Faculty

Surgical outcomes

RI - PIQASO™ Quality Control Report:
Surgeon: Dr. Dan Z Reinstein
Parameter: SAFETY

At Reinstein Institute, we believe that it is very important for our patients learn and fully understand the techical aspects of LASIK safety. It is only in this way that a patient can become truly informed and provide true "informed consent" for surgery.

Technically, if surgery were a 100% safe procedure it would mean that the probability of damage to the vision would be 0%. "Damage" to the vision, means blurring, doubling, distortion that can no longer be corrected with glasses. This is to be distinguished from the situation where a procedure is performed, the vision is greatly improved, but there still remains some blurring or other which can be corrected with glasses: In this case, the ability to fully sharpen the vision to presurgical levels has not been changed. In contrast if there were some damage to the vision, the vision would not be correctable with glasses to the presurgical level.

In many cases where such "damage" develops, it is possible to correct all if not most of the visual disturbance with RGP contact lenses or possibly further surgical procedures. The Reinstein Institute, through the use of the Artemis VHF digital ultrasound system developed, has been at the forfront in the research and surgical correction of the complications of refractive surgery with publications in this field (pdf download - 600K ).

The technical way of measuring "damage" to the vision is in reporting the number of lines on the vision chart that the patient is no longer able to see, starting the count from the bottom of the chart. For example if before surgery the patient is able to see 20/20 (or 6/6) and after surgery, for whatever reason, the best vision that can be achieved, even with the use of spectacles is now 20/25 (6/7.5), this would be classified as a loss of "one line" of best spectacle corrected vision. In the profession, it is considered that a loss of two lines or more is "significant" to vision.

It should be understood that the conventionally accepted method of measuring vision (the "Snellen chart") does not describe some types of visual side-effects that may occur after refractive surgery incluing night vision changes (halo, starburst), image doubling or ghosting. In other words, a patient may be seeing nominally "20/20" but in some circumstances still have some form of visual disturbance. The likelihood of developing a disturbing level of these symptoms depends on the one hand on the type of correction to be done and the laser used for surgery and on the other hand on the ability of the surgeon to manage the complications of surgery to stear toward a good outcome. Sadly, a perhaps most patients with such postoperative side-effects may have been able to avoid these altogether by more careful patient selection - in some cases, no surgery at all. To this end at Reinstein Institute we use a comprehensive testing system to minimize the chances of this happening, and in some cases, recommend that no surgery be done at this time. In addition, we try our best to see that patients understand their own personal risk-profile of getting such visual side-effects - ensuring that for the individual, this risk is acceptably low enough, relative to the benefits of vision correction.

Below is a table showing SAFETY outcomes for Dr. Dan Z Reinstein.

Loss of Best Corrected Snellen Visual Acuity
Myopia and HyperopiaRange: -7.00 to +3.00	Loss of 1 line	Loss of 2 lines	Loss of 3 or more lines
Number of eyes: TOTAL 732	30	0	1 1
Percentage Eyes	4.1%	0.00%	0.14%
Number of eyes losing vision to 20/40 or worse		0

	Percentage	Eyes out of 6,300
Flap Complications
Free Cap 2	0.002%	1
Thin Flap 3	0.004%	2
Incomplete flap with no laser ablation 4	0.004%	2
Corneal perforation	0.000%	0
Blindness (total loss of vision)	0.000%	0
Corneal scarring reducing vision	0.000%	0
Inflammation with decrease in vision 5	0.002%	1
Infection	0.000%	0
Epithelial Ingrowth requiring further surgery 6	0.004%	2
Laser Complications:
Visually significant decentrations of laser treatment	0.000%	0
Laser Parameter Data entry error	0.000%	0
Faulty calibration of laser	0.000%	0

RI - PIQASO^™ Quality Control Report:

Surgeon: Dr. Dan Z Reinstein
Parameter: LASIK Efficacy - one procedure - when medically indicated an enhancement procedure may be performed to improve the outcome even further ⁷

Myopia 8	20/40 or better (able to legally drive without glasses)	20/25 or 20/20
-0.5 to -3.00	99.5 %	92.0 %
-3.01 to -5.00	99.3 %	88.3 %
-5.01 to -7.00	98.8 %	83.6 %
-7.01 to -9.00	93.9 %	78.6 %
over -9.00	75.0 %	63.8 %

Hyperopia 9	20/40 or better (able to legally drive without glasses)	20/25 or 20/20
+0.76 to +3.00	94.6 %	76.6 %
+3.01 to +4.00	90.3 %	61.5 %
+4.01 to +5.50	81.4 %	45.1 %

Mixed Astigmatism 10	20/40 or better (able to legally drive without glasses)	20/25 or 20/20
-1.30 to -6.00 Diopters of Total Astigmatism	100 %	97 %