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THE LASIK LETTER


Angels-In-Training on the Internet, 
out of the kindness of their hearts, 
expecting nothing back,
make it possible for you 
to know what you 
NEED 
to know about 
LASIK. 

They wish someone would have
shared with them what they
share with you
to make you
THINK
2x

Subject: MUCH THANKS 
To:  surgicaleyes.com
From:  Doc X

Please be sure to click on the links.

I commend all of you at: http://surgicaleyes.com, as well as those who have contributed their personal refractive surgery  horror stories to help others. 

I am sharing your informative site with our patients, and have included it in our newsletter and now on our website, as well as in our speaking engagements. 

Your  touching, heart-breaking accounts of the poor outcomes,  complications,  frustrations of refractive surgery moved me to tears.

I know these were written from the heart and many through tears, with the intent to help others.  Bless you all!  

Know that I will do all I can to make your words make a positive difference.  You inspire me.

I am a doctor of optometry, a.k.a. an optometrist, in private practice (more background later, so you will know "where I'm coming from").  I wish to share my thoughts with you:


IN A NUTSHELL: 

I am one of four doctors in a group practice, all four coherent and in agreement that LASIK is not ready for our patients.

Like your website's stance, I am neither for, nor against the refractive procedures, per se. They are just procedures, sometimes indicated, often not.

I am very much for the ETHICAL advancement of eye science, technology and care. 

I am very much AGAINST the failure to FULLY inform patients of the  possible outcomes including the most dire, as well as the false portrayal of this surgery as  minimal / low / no risk procedure. 



YOUR IMPORTANT WORK:

Your website, http://surgicaleyes.com,  tells the full story that the ads and infomercials do not. 

It is a godsend.

You are providing priceless reality checks to the unwary public that are best expressed by those of you who were not-fully-informed or misinformed and now paying the steepest of prices.

And your Visual Effects Simulator is educational beyond a thousand words. 

It clearly  illustrates that an eye subjected to "flap-and-zap" -- the euphemistic  slang for LASIK.  In tell-it-like-it-is words, the LASIK surgery involves slicing your cornea like an onion and vaporizing healthy tissue forever.

A sliced-and-vaporized cornea is forever a damaged-for-life cornea at worst, and at best, compromised with the possibility of future, serious consequences.

Unfortunately, for a growing number, the future has arrived.  More and more LASIK casualties are knocking at our door,  just as the RK patients did twenty years ago:

We listen to them. We see their tear-streaked faces. We comfort them the best we can.  We cringe with them in their embarrassment:  "This was elective!"  We hear their frustration: "Why didn't I know this could happen?"  We feel their pain of broken trust.

Letting the public in on the full truth about  LASIK is playing fair. It is the right thing to do.

And you are doing it very, very well.

WHY I DO NOT RECOMMEND LASIK:

I cherish my sight beyond measure, and I believe in the old-fashioned rule we all learned as kids, The Golden Rule. 




I will not gamble on a gift so precious, 
mine or anyone else's.

Nearsighted, I run a higher risk of retinal detachment and glaucoma as I age. Why increase the risk of  long-term complications? 

Besides, I enjoy 20/20+ with my glasses or contact lenses, and my work demands that I look for fine nuances of changes in my patient's eyes.  


LASIK can't promise me or anyone else that kind of clarity.  Less than 20/20 is not good enough. 20/20 with glare, starbursts and haziness is not normal. Sadly, too many are now stuck with 20/40, best corrected, with no recourse. 

20/40 is the driving requirement in many states.  Young people with 20/40 have no "cushion" for the future.  Age happens.  20/40 with glare, arcs, starbursts, and haze (GASH) at night is an accident waiting to happen.

The buzz is out that we remained steadfast in not recommending LASIK, and post-LASIK patients are now seeking us out.  

Beset with problems they never dreamt would be theirs and distrustful, they are not about to return to their original doctors who referred them to LASIK surgeons.  They are especially upset if they've learned of the financial arrangements (good, bad, or neutral) between optometrists and surgeons; they are livid if they've learned that the referring doctor had a financial stake in the laser center.  Think: conflict of interest.

These are the complications  that post-LASIK patients come to our door with:

Once ecstatic,  throwing out their glasses and contacts  just like the actors and actresses in the infomercials,  many are back in glasses with less  vision quality than before surgery. 

In general, the older they get, the worsening is accelerated, compounded by natural aging changes.  

LASIK involves "the severing of millions of microscopic corneal nerves, the thinning of the cornea, the reduction in the strength of the cornea by 50%, the endothelial and optic nerve fiber cell losses, equivalent to an aging of the eye by 10+ years." *

I'm close to 50, and I choose not to surgically speed up the inevitable aging changes.  Nature is doing a commendable job all on her own, thank you.

I was mortified when refractive surgeons enticingly offered to do the surgery on us (doctors and staff) for free. 

None of us fell for this PR ploy, as free can mean less than nothing.  

We are not guinea pigs, especially in view of the following known possibilities of LASIK surgery: 

Please drive defensively.  The independent are not about to surrender their licenses, even if they know they are unsafe on the road.

And think what happens when age collides with LASIK complications in another ten years or so. Uh-oh.

  • Visual impairment that can profoundly alter the lives of complicated post-Lasik patients, their families, and society-at-large.  Taxpayers support those who can no longer support themselves.


These complications were predictable from what we learned as students in Cornea 101.   Practically revered, the cornea and its osmotic balance were to be vigilantly protected .You tamper with delicate balances, you pay.  I am amazed by the selective amnesia that set in when the juicy carrots were dangled.



IF YOU ARE THAT SURGICAL FAILURE,
IT'S ONE OUT OF ONE 
FOR YOU: 

Our practice has served close to 30,000 patients, some make the effort to come to us from across the country and internationally.

Just ONE of our patients losing their sight is one too many to risk.  Do the math:

3% of 30,000 = 900! 

Far greater than one. Not good.  Very, very bad.

Watch that underestimated "3%" failure rate balloon in the near future, as time and natural aging catches up with a surgically-compromised cornea. 

Out of the two patients in our office who chose to do it in spite of our efforts to fully inform, both are not doing well.  2 out of 2. One is diabetic; she should never have been touched.  The other  is in glasses, full-time, and can't get over how he was "treated like cattle" at the laser center.


I would NOT have this surgery done to myself, nor to my family. 

And my patients are family to me. 



BACKGROUND INFO: 
(So you may know from whence I come)

For me, optometry was a spiritual calling, and I've devoted my heart and soul to it.

I love my profession. I love the work that I do. I am grateful for the privilege of serving our patients. 

Optometry has provided me with opportunities to serve in meaningful, life-enhancing ways for over 20 years. 

No job is perfect. For me, optometry gets pretty darn close:

  • Your basic healthy patient. Of all ages. Lots of smiles.

  • Minimal contagion. No needles. Rarely bloody.

  • Few emergencies. No deaths. No convulsions. No bad breath. Few sneezes in the face.

  • Patients who are referred to us by patients and doctors in the area.

  • We choose not to be HMO-, PPO- or managed care-affiliated. Our hands are not tied. We choose to practice at the highest level.

  • Our state-of-the-art instruments keeps things  interesting and us on our toes.

  • Saving eyes and lives.

In short, besides providing a comfortable, but far from extravagant,  living (we don't take it with us, you know), I owe a huge debt of gratitude to my patients. 

Especially for the intrinsic rewards that they grant me every day. 

Their reactions to seeing with clarity -- and their hugs -- provide me with natural highs. Their kindnesses inspire me to keep giving back to them in greater measure. 

My needs are few; my wants, even fewer. It is important for me to be kind back, and most of my income has been plowed right back into the practice and patients. 

Through my work, I overcame my shyness to become a contributing member of my community as a speaker at civic clubs and supporter of scouting, youth athletics, and indigenous culture.

Professionally, I became the first woman, first minority to serve on a optometry-ophthalmology eye care national board entrusted with the care of over 33 million patients. They tapped my shoulder for the position. 

Basically, I'm a country doc who likes puttering in the garden. And I don't like to fly (in planes).  On the third tap, I relented. In other words, I didn't seek out the position; it sought me. 

It's been a huge learning experience that has opened up greater opportunities to further the good.

Most gratifying for me has been watching the children of our practice grow up into good, kind people. 

Over the years, they've become in many ways, my own kids. I have never, for one moment, regretted choosing my work, over having my own children. 

Fifteen -- soon to be 16 -- of our young patients have chosen to pursue optometry.  Don't I sound like a proud Mom! 

I encourage those who express interest in my field to pursue it ONLY if their hearts tell them that they truly want and like to help people. 

If they admit that they are doing it for the $$$, I encourage the bright, self-motivated ones to become stockbrokers first (many have indeed done very well): 

"Your grade point average tells me you're smart enough to make more money --and faster -- as a stock-broker. Get the
$$$ thing out of your system.

Then and only then consider being a doctor." 

With this kind of screening and conscious values clarification,  I believe we  stand a good chance to have  future patients-first, conscientious doctors. 

 Hopefully, my successors!

[ I added  this section for the bit-o-the-cynic  in all of us:  My patients know me, and those reading this online do not.  Let me make this perfectly clear: This site is not an advertisement. This is posted for educational purposes, without names (Doc X is a pen name) or an address for prospective patients to find us.  

Like Roger, I'm just telling it like it is, with the intention to help, rather than hurt.

Except for challenging cases, I stopped accepting new patients some time ago. Rather than doubling / tripling our load, we add doctors to take care of the overflow. 

We schedule seven (7) comprehensive examinations a day per doctor, providing the time to communicate with our patients and give the highest level of conscientious care, 75 year old traditions in our practice.  Not surprising, after these many years, I'm full up.

Our fees are in line with what is usual and customary for our area. To be direct, we give at least twice as much time and care for the money, and we do it gladly.

Patients schedule their appointments a year ahead, keeping the schedule saturated with a daily waiting list. A practice built on the referrals of patients and doctors in the area, we have never lacked for patients. We do not advertise to the public. Like Smith-Barney, "We make money the old-fashioned way. We  EARN it."  :-)

It's not that we're so wonderful. We may be high-tech in equipment, but we like sticking  to good old-fashioned caring.

Basically, this is the Rx of our success:
We treat our patients as people with hearts, minds, and souls.

Simple as pie.] 

SINCERE THANKS TO SURGICALEYES.COM: 

At the end of my hour with my patients, when the "doctoring" part is done, I especially enjoy "visiting" with them as friends and family. 

These days, however, much of that time is spent talking about refractive surgery, especially LASIK. 

I sincerely thank you for your site, as you make it easier for me to fully inform them.  I refer virtually every patient -- whether they inquire about it or not -- to: 


http://surgicaleyes.com 



I tell them:

"If you or those you care about are contemplating refractive surgery, suggest to them that they spend an evening at  http://surgicaleyes.com

An evening that may prevent a lifetime of regret. 

If someone you know has already had it done, suggest they keep this website's URL handy for the future problems. 

Don't rain on their parade. For those doing well, we wish NO ill.  I love Tiger  Woods! 

Grant them their joy in their new vision,  but keep them grounded and informed.  Advise them to temper their proselytizing. There is and will always be a percentage of surgical risk and failure, and they too may be experiencing the down-the-road complications.

I shall never forget the sobbing patient, sobbing uncontrollably, not for the loss of  his vision from a collapsed, scarred cornea, but for the friends and colleagues he had gleefully referred to his refractive surgeon. "If this happened to me, it can happen to them. They did it because I told them how great he was!"

Hopefully, their awareness of unsuccessful outcomes will make them compassionate and  sensitive toward those less fortunate, who suffer physically, as well as from emotional distress and depression.

Unsuccessful post-LASIK patients have contemplated suicide, and such LASIK- associated suicides have been reported.

Things change. For many, it  already has.  It did for  Congressman  Rick Hall of Montana.

For every LASIK patient, the jury is still out.

When a safe, reversible procedure comes along, as it will one day, I'll be first in line, and you can line up behind me. Until then, I suggest you wait with me and Mark McGwire. 

Some things are worth waiting for."


TRUST ISSUES:

Believe me, looking forward to a simple country life when I retire,  if I had no conscience,  I'd be tempted to use these persuasive words:

"You're the perfect candidate for this surgery. Trust me …" 

I'd be raking in those co-management fees and paid more handsomely than ever in the history of my profession. 

But because our patients trust me implicitly to do what is best FOR THEM, my choice has been simple. I will not breach that trust, nor take advantage of it. 

Doctors do not always agree with one another, and I will respect each doctor's right  to choose their paths.  Not having walked in their shoes, I will not judge the paths taken by others.

A friend from school sat me down and had a heart-to-heart with me:

"It's so easy, X.  I can get my patients to go for LASIK in five minutes. Your patients love you.  You can do it in three.   We've never made money like this before. You can retire early to the country. And, X, if you don't refer them, they'll go to another doctor down the street and that doctor will be collecting the co-management fees."

I think he was looking out for me. We'll always be dear friends. No matter what. I don't walk in his loafers.  And he doesn't walk in my heels.  It's like politics...

I will NOT, however, condone the manipulative tactics described by a giddy peer, who is an exception. Delighted with the referring doctor - refractive surgeon financial arrangements, this was his modus operandi:

Whenever one of his patients was scheduled for surgery, he'd duck out of his office and drive down to the laser center. Comfortingly stroking the patient's hand as the eye was being lasered, the doc made sure that he was the first person seen by the patient. "I look like a hero," he said. He felt that doing "this little extra for the patient" nailed his referral fee for the second eye. Ka Chinnng! 

Hearing this turned my gut. It embarrasses me to mention it. But I can be as ingenuous as Pollyana, thinking the best of people.  This example knocked my naive quotient down a few notches. As distasteful and as much as we wish not to believe it, these folks exist in any walk of life.  

As a group, optometrists are sincere, salt-of-the earth people. It is not a black-and-white issue.


Rest assured, there are independent-thinking doctors out there who do care. 

I am blessed to be working with three of them, as their judgment remains untainted by the hype, dangled carrots, and lemming mentality.  I am in contact with peers who feel the same way we do, and we reaffirm one another and bolster each other's resolve. I refer to  like-minded, respected  ophthalmologists in my area for necessary surgeries and/or treatments, when it is in the best interest of the patients and not for a fee.  

I have surrounded myself with those  who take their oath seriously: 

"Above all else, do no harm."


POOP


The poop has only begun to hit the proverbial fan, 
just as your fast-growing site attests.
The lawsuits have begun.
The trickle before
the flood.

Good people are hurting.
Good people are still being hurt as we speak.
Good people can be your loved ones.
When they hurt, you hurt.
We all hurt.

Keep up your sight-saving work.

Together, 
we can make a positive difference.
BE AWARE.
Make others aware. 

But it is NOW that we make a difference. 

Not later.

Once sliced,
it's a done deal.

© 2000
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Pay it forward

The movie, "Pay It Forward"(as opposed to pay-it-back) is about a child who has an idea on how to create a better world: if a kindness comes to you, pass it on to three more people and challenge them to do likewise. 
So one becomes three. Three becomes nine. Nine becomes 81. And so on...and so on...and so on...

The movie taught me something valuable and new: 

Challenge the recipients of your kind deeds to 
PAY IT FORWARD.

"So one becomes three. Three becomes nine. Nine becomes 81. And soon...and so on...and so on." 

And so I challenge you: 
If you have benefited from this site, 
pass it forward to three more.

This is a grassroots effort that's 
worth getting involved with, 
as it's about sight.
For Heaven's 
Sake.

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Thank you.

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