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                            What is CRSQA?

CRSQA stands for Council for Refractive Surgery Quality Assurance.  CRSQA is the invention of Glenn Hagele, of Sacramento, California.  I believe that Mr. Hagele saw that the numbers of unhappy refractive surgery patients was growing each day, and that he conjured up a niche market for himself whereby he could "certify" refractive surgeons as being "top" doctors and offer them referrals from his CRSQA website, in return for "certification" fees of several thousand dollars, explaining to them that his fee was only the profit from one or two LASIK surgeries.

From an article about CRSQA:

"Many are skeptical of the value of any of the certification programs
in existence today. The essential problem with the surgical
credentialing boards is that they have no standards for surgical
skill, said Mark Johnson, MD, Venice, Fla. Holladay acknowledged that
there would always be debate between surgeons who see ABES and
CRSQA-like credentials as nothing more than marketing tools and those
who proudly display the seals of approval as evidence of an elevated
level of excellence.

Certification is not CRSQA's primary focus, according to Hagele.
"Providing certification is a means to an end for CRSQA."

What's in it for the surgeons besides a DISCOUNT ON ADVERTISING?
Public credibility, according to Hagele, is an important asset, even
for those whose names are well recognized within their field.

CRSQA-certified surgeon Barrie D. Soloway, MD, director of vision
correction, New York Eye and Ear Infirmary, said, "In one sense, any
layperson can go out and set up an organization similar to what Hagele
has done. There is no way to prevent an organization from simply being
a rubber stamp, 'Good Housekeeping Seal of Approval©' for payment."

http://eyeworld.org/june03/0603p12.html

November 3, 2003, posted on alt.lasik-eyes newsgroup, where Glenn spends much time trying to defend CRSQA:

From: sqrrlbird (sqrrlbird@yahoo.com) Subject: CRSQA Surgeon advertising GUARANTEES and $295 lasik per eye?   View this article only Newsgroups: alt.lasik-eyes Date: 2003-11-02 18:09:06 PST

Hi Glenn,

In this Sunday's paper, I noticed that one of the "$295*" an eye lasik
advertisers now shows a CRSQA certified seal and they are offering
GUARANTEES for wavefront!  Do you check to make sure your surgeons are
not involved in questionable advertising practices?

One of the two surgeons at this clinic holds a new CRSQA certification
as of July 19, 2003.  They regularly run ads, but this is the first
week that I noticed the CRSQA seal.

http://www. usaeyes. org/surgeons/michael_mockovak.htm

In the Sunday Oregonian's Comic section (11/02/03) there is a full
page color advertisement (1/2 page front and back) for King & Mockovak
Lasik Center.  I wrote these phrases in the same order that they
appear in the ad.

(The caps are in the ad this way, large print)
"ANNOUNCING WAVEFRONT GUIDED LASIK!  This breakthrough technology
allows us to GUARANTEE YOU 20/20 vision or your money back!"

(large print, [small print])
"Lasik [from] $295* [per eye limited time offer]"

(tiny print)
"Prices vary according to Rx and astigmatism.  Call for details. 
Prices subject to change without notice."

(small print)
"We also have conventional laser technology that allows us to offer
LASIK from $295.  If you think you will receive a better price
elsewhere for conventional lasik, bring in a competitor's ad."

(tiny print)
"*All inclusive price includes pre-procedure examination, laser vision
correction, post-procedure care.  Pre-operative screening exams are
free of charge.  Deposit of $125 at pre-operative evaluation is
applied to procedure fee.  VISA, M/C, cash, or money orders accepted. 
Limited time offer.  Nidek laser only."

I hope CRSQA looks into this.  It doesn't give the certification much
value if surgeons are using this kind of advertising while displaying
the CRSQA seal.

-sb

Glenn's response:

Normally, one would not think a low price and a guarantee is a bad
thing - and it is not - but the assumptions that can arise may be
problematic.

CRSQA's evaluation and certification is based upon patient outcomes,
not advertising taste or business techniques.  Only if a CRSQA
Certified Refractive Surgeon makes false statements or uses illegal
business tactics would there be a legitimate reason for review.  It
appears to me that the claims made are, in fact, accurate.

Being accurate does not make them appropriate, but appropriate is a
matter of opinion and perspective.  CRSQA's certification is not based
upon opinion or perspective, but upon represented fact.

My personal opinion and perspective is that a "guarantee" of any kind
is a potentially problematic method to promote any medical procedure.
A money back if not 20/20 guarantee is only a contract that a
financial response will arise if particular evaluation criteria are
not met, however such money-back guarantees imply a guarantee that the
patient will be satisfied.  As I've said many times, one cannot
guarantee a particular outcome - and this doctor does not guarantee
that a particular outcome will occur, but this doctor makes a contract
to provide a monetary response if Snellen 20/20 is not achieved.  It
may seem like semantics, but it is the crux of the matter and the crux
of the potential problem.

Heavy discount pricing on a limited range of patients is an issue that
I personally find problematic for many, many reasons.  The obvious is
the appearance of "bait and switch", even if actual bait and switch
does not exist.  Another is the productization of a medical procedure.
If price becomes the issue, then the more important issues such as
quality of care and patient expectations can become less important.  I
am delighted, however, that some people in the Pacific Northwest are
able to receive refractive surgery at such a low cost from a doctor
who has been independently evaluated.

This doctor meets or exceeds our organization's patient outcome
requirements and has received our certification.  Those outcome
requirements are clearly stated for anyone to see.  Although this
particular doctor may utilize business methods that I personally
believe are problematic, the quality of the surgery provided is
affirmed.  If people want surgery from a doctor who has been
independently evaluated, with the possibility of a low price, and a
contractual obligation for remuneration if particular criteria are not
met, then they know whom to consider.

Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance
http://www. USAeyes .org
http://www. ComplicatedEyes .org
glenn dot hagele at usaeyes dot org

I am not a doctor.

My own words are in red.

>No, Glenn, actually it's a surgeon telling me that the study shows that
>pupil size doesn't matter after three months.
>
>Here's what he wrote:
>
>"there is a major article coming out in Ophthalmology by Schallhorn et al.
>that show no effect of pupil size on night vision after 3 months
>postoperatively."
>
>So I take it that you disagree with this, Glenn.

Since Keller again has parsed out a quote from an obviously larger and
undoubtedly more encompassing message, I can only say that I do
disagree with the small quote Keller has provided, but I seriously
doubt it is inclusive and complete.

I would love to discuss with the surgeon to whom Keller refers (yet
another of Keller's "I know somebody who...") to determine how and why
s/he came to this conclusion.  It is not the conclusion of the author.
It is not the conclusion I determined after reading the study and
talking with the author.  It is not the conclusion of DrG.  It seems
terribly odd that the author, a patient advocate/researcher, and an
optometrist would all come to a different conclusion than the surgeon
to whom Keller refers.

Perhaps Keller will have this doctor contact me.  I'm sure it would be
an enlightening conversation for all.  Or Keller could suggest that
this surgeon contact Schallhorn or DrG.

As I said, I would not want surgeons saying that pupil size does not
matter and attempting - as Keller did - to use Schallhorn's study to
legitimize this misinformation.

Yet again Keller makes proclamations that are inaccurate, then blames
her own comments on "somebody told me"; that somebody always being
unidentified.

Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance
http://www. USAeyes .org
http://www. ComplicatedEyes .org
glenn dot hagele at usaeyes dot org

I am not a doctor.

I replied:

The surgeon is Dr. Robert Maloney and he wrote:

"Interestingly, Dr. Hawley was right about pupil size:  there is a
major article coming out in Ophthalmology by Schallhorn et al. that
show no effect of pupil size on night vision after 3 months
postoperatively.  I know you keep tabs on the latest advances, so you
may want to keep an eye out for this article."

For the life of me, I cannot figure out what Dr. Hawley (my former OD)
was right about.  His response when questioned under oath about the
relationship between pupil size and refractive surgery was "I have no
knowledge".  He never knew what size my pupils were until the end of
his deposition, when my attorney told him.  This was nearly two years
post-op.

He proclaimed me an excellent candidate for lasik when the only
excellent qualification I had was my bank account.  I had dry eyes,
RGP-warped corneas and huge pupils.  He told me that Dr. Weinman, who
had done less than 100 lasik procedures, was getting better results
than the doctors at UCLA, which included Dr. Maloney.  He didn't know
DLK from SPK, and failed to diagnose a problem until my cornea had
melted, and didn't tell me he was part-owner of Pacific Laser Eye
Center.  He tried to imply that I'd caused my own complications, then
when push came to shove, had to back down and admit that they were not
my own doing.  He implied that I'd been a non-compliant patient, and
then when pressed, couldn't come up with any non-compliance other than
a couple of instances when I'd worn my contacts longer than he would
have liked.  Yes, I'd fallen asleep in my contact lenses a few times
over a 14 year period.  In fact, after the birth of one of my
children, he actually told me that I could start sleeping in my RGPs,
so go figure.

Glenn replied:

> Keller, did it occur to you that Dr. Maloney may have meant that Dr.
> Hawley was right in that the Schallhorn study shows no effect on pupil
> size as a predictor of night vision problems?  That is not to say that
> pupil size is unimportant, but that pupil size is a poor predictor of
> night vision problems.  Although you have attempted to create a
> situation where I disagree with a well respected CRSQA Certified
> Refractive Surgeon, if you actually look at the information and facts,
> my statements are consistent with Dr. Maloney's AND apparently
> consistent with Dr. Hawley as well.

My reply:

And obviously, your version of the truth depends on who says it.  An
unknown surgeon making an inaccurate statement is one thing, but when
it turns out to be a CRSQA surgeon, the truth changes, all in one day.
 At least your version of it.

It is my opinion that Glenn Hagele is not interested in the truth and that he blows smoke to avoid 
incriminating himself, and the industry, especially his CRSQA-certified 
surgeons.  Dr. Maloney didn't say a word about pupil size as a predictor.  
He said that there is no effect of pupil size on night vision after three months.

Glenn later comes back and states that Dr. Maloney's statement was 
"less than artfully worded".

____________________________________________________________

Alt-lasik.eyes newsgroup

From:  06 May 2003 13:27:29  

Lines: 175 Message-ID: <l19fbvsdn302028c1jp8uqf1a1ht8ifiai@4ax.com>

(((Note:  My (Sandy's) comments appear in red here.)))

>Glenn's paid job with the refractive surgery industry 

I am paid by our nonprofit organization that is involved in the refractive surgery industry only to the extent that we evaluate and certify refractive surgeons based upon actual patient outcomes, and we provide factual and objective information about refractive surgery issues. Our funding is derived from the certification fees we charge the surgeons we evaluate, but receiving funding from doctors should not be an issue for you, Sandy. Your intrepid leader Ron Link has accepted donations from doctors in the past and I know is seeking donations from doctors now. Link was not the least bit troubled by asking the American Society of Cataract and Refractive Surgeons (ASCRS) for $380,000 to fund SurgicalEyes. At least CRSQA provides a certification service for the doctors who provide our funding. 

>is to point out here 

What I do is provide substantiated information and a bit of objectivity to the hyperbole you and other zealots post. 

>that "a gazillion things can go wrong during lasik, just like a gazillion 

>things can kill you, but the risk is tiny and of course, it would never be 

>you who is hurt." 

You are using quotes, but that is absolutely not what I have said. I have never said the risk is tiny, nor have I said it would never be you who is hurt. That is an outright lie. The risk in refractive surgery is relatively small, but relatively small is...well...relative. Three percent to one person may be small, but to another may be way too high. That is why everyone must make his or her own decision about refractive surgery. There ARE a gazillion things that can go wrong with refractive surgery, just like there ARE a gazillion things that can kill you. The relevant question is: "What is the probability that something will affect me?" 

>My unpaid job is to post all gazillion complications here, one by one, and inform you that yes, it might be you 

who is harmed. If so, how will that affect your life? Is it worth it? Is it worth the possibility that you 

>might end up undergoing multiple cornea transplants in your quest to see 

>again post-lasik? 

You are affirming my position. One must not only ask if the possibility of problems is worth the risk, but one must also ask what is the probability of the problem affecting me. >Glenn: "At six-months postop, 3% of patients report an unresolved >complication >induced by refractive surgery." 

> >Sandy: "This is 30,000 people per year, given about a million surgeries 

>performed yearly in the U.S." 

Yes, we agree on this point. 

>Glenn: "Only 0.5% report a complication that was catastrophic." 

> >Sandy: "This is 5,000 people with a catastrophic result from laser eye 

>surgery each year. Catastrophic doesn't include night vision problems, 

>double vision, dry eyes, regression, fluctuating vision, etc, etc. etc. 

We agree on the number, and agree that "catastrophic" does not include the potentially disruptive, but relatively minor, problems you list. All those problems you list would be within the 3% category. 

>Only 5,000 lives are shattered each year........." 

Now this is where Glenn really loses it...

That's enough Sandy. I am fed up with your whimpering and whining. I have volunteered for years, since long before excimer laser ever came about and long before you decided to have LASIK, for the National Federation of the Blind (NFB). I have been a member of the President's Club since the mid 1980s. I can tell you that these fine people, who are functionally or totally blind and don't have options for vision restoration, would take you to task for even suggesting that they or someone who has functional but disrupted vision have "shattered" lives. Your suggestion that someone who needs a corneal transplant to restore vision has a "shattered" life is offensive, rude, abusive, and mean spirited. Who the hell are you to tell these people their lives are shattered? Look at yourself. You had a catastrophic LASIK outcome. By your description, you have gone through hell. You have decided not to have a corneal transplant that several doctors have suggest may be beneficial, but even without a transplant and by your own admission, your vision now is 20/20 corrected, functional, but not perfect. You operate your own business, you have a family life, you have friends, you travel, you are able to communicate here and on your own website. There is no doubt that all of the things you do are limited or done with limited vision, but where do you get off calling your life "shattered". I don't know what you consider a "shattered" life, and everyone has his or her own opinion about what that would mean, but people with real problems would not consider your life "shattered". Not one bit. Why don't you visit the NFB's convention this July and tell them how your life is so terribly shattered because your 20/20 vision is distorted and you won't have a transplant. How dare you insult these fine people by characterizing your wimpy-ass problems as "shattering" your life. You just don't get it Sandy. You never have and you never will. The world doesn't give a damn about Sandy Keller and her little problems, because the world knows what real problems are. You are a mosquito in the Taj Mahal. You go on and on about how you had to do this and have to do that while there are people out the functioning perfectly well without a complaint who don't have any vision at all. Then you have the audacity to characterize them as having "shattered" lives. You are the worst kind of zealot. You are so full of yourself and your "problems" that you don't see or give a damn about people who really do have difficulties and challenges. The fact that you received over $250,000 dollars in a malpractice settlement indicates the severity of your difficulties, but "shattered" is not an adjective that anyone who has encountered real vision difficulties would use to describe you, the great anti-refractive surgery/surgeon/industry zealot whiner. Not everyone who has a bad refractive surgery outcome - even catastrophic - considers the event "life shattering". Not everyone who experiences a corneal transplant (for whatever reason) will spend hours a day on the Internet trying to scare anyone foolish enough to listen. Just how "shattered" a life may be by a bad refractive surgery outcome is going to depend an awful lot on the personality and mental stability of the person involved. You obviously do not have the personality or mental stability to deal with your own problems without inflicting your misery on the rest of the world. There are tens of thousands of corneal transplants performed every year due to natural causes and eye trauma that have nothing to do with refractive surgery. These people's lives are not "shattered". Their lives are challenged or disrupted, but not "shattered". Their vision is restored (probably not perfectly, but certainly functionally) with a surgical procedure. That is not exactly a "shattered" life, and at least they have the option of having some vision restoration with a transplant. Not everyone gets this opportunity. I have said time and again that refractive surgery is not just about the physiology of the eye. It is about what the individual patient expects from refractive surgery. If someone is unable to accept the 3 in 100 possibility of any kind of unresolved problem and the 1 in 2,000 possibility of a catastrophic outcome that might even result in a transplant, then that person SHOULD NOT have refractive surgery. If someone is unable to emotionally handle the consequence of the potential adversity, then that person SHOULD NOT have refractive surgery - or any other elective surgery, for that matter. Next time you are going to spread your bovine fertilizer here or anywhere, think about the white cane that YOU DO NOT USE and think about the people who you insult by claiming some sort of righteous indignation because you made a bad decision in your life. Not only have you demonstrated time and again that you don't have the emotional ability to handle your own problems without vomiting your neurosis on the rest of the world, you have the unmitigated gall to tell people who have real problems that you have a "shattered" life. I, for one, have had enough of you. Take your sniveling whining to SurgicalEyes where it is appreciated and leave the rest of the sane world out of your self-perpetuated gloom. Glenn Hagele Executive Director Council for Refractive Surgery Quality Assurance http://www.usaeyes.org glenn.hagele@usaeyes.org I am not a doctor.)

What Glenn posted shocked me.  I don't whine about my problems on this newsgroup and never have.  In fact, I challenged Glenn to tell me what my current problems are, because I don't complain publicly and knew he wouldn't be able to find out what visual challenges I currently face.  I don't consider my life shattered.  I have never walked around saying that my complications were catastrophic, and in fact when I did try to reply to his accusation, I used the word "catastrophic" in quotation marks, because that's how he had labeled them.

My reply:

From: Sandy (sandykeller01@netscape.net) Subject: To Glenn: You are pathetic View: Complete Thread (22 articles) Original Format Newsgroups: alt.lasik-eyes Date: 2003-05-07 19:42:09 PST

Find one post.  ONE.  One post where I say my life is shattered, was
shattered, was partially shattered.  Find a post where I am
complaining about my vision.  Please, Glenn, find one.  When asked, I
have presented facts about how I see, but I have never complained.

I have said over and over and over again on this newsgroup that I feel
lucky, blessed, happy that I ended up here, where I am, with my
vision.  I never thought I'd be able to see 20/15 through a melted,
thinned, scarred, hazed up and wrinkled cornea with a stop-start ridge
in it.  Well, I can.  I thank God constantly for the vision I now
have, because I can hardly believe that I escaped without a
transplant, at least so far.

I am not a whiner. Find a post where I have whined about my vision.
Why would I risk a transplant when I can see?  Dr. Rabinowitz told me
that when I am ready to risk the immediate need for a transplant, it
would be worth trying custom ablation.  Fat chance, as long as a
contact lens will correct my vision.

My sympathies are not for myself--they are with my friends who are not
having any success regaining their vision after botched LASIK with
top, and yes, even CRSQA-certified surgeons.  Multiple transplants. 
Months and of waiting. Still no correctable vision, even with hard
contacts.  What is going to happen to these people?  Two doctors, out
of work, practices gone.  A mom who will likely lose her driver's
license soon when she has to try to read the chart at the DMV.  People
who can no longer work.  People who cannot talk about what lasik did
to them without breaking down and crying--even men.

Did you know that I had to intervene on the part of a LASIK patient
who was going to commit suicide the next day and arrange to get her on
a plane to California within 12 hours in order to save her life?   I
paid for her airfare, a cornea transplant, strabismus surgery and
doctor visits, glasses, etc. because her LASIK "doctor" would not take
responsibility for how he had butchered her vision and she had no
medical insurance.

In the end, SE members reimbursed a big chunk of what I paid out,
because we are a family, more than you could ever understand.  We are
left to pick up the pieces of each other's lives because the doctors
are too busy lasering more eyes and attending seminars on how to avoid
malpractice lawsuits.

YOU HAVE NO CLUE, GLENN, how LASIK has shattered lives. 

The biggest hell I went through was not with my vision.  It was
discovering the betrayal by a trusted doctor.  A doctor who sold me to
the highest bidder.  A doctor who had a financial interest in
determining where to refer me, and in telling me what a great
candidate I was.  Women who've been raped said they understand how I
must feel---women who've contacted me via this newsgroup.  I'm not
sure about that, but whatever I went through, I've emerged on the
other side and I want the world to know what I have learned.  The
information is out there, but I didn't know to look for it.  I will
continue to post articles, studies, case reports, etc. to my heart's
content and I don't care what you say about me, because I do not like
you.  Your opinion of me means nothing to me.

Life is too short to waste talking any further to the likes of you. 
Talk about me all you want.  It actually serves no purpose other than
to make you look ugly.  You are lower than low.  I have nothing else
to say to you.  Ever.

Glenn never could find a post where I called my life shattered.

The bottom line is that in my opinion, Glenn Hagele claims to be a PATIENT ADVOCATE spending the majority of his time defending the lasik procedure and lasik surgeons, while attacking patients with complications.  I don't believe that Glenn Hagele is a patient advocate.  I believe him to be a LASIK ADVOCATE.