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LASIK dry eye, corneal damage etc. - possible resource if one has deep pockets

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  • LASIK dry eye, corneal damage etc. - possible resource if one has deep pockets

    I stumbled across this in another group I'm in... figured I'd share:

    https://www.amazon.com/Management-Co...dp/B078S2K3FH/

    More info on it here: http://www.doctorjorgealio.com/en/th...0-downloads-2/

    Because it's a medical textbook aimed at surgeons, it's super high priced compared to books intended for laypeople.

    It's not cheap, but does have chapters on post-LASIK tear dysfunction, ocular surface issues etc. I was looking at the preview on Google books, but wasn't able to see the part about treatment. I was curious to see if there's anything in there that's not already in the DEWS II report.

    Anyhow, no idea if I'll buy it... but figured who knows... someone here may be interested. I'm still looking to see if I can get info from the 2 chapters I want without forking out lots of money.

    Actually, on second thought, Amazon sells used copies. Looking now to see if I can get one for cheap... if not, I'll keep my eyes open since availability/pricing for used copies can change anytime.
    Yet another post-Lasik (2005)...
    Anyone have a time machine so I can go back and undo this mess?

  • #2
    Hehehe... well whaddaya know... Amazon.co.uk had the hard cover marked down by 78% so it sold for only 38.25 (about $65 CAD, or about $49 USD). I shall get this sometime between Monday and Wednesday. Odds are there won't be anything not already in the DEWS report when it comes to post LASIK ocular surface/dry eye issues... but for this price, I really don't care.

    After I read it, I'l probably send it via DHL or UPS back to Canada since I don't want to lug a textbook around in my suitcase for the next 5 months (I'm in Europe right now... heading back to Canada in the summer). And to be perfectly frank, the control freak in me likes the idea of having such a textbook in my collection of reference materials in case I have bad luck and develop some other nasty complication from LASIK down the line... I've been burned before putting 100% of my trust in a doctor (I'm referring to my LASIK surgeon here), so would rather have my own baseline understanding of whatever issues may arise. No offense to my current doc... he's been awesome...

    And since the price seems too good to be true, I took lots of screenshots to show that Amazon did indeed promise the SECOND edition for that price.
    Last edited by SAAG; 11-Jan-2019, 05:35.
    Yet another post-Lasik (2005)...
    Anyone have a time machine so I can go back and undo this mess?

    Comment


    • #3
      If you are really interested in this area, typically textbooks are several years out of date. You should google around for journal papers in this area (and most of them can be accessed for free). Another resource is to find faculty/researchers in this area, and backtrack their papers/citations from there.

      Comment


      • #4
        Originally posted by deep_dry_eye View Post
        If you are really interested in this area, typically textbooks are several years out of date.
        Totally agree with that. This particular one was published in Jan 2018... the DEWS II came out in July 2017. So likely the info in this text will not be anything new as far as treatments go. But for 38 , I'm okay with taking the chance just in case Dr. Alio shares some thoughts of interest that didn't make it into the DEWS II report.

        Also, the physiology stuff that's likely to be in a text of this nature could be useful to better understanding emerging treatments I come across online.

        Originally posted by deep_dry_eye View Post
        You should google around for journal papers in this area (and most of them can be accessed for free). Another resource is to find faculty/researchers in this area, and backtrack their papers/citations from there.
        Yeah, I already do that. I have a file on my laptop with studies in my area of interest. :-)
        Last edited by SAAG; 11-Jan-2019, 05:35.
        Yet another post-Lasik (2005)...
        Anyone have a time machine so I can go back and undo this mess?

        Comment


        • #5
          Wow SAAG can't believe the timing here.

          I've reached out to Prof Alio in Spain to discuss my post LASIK dry eye struggles.

          I passed him copies of my confocal nerve images, this was his response:

          "Thank you for contacting me.
          You suffer what is called by us post LASIK dysesthesia syndrome. It has been described in the second edition of my book Management of Complications in Refractive Surgery, Springer 2018. It consists in inadequate nerve regeneration in the interface, following the surgery. It is not a dry eye but rather a symptom without dryness in most of the cases.
          In my chapter I describe how we treat this syndrome which indeed can be treated in your case. However, I need to see you personally and perform a confocal microscopy study and the treatment can be done immediately. You would need to stay in Alicante for about 4 days in total maximum for the purpose.
          With best personal regards,
          Prof. Jorge Alio
          PS: if you wish to read the chapter of the book you can download it from Springer, specifically that chapter, which is very cheap. I cannot resend it to you because of the copyright transfer is in the hands of Springer.
          "

          I'm currently looking at downloading the chapter of interest, which currently isn't an option on the second edition. I've been in touch with his secretary and the lack of chapter download is being looked into.

          I'm also trying to arrange an appointment to allow him to investigate and listen to his ideas.

          I know you are a long-standing LASIK dry eye suffer but have you ever had a confocal?
          Last edited by quattroboy; 11-Jan-2019, 03:57.

          Comment


          • #6
            quattroboy Yeah, I've had a confocal done with Dr. Perry Rosenthal at the Boston Foundation for Sight several years ago.

            What email did you use to reach out to him? I tried using the general contact form on their clinic's website, but received no reply.
            Last edited by SAAG; 11-Jan-2019, 05:26.
            Yet another post-Lasik (2005)...
            Anyone have a time machine so I can go back and undo this mess?

            Comment


            • #7
              Originally posted by quattroboy View Post
              "In my chapter I describe how we treat this syndrome which indeed can be treated in your case. However, I need to see you personally and perform a confocal microscopy study and the treatment can be done immediately. You would need to stay in Alicante for about 4 days in total maximum for the purpose....
              With best personal regards,
              Prof. Jorge Alio"
              I'm very curious if there is something in there that's not easily found online for free. I regularly see studies where the abstract is available, but the full write up (that includes methods in more detail) is behind a paywall. In any case, for 38 , this seems like a cheap research project. Plus, because it's an actual textbook, it could come in handy one day for discussion purposes with a doctor. Who knows... Either way, I'm sure I'll learn a lot - even if it's just physiology stuff - from what's in there.

              I wonder if it was a pricing error... today the second edition is no longer showing up on the amazon.co.uk site for 38 (today it's priced at 171 ). In any case, my order is still showing up as active, so we'll see... I was hoping the low price would have stayed live longer, in case anyone else wanted to order it.
              Yet another post-Lasik (2005)...
              Anyone have a time machine so I can go back and undo this mess?

              Comment


              • #8
                jlalio@vissum.com

                I think I ordered the last copy at 38! As a result, it's now on back order, hence the price increase.

                Can I ask what was the conclusion about your nerves?

                Comment


                • #9
                  They looked like they regrew properly. But he made a point of saying that doesn't mean they are working properly.

                  Among other things, he also did a test where he puts a drop of local anesthetic in each eye - the one they use for this test causes burning for about 15 seconds or so after it's put in. If your nerves are working as they should be OR you have neuropathic pain that is NOT centralized, that burning should go away completely within 15 seconds or so since the anesthetic properties should kick in. In my right eye, the burning went away completely. In the left eye, I could still feel pain (although it was reduced). So his conclusion was that the pain in my left eye was centralized.
                  Last edited by SAAG; 12-Apr-2019, 07:33.
                  Yet another post-Lasik (2005)...
                  Anyone have a time machine so I can go back and undo this mess?

                  Comment


                  • #10
                    Interesting what is the implications of centralised pain?

                    Comment


                    • #11
                      These articles/videos will explain it better than I will :-)

                      ARTICLES

                      1. http://bostoneyepain.org/does-the-te...el-hold-water/

                      One key point from that article that I think is very important is his argument that even if the corneal nerves look normal on confocal microscopy, that isn't sufficient to rule out corneal neuropathy:

                      "Although doctors have an intellectual appreciation that corneal nerves (especially those of the central pain circuitry) are invisible to this instrument, many continue to assume that corneal pain does not exist without visible evidence of its cause despite this disparity being a recognized hallmark of neuropathic pain that involve other body surfaces. Nor have we taken into account that pain generated in and projected from the central corneal pain network can, in some cases, be associated with corneal nerves that show little if any morphological abnormalities even in vivo laser scanning confocal images (personal observations)."

                      (my emphasis by bolding)

                      2. http://eyewiki.aao.org/Ocular_Neurop...nti-psychotics
                      3. https://www.eyeworld.org/article-tre...plainable-pain
                      4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5607443/ <-- this is a really good article... goes into detail if anyone is in the mood to nerd out on this stuff

                      VIDEOS

                      And some videos that are worth a watch to learn more:
                      1. http://videoed.corneasociety.org/con...y0XImeYJIUze5I
                      2. http://videoed.corneasociety.org/con...IzqTHrwIRohGg4
                      3. https://www.youtube.com/watch?v=ks50...5cXtr62eGx2AIs
                      4. https://www.aao.org/1-minute-video/d...ZXti5AHn-IG3vE

                      If I recall correctly, docs say they think it's possible to reverse centralized pain (particularly if you get on it before it gets really entrenched).

                      Anyhow, us post-LASIK peeps definitely should be aware of this possibility, since corneal surgery is a possible cause.

                      And add to that the fact that dry eye itself can cause this if it goes on long enough... so we are even more at risk.
                      Last edited by SAAG; 12-Jan-2019, 10:21.
                      Yet another post-Lasik (2005)...
                      Anyone have a time machine so I can go back and undo this mess?

                      Comment


                      • #12
                        quattroboy SAAG - The chapter by Alio is available for free online if you access it from the UK. His idea is to lift the flap and cut the faulty nerves, allowing them to regrow properly. I've talked to someone who this worked for, someone who got worse and someone who stayed the same.

                        https://books.google.co.uk/books?id=YCdFDwAAQBAJ&pg=PA113&lpg=PA113&dq=cornea l+dysthesia+alio+flap+2018&source=bl&ots=Wuwe2_gGG n&sig=HpVZPrGwVastFcDHESUAsDRF_Ao&hl=en&sa=X&ved =2 ahUKEwim64in5uDcAhUGMuwKHVTGBW4Q6AEwAXoECAkQAQ#v=o nepage&q=corneal%20dysthesia%20alio%20flap%202018& f=false

                        Comment


                        • #13
                          Originally posted by Lena11 View Post
                          The chapter by Alio is available for free online if you access it from the UK. His idea is to lift the flap and cut the faulty nerves, allowing them to regrow properly. I've talked to someone who this worked for, someone who got worse and someone who stayed the same.

                          https://books.google.co.uk/books?id=YCdFDwAAQBAJ&pg=PA113&lpg=PA113&dq=cornea l+dysthesia+alio+flap+2018&source=bl&ots=Wuwe2_gGG n&sig=HpVZPrGwVastFcDHESUAsDRF_Ao&hl=en&sa=X&ved =2 ahUKEwim64in5uDcAhUGMuwKHVTGBW4Q6AEwAXoECAkQAQ#v=o nepage&q=corneal%20dysthesia%20alio%20flap%202018& f=false
                          I can only see pages 113 and 114 (the first two pages) of that chapter, the rest of the text is unavailable in the preview. Are you able to see the entire chapter? (I was viewing it from Spain.)

                          Funny thing though... I used a VPN to connect via the UK... now I can see pages 113-114... 115-116 are blocked, and 116 starts the next chapter. Is this how it looks for you Lena?

                          Fascinating how what you can see varies so much depending on where you are lol
                          Last edited by SAAG; 14-Jan-2019, 09:47.
                          Yet another post-Lasik (2005)...
                          Anyone have a time machine so I can go back and undo this mess?

                          Comment


                          • #14
                            Originally posted by Lena11 View Post
                            quattroboy SAAG - The chapter by Alio is available for free online if you access it from the UK. His idea is to lift the flap and cut the faulty nerves, allowing them to regrow properly. I've talked to someone who this worked for, someone who got worse and someone who stayed the same.

                            https://books.google.co.uk/books?id=YCdFDwAAQBAJ&pg=PA113&lpg=PA113&dq=cornea l+dysthesia+alio+flap+2018&source=bl&ots=Wuwe2_gGG n&sig=HpVZPrGwVastFcDHESUAsDRF_Ao&hl=en&sa=X&ved =2 ahUKEwim64in5uDcAhUGMuwKHVTGBW4Q6AEwAXoECAkQAQ#v=o nepage&q=corneal%20dysthesia%20alio%20flap%202018& f=false
                            Yes this is his approach I got the book yesterday.

                            I've cancelled my appointment for now. Not keen on getting the nerves cut. Will wait to see if my current treatment produces results.

                            Comment


                            • #15
                              quattroboy Yeah, if cutting the nerves is the only approach he has, then I don't think he can be of help to me either since as far as I know, my nerves re-enervated the flap properly.

                              On the other hand, he also does some interesting things with PRP as far as I know (ex. injecting it adjacent to the lacrimal glands in addition to providing it as actual eye drops)... so that's also worth keeping in mind just in case it ever becomes of interest.

                              My textbook has shipped and is apparently arriving tomorrow.
                              Yet another post-Lasik (2005)...
                              Anyone have a time machine so I can go back and undo this mess?

                              Comment

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