Dr. Joseph Lee’s Top Ten “Surgeries and Techniques I HAVE NOT performed”

Many doctors want to be on the cutting edge of a new medical technology.  Have you ever wondered what happened when it was later discovered that the machine or technique was flawed and serious side effects occurred for a large percentage of the patients who underwent the “latest” technique?  A surgeon’s judgment is key in assessing new technology and deciding when and how to adopt the new technology.   It is difficult for the average person to assess a given surgeon’s surgical judgment, which is probably one of THE most important factors in determining how good a surgeon is.

One very clever way for an average person to judge for himself or herself the caliber of a surgeon’s judgment is the use of that particular surgeon’s past judgment in using particular machines or techniques.  I am NOT saying every technique or surgery listed below is bad; just that it’s not as straightforward as one might think.  Comments below reflect MY opinion only, as a refractive surgeon who has performed 70,000 lasik cases in the past 17 or so years.

Feel free to print the list and ask other lasik surgeons whether or not they have used the techniques below.  It should be eye-opening to you.  😉

Starting with Number 10!

10.  Radial Keratotomy (aka RK).  Okay, I’ll admit I have performed RK on one eye.  Not a very good procedure.  I feel bad I even did that one.

9.  Conductive Keratoplasty (CK).  Never performed one.  Many lasik surgeons did use this at one point.  Now, just another couple of letters on the junk pile of dead medical technologies that at one time was supposedly the “latest and greatest”.

8. Lamellar Thermal Keratoplasty (LTK by Sunrise).  Never performed one.  Many lasik surgeons did use this at one point.  Again, now, just another couple of letters on the junk pile of dead medical technologies that at one time was supposedly the “latest and greatest”.

7.  Automated Lamellar Keratoplasty (ALK).  Never performed one.  Many lasik surgeons did use this at one point.  Again, now, just another couple of letters on the junk pile of dead medical technologies that at one time was supposedly the “latest and greatest”.

6.  Epi-Lasik.  Never performed one.  I have performed quite a few PRK’s.  This is how Epi-Lasik works.  Using a dull blade, only an epithelial flap is formed.  An excimer laser then used to reshape the cornea.  Supposedly, the epithelial flap is replaced.  I’ve heard anecdotally that surgeons who use epi-lasik realized that sometimes the epithelial flap would fall off in a day or two. . . then the procedure essentially becomes a slow healing PRK.  So, instead of taking a chance of the epithelial flap sloughing off, the surgeons would NOT replace the epithelial flap.  Okay then.  That is merely PRK and you shouldn’t be able to use the word “lasik”.

5. LASEK.  Never performed one.  This is the identical same story as ep-lasik.  Except alcohol is used except for a dull blade to weaken the epithelial layer so the epithelium comes off supposedly fairly easily.  Whether the epithelial layer is replaced or not, is anyone’s guess.  Seriously, though.  If the epithelial flap weakened by alcohol ISN’T replaced, it’s only fair to call it PRK.

4.  PWPIBTS (Prayer with patient immediately before the Surgery).   I have never done this.  I don’t think there is scientific proof to show that this results in a higher success rate.  Anecdotally, I have had many patients who I have done lasik for, who end up with better than 20/20 vision, tell me their results are fantastic because they prayed so hard.

3. PT  (Permanent Twinkle).  I have never performed this and never will.  Eye jewelry, a tiny piece of platinum or gold that is surgically implanted behind the clear skin in the white part of the eye.

2.  The Ladarvision laser machine.  I have never once used this laser on a patient.  Or on a piece of plastic.   While I was a refractive surgery fellow at USC, I had the opportunity to assess this technology at one of the meetings.  One of the questions I had was, can you tell me the pattern that the laser beam takes on the eye?  The response was, “no, it’s proprietary”.  I didn’t like the answer and I didn’t believe that they could consistently do what they claimed to be able to do.  So, I never used it.  I didn’t just not use it.  I made many negative comments on Keranet (once online, you can never erase it, supposedly) on why I felt it was not a good laser.  Turns out, the Ladarvision system had many flaws and FDA recalls.  Recently, Alcon even stopped supporting the system (that’s how bad it was, maybe they’ll spin it like, “oh we moved on to better technology”).   

  If you did a fair number of cases using Ladarvision, the manufacturer  would sometimes give Ladarvision doctors an award called the “Centurion Award“.  It’s fair to say this “centurion award” was never given to a surgeon who didn’t use the manufacturer’s lasers, so I think it’s fair (or not) to say it’s a marketing gimmick.   It should also be fair to say that lasik surgeons who received the “centurion award”  for their use of Ladarvision lasers, got the award while using the Ladarvision system on a lot of patients (who knows if the doctor knew it had issues, but if the doctor didn’t know, who would?), while claiming it was the newest and latest.  Seems, the doctors who were using this Ladarvision platform knew it had serious issues, but didn’t tell their patients.   Do your own research as it seems this laser has a very murky past.  Google “CBS news airs report on ladarvision malfunction” and decide for yourself.

And the Number 1 technique I have never performed.

1.  ICL  (Implantable Contact Lens).  I have never once put this in a patient.   My issues with it. Okay, one of the biggest “selling points” of the ICL is that it is reversible.  Hmmmm.   Let’s say you are driving and accidentally “run over” a deer.  If I just put the car in reverse, and back up, is it all good?  Let’s examine critically why the ICL would be “reversed”.  Let’s examine one scenario.  The ICL is put in.  It causes a cataract in the lens inside the eye.  The ICL is reversed.  Does the cataract now disappear?  I don’t think so.  So, is the ICL truly reversible.  My opinion, no, the ICL is not reversible in the way that a prospective patient who is not an eye professional, thinks it is reversible.  In other words, although the ICL may be pulled out and reversed, the EFFECTS induced in the eye by the ICL may NOT be reversible.  So, not fair, in my opinion again, to present it that way. 

Yes, I may put the ICL in patients in the future.  Do I not put it in now because technically it is so darn difficult?  Absolutely not.  My opinion and many eye doctors would agree that a difficult cataract surgery (which I do often) is much more difficult than simply putting in an ICL.   I perform 15 to 20 cataract surgeries in a morning.  The technicians and OR nurses will vouch for me, that I am an excellent cataract surgeon, as will the medical director of the surgical center where I perform cataract surgery.  My opinion, cataract surgery, ICL, and any other intraocular surgery requires a higher level surgical suite than lasik.

Again, lastly, if I ever put in an ICL, I would perform the procedure in a surgical suite which is accredited at the level of Medicare requirements of a surgery center  for basic cataract surgery.  That means, using a microscope rated for intraocular surgery (which is different than requirements for lasik).  Typically an Eye Surgeons reimbursement by Medicare for cataract surgery is approximately $600 per eye.  If an ICL patient is paying $4000 or more per eye for an ICL, don’t they deserve at least that quality of a surgical suite?

Ultimately, my concern as a surgeon is, not that I want to quickly jump on a new technique so I can claim to be a “pioneer”;  my concern is for the safety and long-term well being of my patients. Unquestionably, it will increase my revenue, $4000 or more per eye for a 10 minute procedure sounds good to me too…. but again, my long term concerns for my patients come before my financial gain and one of my biggest concerns with the ICL is potential cataract formation over 5 to 10 years; I will wait until I am satisfied with the data that accumulates.

Dr. Joe Lee

October 29, 2014