Talk:Refractive surgery

Does debate still exist?

In regards to LASIK, the following quotation is taken from article as of the time and date this post:

However, there exists debate over the stability of the healing with the corneal flap.

Is this information current? It is the opinion of the faculty and staff at the Illinois College of Optometry that a patient that has undergone LASIK more than 2 years prior is able to sit for gonioscopy, a procedure that places a glass lens on the surface of the eye and turns it to obtain full views of the structures being examined.

The sentence in the article needs to be updated. If there is no longer a debate, then the sentence should be removed. If there is a debate, it needs to be more specific, because it is misleading as written.

Garvin (talk) 22:52, 30 January 2008 (UTC)

Reversions

As can be seen in the edit history, two anonymous IPs made edits that involved deleting the CRSQA link I posted, without offering any reason for so doing, and posting a bunch of other links (largely, anti-surgery material) in its place. Hadal reverted the first of these edits, I reverted the second.

IMHO it is discourteous to delete material without offering a reason, but that alone's not why I reverted (had that been the only problem with the edits, I would have just re-added the CRSQA link). I reverted because of NPOV issues, exacerbated by failure to adequately describe links. To wit:

- http://www.lasikinfocenter.net/ is in fact an anti-LASIK advocacy site. Sample text: "A lawsuit was the furthest thing from your mind when you underwent Lasik... You will be neither the first nor the last to seek compensation from a doctor whose false promises left you with needless pain and suffering, and a permanent visual disability." By all means link to advocacy sites, but identify them as such - not just the misleading "info center". At least "lasikdisaster.com" gives readers some idea of the content they're going to get.

- Speaking of which, apparent sockpuppets: http://www.bauschandlombsucks.com lists "lasikdisaster@aol.com" as a contact email address. Also, both lasikdisaster.com and visionsimulations.com are credited to "Roger Davis, PhD". While lasikmemorial.com doesn't appear to credit its creator (which is a bad sign in itself), its design style & colour scheme look suspiciously similar to these other two.

IMHO, presenting multiple sockpuppet sites from the same person without indicating that they *are* connected is misleading. When that's accompanied by deletion of links presenting an alternative perspective, it's hard to view it as anything other than a deliberate attempt to undermine NPOV.

I have no objection to presenting anti-refractive-surgery material, as long as it's done in a honest fashion. (FWIW, I work in the vision industry, in technologies that directly compete with refractive surgery; if the RS industry died tomorrow, I'd be a good deal better off.) If people want to present these links with accurate description, and answer the opposing viewpoint with arguments instead of unjustified deletion, that would be very welcome. But if you persist in using anonymous edits to force a POV on people without cooperating with other users, you'll find your changes are quickly reverted and you will eventually be blocked. --Calair 01:13, 19 Sep 2004 (UTC)

('Unjustified' in the sense of 'without providing justification', that is.) --Calair 22:56, 19 Sep 2004 (UTC)

Standardizations for listing various procedures

Any thoughts on whether the acronym should precede the name of the procedure, or vice versa?

• Example 1: RK (radial keratotomy) uses spoke-shaped incisions (usually made with a diamond knife) to alter the shape of the cornea and reduce myopia; this technique has now been largely superseded by other methods.
• Example 2: Arcuate keratotomy (AK) is similar to Radial keratotomy, but the incisions on the cornea are done parallel to the edge of the cornea.

AED 20:55, 20 July 2005 (UTC)

While the acronyms are fairly common in this field, I don't see any strong arguments for doing anything other than full name followed by acronym, especially since it makes the linking cleaner. -- Kaszeta 21:02, 20 July 2005 (UTC)

I agree. --Calair 23:12, 20 July 2005 (UTC)

Sounds good to me, too. AED 23:37, 20 July 2005 (UTC)

20/40?

This is how it reads:

   * Around 90% of patients will receive 20/40 or better uncorrected visual acuity (and, thus, 10% will not).
   * Around 50% will achieve 20/20 or better (and 50% will not); patients with high myopia, hyperopia, or astigmatism, have poorer chances of achieving 20/20.
   * Around 10% of patients will need retreatment
   * "Less than 3%" of patients will have unresolved complications six months after surgery.

This order suggests a decending order from the best possible to the worse possible outcome of a surgery. This leads me to ask: should the first line say 20/40 or should it say 20/10? If 20/40 is correct, then perhaps it should be second in this list. If not, then it could use a correction.

'20/40' is correct. (It wouldn't be possible for 90% to get 20/10 or better but only 50% to get 20/20+, since 20/10 is better than 20/20.) Reordered seems like a good idea. --Calair 22:21, 27 July 2005 (UTC)

I'm fine with the reordering, but the phrases "(and, thus, 10% will not)" and "(and 50% will not)" should go... unless there is a consensus here that most people are unable to do simple subtraction in their heads. AED 00:05, 28 July 2005 (UTC)

IME, most people are quite capable of doing such calculations if it occurs to them to do so; a surprising number are quite capable of hearing "90% of our patients get 20/40 or better!" without apparently seeming to join the dots to "10% are not". The CRSQA site I ganked those from phrased this in percentages-success, but since the section is about the risks of such procedures, I thought it better to explicitly state those as well. Possibly overkill, but I'd rather err on the side of more than less.

(ObDisclosure: I work in a competing industry (contact lenses), but I'm not trying to grind an axe. I think RS is a perfectly good vision solution for some people, but also that people in general are very bad at medical risk/benefit calculations.) --Calair 04:29, 28 July 2005 (UTC)

I think these statistics should be moved to a section entitled "Expectations of surgery" or something like that. Expectations, which those statistics imply, are different than risks or complications. I think it would be reasonable then to mention that not everyone achieves 20/20 or 20/40 vision with reitteration of pertinent statistics.

I also have some problems with this statement: According to CRSQA (an industry body concerned with quality control of ocular surgery), a competent refractive surgeon will typically achieve results at the following levels. I think we should spell out CRSQA, add a link to USAEyes.com, and describe them differently... I think "industry body" is a bit vague and inaccurate. Those statistics refer to what CRSQA considers to be "national norms" which is different than stating what a competent surgeon would achieve. AED 07:15, 28 July 2005 (UTC)

Sounds good to me. I'd rather somebody who knows CRSQA better than me tackled it, though. --Calair 22:54, 28 July 2005 (UTC)

I had a go of it, but there is still a lot more to be done. AED 07:04, 5 August 2005 (UTC)

I think that a good solution is to write more detailed data about the outcomes of refractive surgery.. I agree with creating a seperate section about outcomes of refractive surgery.. that section should have a good deal of unbiased statistics.. smaller details should be included.. for example the complication rate for lasik in mild myopia is a lot less than that in high myopia and even the rate of achievement of 20/40 vision varies according to degree of myopiam besides, those numbers vary with the procedure used as well. Numbers don't lie (or at least they pretend to), so a good deal of statistics from reliable references will solve this issue. I will begin working on that. amrkam

---

I have added a link ( http://www.seewitthlasik.com/docs/treatments.shtml ) in the external link section which is a link to a site which provides patients information regarding LASIK and other refractive surrgery procedures - this has been "labeled" as spam, which it is not. This link, much link the one to anoth link, is an informational link. I added this link here based on the fact that there was a similar another link listed. If these are considered inappropriate for this page, then both sites should not be listed. 151.204.233.81

• I agree that neither should be listed. AED 17:53, 6 November 2005 (UTC)

CRSQA

I created the article for CRSQA to give an outlet to those wishing to post verifiable criticism. Hopefully that will put an end to it here. AED 20:15, 23 December 2005 (UTC)

Much appreciated. --Calair 23:15, 23 December 2005 (UTC)

Request for peer review on Keratoconus

A peer review request has been made for Keratoconus. If anyone would like to contribute to that, it would be very welcome. BillC 22:33, 5 February 2006 (UTC)

From Russia with sight

The first serial-product eye surgery method was invented in the USSR in the early 1980's. They did not use any lasers, but rather diamond blades to cut the eye and correct vision. They literally did it on assembly line, stretchers taking the place of engine blocks. The TV footage I saw was really scary but they did 120 patient eyes or so per shift with very good result. Russians still claim the diamond cut method is better than lasers. Why is this not addressed in the article? 195.70.32.136 07:33, 21 June 2006 (UTC)

Nearsighted/Farsighted

Hi, I'm betting, like me, a lot of people visiting the page are wondering is the treatment works for nearsighted and farsighted people but no reference to this is mentioned. —Preceding unsigned comment added by 117.98.1.231 (talk) 11:26, 8 September 2007 (UTC)

I'm not sure the best way to state it, but it works for most forms of nearsightedness and many forms of farsightedness. The biggest group it can't fix is the age-related farsightedness (e.g. those that wear reading glasses). Jon 19:30, 24 October 2007 (UTC)

The technical terms are hyperopia for farsightedness and myopia for nearsightedness. Age related loss of near vision is called presbyopia. I agree that patient eligibility should be addressed more.Garvin (talk) 06:42, 13 January 2008 (UTC)

As is true of the LASIK entry, there isn't much here on the degree of myopia, hyperopia, and/or astigmatism that can be corrected; the level of success attained per amount of myopia/hyperopia/astigmatism; how approaches change per level of myopia/hyperopia/astigmatism; how surgeons plan (or how lasers are programmed) to correct specific amounts of myopia/hyperopia/astigmatism; and how results are analyzed and reported. I'm working on a new entry for the Alpins method of astigmatism analysis, which offers at least one approach to accomplishing some of these goals. The new entry is currently an orphan; refractive surgery should definitely link back to it. I'm not sure of the protocol involved in doing that...all suggestions welcomed. Kcroes (talk) 14:23, 5 February 2012 (UTC)

External link opinions

Opinoins would be appreciated on whether this link: Refractive eye surgery video would be an appropriate addition to the article. Thanks. -- SiobhanHansa 21:21, 8 October 2007 (UTC)

No: Although the information appears solid, but (1) authorship is unknown (2) any references to reputable/verifiable sources of the provided information are absent. Therefore this website fails Wikipedia:verifiability criteria. `'Míkka 23:09, 8 October 2007 (UTC)

??

"In 1986 Dr Swinger improved the surgery (keratomileusis without freezing) but it was still a slightly imprecise technique." this sentence was in the middle of the History section. The "Dr Swinger" was not mentioned previously anywhere.I also do not see any reference links anywhere in the History section. 66.32.146.72 (talk) 23:38, 23 January 2008 (UTC)

The first line in the History part is factually incorrect

As can be seen from this book: Refractive Eye Surgery by Leo D. Bores, page 273–275, the first person to perform refractive surgery for correction of astigmatism, and publish a paper about the method (Archives of Ophthalmology, vol 23, 1894) was William Bates, not Jeendert Jan Lans. (Syd75 (talk) 16:04, 18 August 2008 (UTC))

Please disregard the above comment by me. I was wrong about the fact of who was first, as some more research taught me that it was Hjalmar August Schiøtz from Norway in 1885. As the History part doesn't say anything about who was first, I was also wrong about it being factually incorrect. Syd75 (talk) 18:03, 3 September 2008 (UTC)

Copy editing on History section

I've taken a hatchet to the history section, removing extraneous explanations, things that have nothing to do with the history of refractive surgery, and outright wild speculation. Someone still needs to edit it and add up-to-date information about WHO pioneered the LASEK method (removing a small epithelial portion with alcohol solution and replacing it) and WHEN, and also WHO pioneered use of femtosecond lasers and WHEN. Those sections have been left in comments inline, until someone can research that, cite it, and add it in.

Please, for the love of God, do not add in irrelevant or offtopic stuff to History as was there before. The history should be objective, and as brief as possible while providing the WHO and the WHEN. Leave detailed explanations of techniques to later sections. --RabidDeity (talk) 04:21, 14 October 2009 (UTC)

Risks mentioned still relevant?

The article mentions some serious risks (footnotes 7 & 8), but the referring articles are from 2004. Is this still relevant, or have advances in medicine made this a thing of the past? Evert (talk) 08:13, 11 March 2010 (UTC)

clarify the Surface procedures section?

I am unsure of a sentance, but think there may be words missing. Towards the bottom of the section the following: <snip on> Another advantage of C-Ten is the absence of flap associated complications that can occur after Lasik or Femto-Lasik and changes in corneal stability are minimal. This is in contrast to Lasik, after which there is an unmistakable decrease in. C-Ten is especially suited to the treatment of myopia and irregular astigmatism. <snip off> The part "after which there is an unmistakable decrease in ." = a decrease in what ? Bill Anderson, Nova Scotia Canada 76.11.73.151 (talk) 14:54, 8 May 2010 (UTC)

The claim in wikipedia that C-Ten is the newest form of surface laser vision correction is simply erroneous. The late Dr. Donald Johnson of New Westminster, Canada and Dr. Michel(Mihai) Pop of Montreal, Canada are considered to have pioneered trans-epithelial laser removal(No Touch) as far back as 1994. C-Ten is clearly just a new marketing term for 'No Touch' PRK which has been around for many years. Would like to hear if anyone can clarify how C-Ten differs from the trans-epi laser removal with the VISX excimer laser that has been done in Canada for over 15 years.

Recent systematic reviews

• Barsam, A.; Allan, B. D. (2012). Barsam, Allon (ed.). "Excimer laser refractive surgery versus phakic intraocular lenses for the correction of moderate to high myopia". The Cochrane Library. 1: CD007679. doi:10.1002/14651858.CD007679.pub3. PMID 22258972.
• Shortt, A. J.; Allan, B. D.; Evans, J. R. (2013). Shortt, Alex J (ed.). "Laser-assisted in-situ keratomileusis (LASIK) versus photorefractive keratectomy (PRK) for myopia". The Cochrane Library. 1: CD005135. doi:10.1002/14651858.CD005135.pub3. PMID 23440799.

pgr94 (talk) 03:44, 19 November 2013 (UTC)

monovision

Should we mention monovision? Benjamin (talk) 20:37, 5 January 2024 (UTC)