I am researching possible contreindications for Lasik surgeries.  I am
specifically looking for two U.S. titles of documentation relating to
ophthamology referance manuals or medical journals which list
occupations in which potential Lasik clients should not receive the
Lasik Surgery.  I suspect that this list would be in an index of a
professional manual. I am already aware of common limitations ie
contact sports, pilots, pregnant women and people with eye diseases. 
In the list I am looking for occupations that use computers
extensively.

---

Request for Question Clarification by czh-ga on 15 Nov 2005 18:00 PST

Hello stephen48-ga,

In your question you refer to ?ophthalmology reference manuals or
medical journals? as the sources of lists of occupations. I have found
a few references to jobs or occupations where LASIK surgery may not be
acceptable but these references are not in manuals or journals. Will
this meet your needs?

What jobs/occupations do you believe/expect will be on the list?
Please tell me more about the context of your question and the type of
information that will be acceptable to you.

I look forward to your clarification.

~ czh ~

---

Clarification of Question by stephen48-ga on 16 Nov 2005 05:22 PST

I prefer that the occupational list came from referance manuals for
Ophthamologist.  I suppose two titles of professional books which
contain list would be satisfactory.  In the list, I am looking for
occupations or careers which utilize computers extensively such as
computer operators, engineers, programmers or systems analyst.  I am a
computer systems programmer and I had a very bad Lasik surgery which
was partially corrected with intraocular lens (IOL)inplants.  My
vision is still very poor and I am looking for occupations that should
not receive Lasik and/or IOL's. The material will be used for support
of a disability insurance claim and possible law suit. Documents to
support my case will be appreciated.

---

Request for Question Clarification by czh-ga on 16 Nov 2005 13:36 PST

Hello stephen48-ga,

Thank you for the clarification. It helps to understand the context of
your question and to help you consider alternate approaches for
getting the information you need.

I have not been able to identify any ophthalmology reference manuals
that might be available online. However, even if they were, I have not
found any evidence that the professional literature would confirm your
hypothesis that there are occupational lists for which LASIK surgery
is contraindicated. The prohibitions on LASIK surgery or qualifying
for a job through LASIK that I?ve found are mostly grouped in the
military services and law enforcement. Even these prohibitions are
being eased so the likelihood of finding an official list of medically
prohibited or constrained occupations seems remote.

The lists of cautions and contraindications I?ve found all have to do
with the individual surgery candidate?s physical/medical condition and
personal or work environment. If anything, LASIK surgery is touted as
a solution for people who need vision correction to be able to get
into certain jobs who cannot wear glasses or contacts. I?ve also found
a few cautions about conditions of work that might have a bearing on
LASIK surgery but these seem to be legal boilerplate. The closest I?ve
come to any references on computer jobs and LASIK was a caution about
chronic dry eye which might be exacerbated in some computer jobs.

?Frequent computer users who already have dry eye symptoms or contact
lens intolerance need to be aware that they may be at higher risk of
severe chronic dry eye following surgery.?

You say that the information you?re looking for will be used to
support a ?disability insurance claim and possible law suit.? It seems
to me that even if you found the type of occupational list you?re
looking for it would not be very useful in supporting your claim. I?ve
found that the LASIK authorities uniformly recommend that surgery
candidates be advised about the possible complications and to consider
whether their jobs or working conditions would make them unsuitable
for this surgery.

Are you trying to establish that you were not informed sufficiently
about the possible outcomes? If this is the case, other research
avenues may be more productive than looking for the occupational lists
you?ve specified.

Please consider my preliminary findings and let me know how you want to proceed.

I look forward to your clarification.

~ czh ~

---

Request for Question Clarification by pafalafa-ga on 16 Nov 2005 19:39 PST

Stephen48-ga,

It seems to me there are other ways to go about making your case,
beyond a (possibly futile) search for occupational contraindications.

The popularity of Lasik surgery has given rise to a robust body of
legal cases regarding Lasik malpractice.  The existing cases probably
create the best body of information you could draw on regarding a
possible case of your own.

For instance, I found the following articles in legal news reports and journals:

===============


April 1, 2003
Evaluating LASIK Malpractice Cases

...The vision-improving eye surgery known as LASIK ...is marketed as a
painless 15-minute outpatient procedure that produces stunning visual
improvement in the vast majority of patients. LASIK surgery is
estimated to garner revenues in the billions in the United States
alone, with 1 million or more people undergoing the surgery each year.
To help you to evaluate potential LASIK malpractice cases, this
article discusses the eye's basic anatomy and function, the practice
of LASIK, including patient selection factors and common
complications, and provides resources for further information...






August 8, 2005
Screening Lasik Cases; 
Medical Malpractice; 

...The rapid acceptance of laser eye surgery has led to a
proliferation of malpractice claims



August 18, 2005
LASIK verdict nearly doubles record

...A New York jury awarded $7.25 million recently to a former Wall
Street investment banker who said his vision was permanently damaged
after botched LASIK eye surgery...


and so on.


===============


If you'd like, I can certainly cull through the literature, and post
references and excerpts from the most current and in-depth articles (I
can't post the full articles, since they are copyrighted).

This might be a more fruitful approach that trying to rely strictly on
the search for a list of occupational contraindications -- a list that
doesn't appear to exist.

Let me know what you think,


pafalafa-ga

---

Clarification of Question by stephen48-ga on 17 Nov 2005 06:36 PST

I have an medical malpractice attorney who is using his legal
resources to make the case.  I just wanted the nail of occupations,
careers or environments in which people not approach Lasik or IOL's. 
It seems that the doctors leave that decision up to the client.  Prior
to the Lasik surgery I counseled with the doctor about the various
complications, ie halos, glare etc. He said that in my case there
would be minimal or no complications but he never asked what my
occupation was.  Prior to the surgery I signed a standard release form
which included these complications.  I received someone elses Lasik
surgery.   I was farsighted, he was nearsighted, I became very
farsighted.
My disability insurance company says that I may be able to perform the
duties of my last occupation. I need proof/support that I cannot
perform those duties. There may be occupational limitations in the
earlier years of Lasik.  Prior to 2000.

---

Request for Question Clarification by czh-ga on 17 Nov 2005 12:00 PST

Hello again stephen48-ga,

I?ve spent a lot of time researching your question and I keep coming
up short. Your clarifications show that you want to establish that
there are some occupations that are inherently inappropriate for LASIK
surgery candidates either because of environmental or behavioral
issues. You are specifically trying to establish a link between
computer jobs and contraindications for LASIK surgery.

LASIK surgery was first approved by the FDA in 1998. The consumer
information furnished from the earliest dates warned that ?Some
patients may develop severe dry eye syndrome.? I?ve found some
literature linking dry eye syndrome to computer jobs because ?computer
use dramatically reduces your blink rate.? The information I?ve found
along these lines is very general.

Have you already explored whether there is creditable research linking
dry eye syndrome, heavy computer use and LASIK surgery? Is this the
kind of research you?re looking for as an answer to this question?
Would the consumer information and anecdotal reports on dry eye as a
complication from LASIK be an acceptable answer?

It sounds like you?ve already conducted a lot of research. Please tell
me how to proceed to be able to help your case.

I look forward to your clarification.

~ czh ~

---

Clarification of Question by stephen48-ga on 17 Nov 2005 13:55 PST

The dry eye syndrome link to computer jobs is not going to be of any
help.  AQ person can have dry eye without Lasik. I need something
about the high rate of glare or hase caused by Lasik proceedures and
how occupation working in low light conditions may encounter more
difficulties.  I consider most indoor occupations low light
conditions.  You are correct that I have researched this extensively
on the internet and have come up with simular results. Your work and
determination is appreciated.  I wonder if the information I am
requesting is not on the net or of the U.S. I was told by an
ophthamologist that there was a listing but he could not remember
where he saw it.  This is the reason I am determined to locate and pay
handsomly for the list.

---

Clarification of Question by stephen48-ga on 18 Nov 2005 04:10 PST

I appreciate the comment entered by doctawood-ga.  The list that I am
seeking may not be a contraindication or listed in a professional
journal.  I am at the point now of accepting a list of occupations
which should not seek Lasik surgery from any publication that I can
purchase.  doctawood-ga comments are greatly appreciated and he makes
a good point.  His information will prove the case of malpractice but
I am in the damages area of the case.  How much damage have I received
and how does the damage impact my occupation or ability to work in any
occupation?

Hi stephen48-ga, and thanks for your question.

My condolances on your difficult situation.  As suggested by Pafalafa,
your case is likely to ultimately be based on your having received the
wrong procedure.  As you state, I'm sure that your attorney is
covering that angle thoroughly.  That being said, I understand that
you are still interested in a list of occupations for whom LASIK is
relatively contraindicated. I'll admit that, like some of the other
researchers, I did several unsuccessful searches before happening upon
a single source of such a list.

The text Refractive Surgery: A Guide to Assessment and Management
written by Shehzad A. Naroo describes absolute and relative
contraindications for LASEK surgery on page 29, Table 4-2.  Here is an
excerpt:

-------------------------------------------------
Indications:
Age 21 years and above
Stable refraction
Adequate central corneal thickness
Myopia (-3.00D to -6.00D)
Hyperopia up to +4.00D
Astigmatism up to 4.00D

Absolute Contraindications:
Keratoconus
Herpes virus infection of the cornea
Deep corneal dystrophy
Grossly amblyopic eye
Corneal melt
Unstable refraction

Relative Contraindications:
Significant cataract
* Certain occupations:
  pilots
  * computer programmers
  heavy goods vehicle drivers
     * because contrast sensitivity and glare can be a handicap among
these groups of patients
Patients with obsessive personality
-------------------------------------------------

Table 4-4 gives the same information for LASIK. The Relative
Contraindications section is the same as that for LASEK (including the
occupations listed above).

This is a relatively inexpensive, short text.  I would characterize is
as more of a focused guidebook than a textbook, given that it is only
96 pages long.  You can find it at Amazon.com, among places:

http://www.amazon.com/gp/product/0750655607/103-0900456-0039845?v=glance&n=283155

Apparently a new edition is coming out soon:
http://us.elsevierhealth.com/product.jsp?isbn=0750655607


Here is a description of this text from the publisher:

Clear and concise, this book provides the optometrist and eye care
practitioner with an introductory, unbiased approach to the current
techniques and procedures available to surgically correct ametropia.
The content offers clear guidelines on key topics in refractive
surgery--- everything from wound healing to legal issues, enabling the
practitioner to empower the client to make an informed choice. This
resource also features a CD-ROM, which shows surgical procedures and
real-life case studies to help bring the book to life.


============

Also of potential interest, the text Refractive Surgery, A Color
Synopsis by Probst and Doane mentions on pages 65-66 that

"Determination of the refractive target may be the most important part
of the presurgical patient examination."

"[t]hough less frequently pursued, some individuals choose to have
bilateral near or intermediate targets. Bilateral near or intermediate
vision may be useful fo rcertain occupations that require prolonged
near-vision tasks (e.g., a computer programmer or professional
pianist)."

You can find more details about this text at Amazon.com or from the
publisher (Thieme):

http://www.amazon.com/gp/product/0865779147/103-0900456-0039845?v=glance&n=283155

http://www.thieme.com/SID2266256218962/productsubpages/pubid251211344.html
______________________

Search terms on Google Scholar:
occupation contraindication lasik

After finding the above text, I did an additional search within it for
"contraindications."
______________________

I hope this information is useful.  I wish you the best in your
recovery.  Please request any clarification prior to rating.

       -welte-ga

The question I submitted required a substantual amount of internet
research.  I appreciate the amount of effort the Google researchers
did.  The answer was correct and equal to what I had obtained from the
local University Medical Library in two hours.  I did not understand
that Google researches were limited to the Internet. I would like to
suggest that the Google researchers have access to resources such as
online national libraries or other sources to improve this wonderful
tool.

FYI - most of the time when a broad list of contraindications is
involved it is a manufacturer's or pharmaceutical company's meant to
protect them from litigation and may not be based on actual clinical
data.  They often incorporate contraindications into this list based
on solitary case reports or anything that might come near to
suggesting a contraindication in a solitary case rather than data
driven investigations of safety and efficacy.  Thus, standard of care
(which is what any doctor will aim to prove in defense) might not have
been breached even if you find your list.  A brief review of practice
guidelines that are normally readily available at professional society
websites or in those organizations journals (in you case - American
Academy of Ophthamology) will usually tell you what Standard of Care
is including established contraindications.  I believe you are likely
to find what has been mentioned above, that they are limited to
characteristics of an individual's ocular disease / thickness of
cornea and other medical conditions (some specific medication usage,
pregnancy, connective tissue / autoimmune diseases come to mind). 
Good luck but the list may not end up being the final answer.

Hello stephen48-ga

I was one of the researchers who put in several hours trying to answer
your question. I'm glad that welte-ga confirmed what you already knew.
It would have helped the researchers if you had given us a full recap
of your situation, what research you had done on your own, and what
you had found. Because you did not, we ended up doing useless
research, asking for multiple clarifications, and eventually ending
the same place you ended.

Many researchers have access to a variety of databases as well as
excellent "real world" libraries but the probability has to be high
that the information we seek will only be available offline before we
take that route. Remember, researchers get 75% of the question fee, so
adding travel time to the research effort is a cost that most
researchers choose to avoid when possible.

Several researchers put in multiple hours of unnecessary research to
simply identify the scope of your question and to get on the right
research track. It's unfortunate that we could not help you more
because we didn't have all the starting information that was available
from you. I hope that you'll come back to Google Answers. I also hope
that you will give us a more complete starting picture the next time.
The more information you give us, the more likely that someone will be
able to get you what you need.

Best wishes for your claim.

~ czh ~