was poor. Maybe even worse than before enhancement.

Day 2 after enhancement still a bit sore but improvement in vision about back to prior enhancement vision 20/30. Eye was quite tired and sore late in day.

Day 3 soreness almost gone, vision has improved even more, still a little blurry and not as good as right eye. I would say some where between 20/30 and 20/20.

keep your fingers crossed the improvement continues.

The surgeon said he may have to do a second enhancement if if is necessary.

Rustysud
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Postby LasikExpert » Fri Jul 21, 2006 5:10 pm

At least you are going in the right direction - improvement!
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One week follow up visit

Postby Rustystud » Tue Jul 25, 2006 3:02 am

I went back for the one week follow up post Custom view Lasik enhancement.
Vision in my left eye was 20/25 to 20/30.

Surgein says to continue using prednisone QID and use Timertrol.

I return in another week.
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Postby LasikExpert » Tue Jul 25, 2006 4:26 am

Not quite where you want to be, but keep the faith. Fingers are crossed.
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Custom Vue overcorrection

Postby gsjernigan » Tue Aug 08, 2006 7:56 pm

I had my original LASIK procedure 8 years ago - left eye has been 20/20 since then - right eye developed a "central island" which I leardned with. Once the Custom Vue wavefront technology became available, my doctor said I was a good candidate for the procedure. Right eye (dominant eye) was 20/40. After the initial procedure, it was obvious something was wrong - field of focus was about 3' and in. An enhancement was done 30 days later with little change. I was kept on steroid drops for an extended period - no change, except then developed a sub-capsular cataract. @nd opinion doctor agreed tha the cataract was the problem - had cataract removed 30 days ago - no change in vision - still 20/50, same as after the Custom Vue procedure. Cataract doc says the issue is now a significant overcorrection.

Is there a surgical solution or am I stuck with contacts or glasses?
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Cataract surgery after Lasik overcorrection

Postby LasikExpert » Tue Aug 08, 2006 8:15 pm

GSJernigan,

During cataract surgery, which is exactly like Refractive Lens Exchange (RLE) surgery, an artificial intraocular lens (IOL) replaces the natural lens of the eye. This IOL is of a refractive power to provide good vision. After Lasik surgery, determining the correct IOL power can be more difficult. It appears that your cataract surgeon was not able to accurately determine the correct IOL power.

If the problem is only refractive error, then an IOL exchange or a "piggy back" IOL added in front of the existing IOL would seem appropriate. You could also possibly have additional Lasik enhancement surgery to resolve the residual refractive error, but whether or not that is appropriate would depend upon the current state of your cornea.

It would appear that your possible options are glasses, contacts, Lasik enhancement, a piggy back IOL, or IOL exchange. These are in order of least invasive to most invasive. Which is appropriate would need to be determined after a comprehensive evaluation by a competent doctor(s).
Glenn Hagele
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Went back for 3 week evaluation, new developments..

Postby Rustystud » Thu Aug 10, 2006 11:43 am

Went in Monday, was seen by post graduate fellow, not my surgeon. My vision had lost two lines, now 20/40. I was told I was developing epitheial cells. Tuesday, I returned and had flap lifted and corneal debridement. Procedure lasted about 1/2 hour. I will say it was fun but was tollerable. I was told all visable epitheial cells were removed. I was fitted with a protective contact. It was somewhat painful after the numbing wore off. I took ibuprophen. I am putting antibiotic and steroid in my eye 4 times a day. Returned Tuesday morning. Both the surgeons were very positive about the results. Even with the protective contact still in I can see better than before. I will retrn Friday to have protective contact removed and have a further evaluation. The surgeon could not have been nicer the last 2 visits.

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