July 1, 2003

Surgical Eyes News

Volume 1, Number 5 

A monthly E-Journal

 
 

Your Pic HereMany of us have patients that have pushed us to our limits of clinical expertise. Indeed, the types of challenges that we are provided by seeing patients after refractive surgery can be downright exhausting and mentally taxing.  However, every once in a while, patience and effort pay off and our patients are able to achieve a level of visual improvement that was previously impossible. I take a great deal of pride in being involved in those types of situations. Often times, it is enough to recharge my batteries and get me going again.

I’m sure if we peruse the board, we will find periods where all of us wax and wane with postings and effort. Many of you do an excellent job with consistency and execution. Patients around the country (and around the world) are indeed grateful and receive benefits that are sometimes life changing. I challenge us all to redouble our efforts and continue to promote patient welfare and improve dialogue between us as practitioners so that we can better serve our fellow man.

Sincerely,

Gregg Eric Russell, OD, FAAO
Chief Medical Editor
Co-MedicalDirector@surgicaleyes.org

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tIN THIS ISSUE
 
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tFEATURE CASE REPORT


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Fig. 1. Topography showing area of inferior relative steepening dues to flap melt and significant irregular astigmatism in the right eye. The patient DID NOT have ectasia.
Fig. 2. Topography taken over the top of the piggy back Soft sphere / Reverse geometry RGP fit showing relative unity along the visual axis in the right eye. Patient comfort was excellent.
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Patient BR is a 52 year old Caucasian male who presented with poor vision in his right eye following LASIK over RK. As a result of DLK, he developed a significant amount of flap melt inferior temporally which resulted in significant irregular astigmatism. 2 years after the last surgery, BR noticed that his vision was further degrading to the point that he was going to have to take a medical disability. Upon presentation, unaided visual acuity was 20 / 100 OD and 20 / 20 OS. With a refraction of -2.75 +3.75 X 134 in the right eye, the patient could read 20 / 32. A series of lens fittings was attempted; including primary RGP’s using aspheric, reverse geometry, cone lenses, Focus Night and Day, Preference Torics, and Wave RGP’s. While best vision was achieved using the Wave lens, poor fitting characteristics were achieved and the patient was unable to tolerate the material. As a last ditch effort, an attempt was made to fit the patient in a piggy back design using a large reverse geometry lens and a Korb fit. With a 10.5 diameter, 9.0 optical zone, 38.00 diopter, plano powered RGP in HDS material, the patient was able to achieve 20 / 25 vision with no ghosting or distortion fit over the top of an 8.4 +1.25 Focus Night and Day.

Diagnosis: Irregular astigmatism, DLK

Case note: I have chosen to highlight this case for a number of reasons. For almost 6 months, I put this patient through HELL trying out various designs and experiments that provided limited success. I can honestly tell you that I had absolutely exhausted every possible thing that I could think of trying and had failed up to that point. The beauty of the fit is that it fits above the steepened, inferior cornea and provides the patient simple comfort and vision. I have now used this fitting style on 2 additional ectasia patients with good success.

Have any clinical observations that you would like to share? Please take a moment to write up a case in which you have made a difference in the way that a patient sees.  Distributing information to our colleagues can help us improve patient care for those individuals having challenging outcomes after refractive surgery. Please send them to my attention at Co-MedicalDirector@surgicaleyes.org.
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tDOCTOR QUESTIONNAIRE ON POSTOPERATIVE CARE

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Do you believe that LASIK will become less popular in the next five years because surface ablation will come to be regarded as a safer surgical procedure?

1) Yes
2) No

Please click here to answer the above poll.

Last months poll results (93 respondents):

Since patients with large pupils treated with a 6-mm optical zone have more complaints of halo postoperatively than patients treated with a 6.5-mm optical zone does this point to the importance of pre-operative pupil size measurement?

1) Yes 94%
2) No 6%
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tREFRACTIVE EYE CARE NEWS

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Photorefractive Keratectomy for Treatment of Flap Complications in Laser In Situ Keratomileusis.  W. Weisenthal, MD; James Salz, MD; Alan Sugar, MD; Alan Mandelberg, MD; Michael Furlong, MD; Steven Bagan, MD; Sergio Kandleman, MD. Cornea 2003; 22(5):399-404. From the abstract: " PRK was performed on 13 patients from 2 weeks to 6 months after LASIK flap complications. The technique used for the PRK varied. Epithelial removal was performed using no-touch phototherapeutic keratectomy (PTK) in six of the 13 patients and manual debridement in the other seven patients. A dilute solution of 20% ethanol was used to facilitate manual debridement in five of the seven patients. In two of these five patients, the epithelium was replaced as in laser-assisted subepithelial keratomileusis (LASEK). " More

For prevention of microkeratome injuries, new surgeons should avoid difficult cases. Maria Iradier, MD. Ocular Surgery News, June 13, 2003. From the article: " To help prevent LASIK complications, refractive surgeons must assess patient characteristics, which can indicate at-risk factors. For instance, patients with deep, flat corneas, previous surgery or epithelium dystrophy may be at an increased risk of sustaining microkeratome injuries." More

Outcomes of Repeat Penetrating Keratoplasty and Risk Factors for Graft Failure. Daniel J. Weisbrod, MD; Marisa Sit, MD; Joel Naor, MD; Allan R. Slomovic, MD. Cornea 2003; 22(5):429-434. From the abstract: “Patients undergoing PKP for the first and second time share common risk factors for graft failure, namely, the original diagnosis leading to corneal transplantation, the presence of preoperative PAS, and the occurrence of postoperative corneal neovascularization. The difference in graft survival rates between the two groups can be partially explained on the basis of higher rates of the latter two risk factors among regrafts.” More

Compared to Surface Ablation, Conventional LASIK was Less Predictable. "Variance was highest for the LASIK patient" as reported in a study by Raymond Applegate, PhD at the International Congress on LASEK and Advanced Surface Ablation in Cleveland, Ohio May 30 -31, 2003. In answer to the question: "Do higher order aberrations really matter?" Dr. Applegate said that it depends on their magnitude, pupil size, neural transfer function, the visual task and the object. Wavefront re-treatment "sometimes does, sometimes doesn't work" because of "fit error" Dr. Applegate suggested the need for another basis function other than Zernicke with regard to re-treatment of complex cases. More

tSPOTLIGHT PROFILE

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William Trattler, MD

First and foremost, Bill Trattler is a decent human being. Early on, he took a lot of heat on the bulletin board of SE, but kept on posting and growing right along with us. If every refractive surgeon took his approach, there would be a lot less problems in refractive surgery. Thank you Dr. Trattler for your caring and sharing over the past four years.

Sincerely,
Ron Link
Executive Director

William Trattler, MD is a Cornea Specialist at the Center For Excellence In Eye Care in Miami, FL, and specializes in corneal diseases, dry eye, and refractive surgery complications.

Dr. Trattler received his bachelor's degree with honors from Dartmouth College and his Doctorate of Medicine degree from the University of Miami School of Medicine where he graduated in 1992 with Distinction in Research. He completed his ophthalmology residency at the University of Pennsylvania Scheie Eye Institute and then spent an additional year for
subspecialty training in cornea and refractive surgery at the University of Texas Southwestern Medical Center. During his Corneal Fellowship, Dr. Trattler performed research on dry eye and oil gland problems of the eye.

In 1997, Dr Trattler returned to Miami to join as the Cornea specialist for a group of 15 ophthalmologists, including his father (Henry Trattler). He also teaches the University of Miami (Bascom Palmer Eye Institute) residents cataract and corneal transplant surgery. As well, he
supervises the residents in the Ophthalmology Emergency room once a month.
Dr. Trattler currently holds the position of Volunteer Assistant Professor of Ophthalmology.

Dr. Trattler has been invited to lecture across the U.S. on various topics, such as corneal infections of the eye, ocular allergy, dry eye, laser vision surgery complications, and sutureless cataract surgery. He is taught courses on computer and the Internet at the National Ophthalmology Conferences (ASCRS & AAO). He has been Course Director at
ASCRS on the topic "Surface ablations to treat LASIK Flap Complications and enhance previous LASIK). As well, Dr. Trattler has been on the faculty at ASCRS of courses on LASEK and Medical Legal Issues in Refractive Surgery.

Dr. Trattler is board certified by the American Board of Ophthalmology, and has been the author of many articles and abstracts. He is also the author of a very popular textbook called "Clinical Microbiology Made Ridiculously Simple", which is used by Medical, Nursing, and
veterinary students throughout the world. Recently, it was even translated into Chinese.

In the Summer of 2002, Dr. Trattler received the "Outstanding Young ophthalmologist Leadership award" from the Florida Society of Ophthalmology.

Future Profiles to follow from Top Doctor Posters on our Bulletin Board:
Gregg Russell OD, Ken Minarik OD, Ophthinfo MD, James Salz MD, Clint Hoxie OD, Tracy Lynn Swarz, OD, Donald F. Ezekiel OD, Steven Lee OD, Sam Omar MD, Alejandro Tirado OD, Demetrian Dornic MD, Ricardo Trigo MD, Arthur Epstein OD, Chris Marmo OD, Hollis Stavn OD, Eirit Yonatan OD, Paul Klein OD, Robert Bard OD, Neal A. Sher MD, Jim Dillard OD, Gregg Feinerman MD, Steven Shum OD, Richard Bursua OD, Jason Jedlicka OD, Mark Ventocilla OD, Barrie Soloway MD, Carlton Chan OD, Jack Miller OD, Brian Boxer Wachler MD, Ken Maller OD, Joe B. Goldberg OD, Bruce Butts OD, Kraig Abe OD, Paul Blaze OD, Bill Berke OD, David L. Davidson OD, Joe B. Collins OD, James Stevenot OD, Jeffrey Martin OD, Johnathan Christie, OD. s

tFEATURED POSTINGS from SE's BB

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Oh the Pain the Pain

This is the Beginning of my Search for Answers

Please Don't Think I'm Whining

My Son Has Post-LASIK Eye Infections- Are These Common?

Scheduled for Surgery - Opinion Wanted

Question for Ophthalmologists

Dry Eye Treatment

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tANNOUNCEMENTS and EVENTS
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  • Annual meeting at Emory Vision in Atlanta is initially planned for the weekend of September 5th. Stay tuned to the bulletin board for further details.
  • Feedback from Eastern Florida Support Group Meeting in Tampa, FL - Saturday, June 21, 2003. Thank you Dr. Steven Maskin.
  • Feedback and photos from Washington/Oregon Support Group Meeting - May 3-4, 2003 at Wills Eye Center. Thank you Brenda Ross and Dr. Will.
tCLASSIFIED ADS

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The Surgical Eyes Web Site received over 14,275,000 hits in 2002 alone. This Newsletter is now featured on the front page of our Web Site with a growing subscriber base of over 3,700 readers - a technologically sophisticated interactive forum on refractive surgery complications featuring interaction between leading MDs, ODs, PhDs and a caring global network of patient participants.
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Chief Medical Editor
Gregg Russell, OD

Editor
/Art/Production/Circulation
Ron Link

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Research Editors

• Karl Albert
• Mark Bilafer
• Paul Fitzpatrick

Copy Editor
• Kirsten Taylor

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TO SUBMIT AN ARTICLE, CONTACT LENS OR SURGICAL CASE REPORT:


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