Volume I Issue 21

Originally published, May 27, 2001

LASIK shown live every Wednesday on the Web

Co-workers watch their friend’s surgery on the net. Viewers in France, England, and Japan, have logged on to www.lasiktv.com.

LASIKTV webcasts unedited surgery live for those with Cable Modems, DSL, and other high speed internet connections

“There is nothing mysterious about LASIK surgery. It is a very precise and elegant procedure,” claims James Lewis, MD, Medical Director of iHateMyGlasses.com. Patients and their families are eager to learn all the details.
Despite concerns by malpractice insurance carriers, Dr. Lewis feels every patient is entitled to a record of their surgical experience. All patients leave the operating room with a videotape.
“Friends, co-workers, and family members are usually very excited to watch the procedure. Some start reluctantly viewing the 42 inch plasma-based flat screen monitor that hangs outside the operating room. By the end of the case they are totally absorbed,” Lewis claims.
Dr. Lewis leaves the OR between patients to answer questions. Many are curious about the temporary colorful marks made on the cornea which helps align the tissue at the end of the case. Observers learn that the same fluid pump that keeps the cornea clear (the endothelium) holds the flap in position after LASIK.
The biggest surprise to those who watch the surgery is the gentle nature of the excimer laser. It appears as a flashing blue light that gently sculpts a precise amount of corneal tissue. A fair number of viewers will say, “This isn’t too bad. I think I will get a LASIK evaluation.”
Patient privacy and the protection of medical information have always been an important considerations for iHateMyGlasses.com. All patients are asked for their consent before any surgical footage is displayed on the screen or used in the webcast. Dr. Lewis is proud that most search engines rank his video and photographic consent near the top. This is important even when no identifying marks are present.
LASIKTV is based on a Linux video server created by Videocomplex in Vancouver, Canada. It provides the best quality video for viewers with high speed connections.
Dr. Lewis is working with another company, NuSpectra Multimedia, Inc. of Alameda, California. They will improve the viewing experience for patients with slower connections (33 or 56K modems). The NuSpectra system will allow users to control the camera and look around the operating suite.
Another exciting advantage of the NuSpectra System, called SiteCam, is the ability to archive images. Patients will be able to tell their friends to log on and view their surgery at their convenience. Lewis is working to make certain there are password or passphrase controls to adequately address medical privacy concerns.
When the LASIKTV project is complete individuals will have a number of ways to view, archive, and even distribute their own surgical videos.
A startup internet company designed to educate ophthalmic surgeons throughout the world was just launched by John Wolfe, former CEO of Staar Surgical, INC. This company, Broadcastsurgery.com, was based, to some extent, on talks Dr. Lewis and Dr. Alan Shelton (Santa Monica, CA) had with Mr. Wolfe during the last three years. “Mr. Wolfe has always stayed ahead of the curve. His emphasis on education and international physician to physician interaction should make this venture a great success.”
Dr. Lewis has been asked to serve on the advisory board of this new webcasting company.
One of the aspects of LASIKTV that makes it special is its lack of editing. All surgeries are seen without modification. Prospective patients experience LASIK that isn’t “sugar-coated.” They also can remain anonymous and consider the surgery without making an intellectual or emotional commitment.
“Of course, there are always a handful of patients who don’t want to see the surgery before or even after their procedure,” Lewis admitted. “There is an off switch.”

LASIK surgery videotapes are provided to all patients. Almost every patients watches their successful operation in the first few days.

Volume I Issue 20

Originally published, May 20, 2001

Independence Blue Cross pays for LASIK

Blue Cross of Pennsylvania offers laser vision correction as a benefit to select employers and their employees. Is this a blessing or a curse?

Area’s largest health insurance carrier adds LASIK to its list of covered services

EDITORIAL
by James S. Lewis, MD

In the last few months nearly a dozen discount LASIK corporations have declared bankruptcy. Employees were fired, doctors were left unpaid, and lasers were repossessed. Patients who gave these companies deposits where stranded without surgery, without a doctor, and without legal recourse.
In my opinion, this is the result of a LASIK price so low it makes quality care impossible. iHateMyglasses.com has always charged $2500.00 for both eyes, lifetime enhancements, and a year of post-operative examinations. This cost allows us to provide excellent staff, state-of-the-art equipment, and top surgical talent. We know we couldn’t have charged less without cutting corners. While I am Medical Director, that just isn’t going to happen.
I welcome the help insurance companies can provide but I worry they will fall victim to the same problems that befell those now defunct LASIK companies. Worse, they may be forced to restrict patient choice in order to compete for corporate contracts.
In my experience, LASIK patients are highly motivated, well informed, and driven to find the best doctor, the best staff, and the best equipment available.
I have researched the experiences in South Carolina, Idaho, North Carolina, and South Carolina involving independent Blue Cross companies. In most cases, exclusive arrangements were made. Patients could not choose their doctor, they could not select their laser, and they could not select the location for their care.
Many of the exclusive arrangements were made with corporations who used lasers that were transported daily by truck. These extremely delicate machines would arrive at a specific location once a week or once a month for surgery. Often a small group of surgeons provided care for an entire state.
Employers who were generous enough to offer this “rider” in their Blue Cross policies may not have realized what they were getting for their employees.
In my experience, patients go to a LASIK provider based on reputation, experience, community standing, and references from family, friends, and co-workers. This can not occur when Blue Cross or any other insurance company makes exclusive contracts with corporations.
Joseph Bilson, Director of the Wills Eye Surgical Network told me he was asked by Independence Blue Cross to charge their patients half his established price. “I sent them packing”, he told me by phone. Mr. Bilson and the Wills Eye Surgical Network have a strong commitment to quality care in LASIK and all areas of Ophthalmology.
Another internationally known LASIK provider was approached by Blue Cross. Reputedly, he politely showed them the exit.
Employers can best help employees who desire LASIK by encouraging flexible medical savings accounts or providing credit or loan programs.
When it comes to LASIK, patients know there are differences among surgeons, equipment, and staff. When an insurance company or employer provides benefits to retain and attract outstanding personnel they must recognize the importance of choice.
I have spent the last six weeks trying to speak with someone in authority at Blue Cross. Only today was I allowed to speak with Dr. Kerr, National Director of Network Services. He was unable to shed additional light on their plans.
I recommend all patients contact their insurance company and their benefits counsellor.
When the Ophthalmologists in Tennessee exposed the facts to their political leaders, Blue Cross withdrew from its participation in LASIK entirely. We can learn something here.

Explanation of medical benefits sent to James S. Lewis, MD showing multiple errors, inconsistencies, and omissions by Blue Cross.

claims to major medical require PTM code: S0800-RT and S0800-51LT along with an ICD 9 code 367.1

Call member services TODAY. Check your LASIK benefits.
turn your card over to find the telephone number

Volume I Issue 19

Originally published, May 13, 2001

Is there something better than LASIK?

STAAR Surigal’s Implantable Contact Lens. This UV-absorbing lens is constructed of a biocompatible material known as collamar.

Implantable contact lenses may replace laser vision correction in special cases

Intraocular lenses (IOLs) have been used for years following the removal of cataracts. New designs have been recently developed for patients who do not have cataracts.
These IOLs provide an alternative to LASIK for the correction of refractive errors. In some severe cases these IOLs can be used in conjunction with LASIK. (This concept is known as bioptics.)
Staar Surgical has been developing their Implantable Contact Lenses (ICL) for several years.
In August, 2000, Dr. James Lewis and three other US surgeons travelled to the Centro de Microcirugia Ocular y Laser in Santo Domingo for special training with this implant. Under the direction of Juan Batlle, MD, Dr. Lewis became one of a handful of surgeons certified in the use of the Implantable Contact Lens.
“LASIK changes the shape of the cornea. The ICL can correct patients we can’t help with laser surgery”, Lewis claims. “It is possible that the ICL might be a better choice for some of the patients we now treat with LASIK.”
Under the direction of the Internationally respected refractive surgeon, Juan Battle, MD, Dr. Lewis performed four ICL procedures in August, 2000. All patients were extremely nearsighted and could not benefit from LASIK. The power of the ICL used in one surgery shown at the right was minus 19.5 diopters. Standard intraocular lenses powers range from plus 6 to plus 32 diopters!
“As ICL technology improves we may find that it encroaches on the higher refractive errors we now treat with LASIK”, Lewis continues. “Once the FDA approves this technology an even greater segment of the population will benefit from refractive surgery.”
Ciba Vision recently obtained exclusive marketing rights for Medennium’s Phakic Refractive Lens (PRL), a competitor of Staar. The founder of Medennium, George Rozakis, MD, of Cleveland, Ohio, is the driving force behind the PRL.
Almost twenty years ago Dr. Lewis and Dr. Rozakis were Ophthalmology residents together at the Duke University Eye Center in Durham, North Carolina. They have collaborated on a number of projects during the last two decades.
“George has always been a visionary. This was true in the early 1980’s and it is true today. I think his PRL has major implications for refractive surgery”, Lewis commented.
Several other companies throughout Europe are working on similar technologies.
The LASIK surgeon of tomorrow may have several additional tools at his or her disposal for the correction of refractive errors.

Myopic eyes (nearsighted) are too long. Without correction, objects focus before the retina and appear blurred.

Implantable contact lenses may replace laser vision correction in special cases

Medennium’s Phakic Refractive Lens also corrects refractive errors when placed behind the iris.

Volume I Issue 18

Originally published, May 6, 2001

Dr. James Lewis evaluates the latest LASIK technology

Nidek announces a Confocal Microscope. Dr. Lewis, Medical Director of iHateMyClasses.com views the finest details of a patient’s cornea.

ASCRS attracts International Surgeons

While ASCRS stands for the American Society of Cataract and Refractive Surgeons few use that name. One reason is the attendance by European, Asian, Australian, and South American Ophthalmologists nearly matches the American contingent.
The quality of the lectures, courses, exhibits, and films explain some of the popularity of this meeting.
“I haven’t missed an ASCRS meeting in a decade,” claims James Lewis, MD. “The hardest thing about this meeting is to spend your time wisely. There are courses and scientific papers from 7:30 AM until 6:00 PM.”
Every year the Innovator Award is given to the Ophthalmologist who has done the most for refractive surgery. This year Gholam Peyman, MD the inventor (and patent holder) of modern LASIK was recognized. Dr. Peyman, surprisingly, is a University retinal surgeon, and does not even perform the surgery!
Dr. Peyman, who has written hundred of books and thousands of articles, is a very quiet and modest man. In the photo to the right Manus Kraff, MD, another pioneer in cataract surgery, prepares to present a trophy for Dr. Peyman’s achievements.
Another lecturer at this very special session was Charles Kelman, MD. Dr. Kelman invented almost every major technique for cataract removal during the last 30 years. Despite terminal cancer, he is working with manufacturers to help patients with small lung tumors before they have metastasized. Expectedly, he was given an overwhelming standing ovation.
“When you see giants like this, it makes you proud to be an Ophthalmologist,” Lewis added.
Another highlight of this meeting was the ASCRS Film Festival. Over 300 short films on refractive surgical techniques are submitted for judging by a distinguished panel of surgeons. They are judged on originality, relevance, educational merit, and production value. Dr. Lewis still displays his trophy from the 1993 ASCRS meeting when he won second place.

Hundred of Exhibitors display their products to Ophthalmologists and their staff. Everyone wants to know what’s HOT.

Thousands of refractive surgeons from around the world attend this week’s ASCRS meeting.

Nidek introduces
device to monitor corneal health in LASIK patients

SAN DIEGO, California- Nidek Technologies has just released the Confoscan 2. This device allows the refractive surgeon to assess corneal thickness, post-LASIK flap thickness, and endothelial health.
As LASIK and other refractive surgeries become more popular the need to address more complex cases is growing. Enhancement surgery for those with an insufficient correction also requires a complete assessment of corneal anatomy.
“I anticipate a day when confocal microscopy becomes the standard of care for the LASIK surgeon. Clearly, it is vital in complex cases,” Lewis reports.
Residual corneal thickness is always a concern in LASIK. The confocal microscope has been used in research laboratories for years. Now that clinically viable devices exist patients will benefit.
Problems like keratoconus, endothelial dystrophy, and infection plague the active refractive surgeon. The confocal microscope will help optimize patient care.
Other companies like Ultralink LLC and others have identified the importance of this new technology. Look to EyeNews for further developments.