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Dr. Chynn’s comments on CXL

Q:
Dear

Not sure if this topic has already been discussed (and if so, can somebody please forward me the conclusion of that discussion?)
If you receive a post LASIK Ectasia in one eye after bilateral LASIK treatment, would you do CXL only in the affected eye or would you do it “prophylactically” also in the unaffected eye, assuming that the “unknown” ectatic factor might be present in both eyes and hasn’t manifested yet (or never will…)
Let me know what you think.
Best!
A:
i think bc kc is often highly asssymetric (so it appears unilateral, but may in fact be bilateral), it’s probably safer to do CXL in the other eye, especially since the downside to doing so is very low

for that same reason, it is probably more medically and legally defensible doing an ASA/LASEK/epiLASEK on the fellow eye (although in canada you’ve not had the multi-million dollar jury awards for post-LASIK ectasia that have become frequent in the US)
i do some medial malpractive review, and want to point out that you need 3 things to lose medical malpractice in the US:
1. negligence (= departure from care, meaning from the community standards/what a reasonable practitioner would do)
2. causation
3. damages
therefore, if you do a LASIK in the other eye and he gets KC, a JD can easily find some MD who said you did wrong
hence you might be screwed on 1
and on 2 and 3 also (so you might lose)
if you, in contrast, did a CXL + LASEK on the fellow eye, the JD might have a hard time getting a MD to say 1 was off
so then even if 2 and 3 exist, you get off the hook (since you need 1 + 2 + 3 to lose, ie all 3 of 3 are necessary to lose)
i don’t know about the canadian system specifically, but i would imagine it is pretty similar to the US system
but in any case, this is the way the US system works, which might be somewhat illuminating to the younger MDs on Knet
hope this helps, and stay out of trouble!:)

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