Talk:Keratoconus

Archived to do list: Talk:Keratoconus/to do

Rearrange Treatment Options

I don't believe the most invasive and severe treatment options(corneal transplant) should be first even if they are the most well-known, as the uneducated reader would be best served to learn about the best credible alternatives before moving on to other worst-case treatment options.

For instance, crosslinking is becoming a true hope for a cure for this disease and many patients are unaware of it as a treatment option.. --arpowers (talk) 19:08, 26 December 2008 (UTC)

Write a proper separate article on the crosslinking, and I will translate it into Russian. A link then could also be placed into Corneal transplantation's "alternatives" subsection. --CopperKettle (talk) 04:28, 8 January 2009 (UTC)

Additionally, Intacs (ICRS) have over 10 years of clinical research, hundreds of peer-reviewed articles and federally regulated clinical studies to reference when looking for a clinically studied keratoconus treatment to consider prior to PK techniques. I think the order is fine in that historically, Contact Lenses are the first line of treatment followed by PK & ICRS. We are just now learning about cross-linking and adequate due diligence should be observed so not to jump quickly into an unknown treatment option like cross-linking without adequate clinical evidence. --intacs —Preceding undated comment was added on 20:19, 24 February 2009 (UTC).

Anonymous contribution about rigid CL

I quote:

It's important to note that although the rigid contact lenses help to provide the best possible vision, they do not affect the rate of progression of the condition. --ref--http://www.rnib.org.uk --ref--

- the phrase is strangely built: "although it is good, it is good"; I doubt the rigid lenses do not affect the KC progression; the link given is too general. --CopperKettle 20:26, 19 January 2009 (UTC) Here's the diff. --CopperKettle 20:28, 19 January 2009 (UTC)

The given URL was wrong; I have corrected it. I also reworded the text, removing the "it's important to note" part: the reader should be able to decide for themselves whether something is important. — BillC ^talk 08:34, 20 January 2009 (UTC)

C3-R corrections

I deleted inaccurate statements about riboflavin penetration and what the FDA legally has jurisdiction over.

1. It is now clear that use of tetracaine opens up epithelial tight junctions to allow riboflavin to penetrate. At the December Crosslinking Congress, Wollensak discussed that his research has confirmed this to be true which corroborates cited studies by other doctors.

2. The newly cited Hayes study has many flaws including that it was performed in porcine (pig eyes) not human eyes. This is the citation for a letter to editor that reports quite a number of flaws in the Hayes study that render it essentially no applicable to living human cornea crosslinking.

Effect of epithelial debridement in corneal collagen crosslinking therapy in porcine and human eyes. Yuen L, Chan C, Boxer Wachler BS. J Cataract Refract Surg. 2008 Nov;34(11):1815-6; author reply 1816. No abstract available. PMID: 19006714 [PubMed - indexed for MEDLINE]

3. The FDA does not legally regulate surgical techniques using available surgical instrumentation. Debridement of epithelium is entirely legal within the United States. The FDA has no jurisdiction whatsoever over surgical techniques with available instruments. — Preceding unsigned comment added by Scubadiver99 (talk • contribs)

When conducting riboflavin treatment, is the epithelium most commonly abraded prior to treatment, or not? — BillC ^talk 06:11, 21 January 2009 (UTC)

The above poster forgot to say that their was 1/5 less crosslinking found with the epi on method with tetracaine and with out tetracaine with epi on was only 7%, it was also said only go by peer reviewed articles, as other articles are not accurate but only being used for marketing purposes. And boy, are they desperate indeed to do that and also at the same time confusing matters ! —Preceding unsigned comment added by 149.254.49.33 (talk) 09:11, 22 January 2009 (UTC)

Possible Commercial Motivation For Edits

I have a Master Degree in Biomedical Engineering and I know the difference between a credible article and one that is for marketing. Studies have shown that the on epithelial treatment(C3-R) is not effective, when compared to the 'debrided' form of treatment (Hayes study)..

I feel this should be referenced in the article. What I had said was not conclusive only suggestive of these results.

Now I am very excited about the new crosslinking treatment developed in Germany, as it seems like it really does work. But in order for it to work the cornea needs to be abraded slightly for the riboflavin to penetrate. Read this published article summary: http://www.ncbi.nlm.nih.gov/pubmed/18361990

In the US this is not possible without clinical trials as it is invasive. (there may be other reasons, but I had spoken to someone at Wachler's office who did tell me abrasion was not possible due to the FDA)

The c3-r method that doesn't debride the cornea and is classified as a 'vitamin'. Studies have shown this approach as inneffective, but since they are charging around $2000/eye for it, it is quite the cash cow.

I believe someone has been editing this wiki article under the name "scubadiver99", to artificially support C3-R as a more effective treatment when compared to the German crosslinking method

Again, to be clear Crosslinking does work but only if the cornea is 'debrided', the C3-R 'vitamin' classified treatment does not work nearly as well This misleading marketing must be stopped... I am appealing to the community for help.

___________________________________________________________________________

These above comments by this person are clearly inappropriate and are also without merit. It seems he or she has an axe to grind by the unprofessional tone and ad hominem attacks which are not appropriate in wikicommunity. The Hayes study this person cited is the exact study that Scubadiver99 referenced as having a number of flaws. I agree the Hayes study is problematic.

BillC, if possible to ban this unnamed person from wikicommunity, I would encourage that be considered. 24 January 2009 Corneadoc —Preceding unsigned comment added by Corneadoc (talk • contribs) 10:22, 24 January 2009 (UTC)

Reply

OK, BillC thank you for your objective viewpoint and moderation. I will do my best to be objective.

Why was the discussion removed about the multiple 'sock-puppets' Scubadiver99/Corneadoc was using? I am not the first to bring up Scubadiver99's possible ties to Wachler and the C3-R treatment...

"CorneaDoc" is it a coincidence you have made only 1 contribution to Wikipedia so far and its a comment in this discussion? Why are you are already trying to get me banned?

why don't you let me know what your real name is and we can talk about this? I am more than willing to have a constructive debate, and I am open to any credible literature that supports your claims... the issue is that I have a strong suspicion of commercial motives for those edits.

I have no axe to grind other than the pursuit of what's best for those seeking treatment.

Arpowers (talk) 03:47, 25 January 2009 (UTC)

Proposed Revision To Cross-linking Section

I propose that the following be added back to the article:

1. The difference between the CXL and C3-R procedures (i.e. removal of corneal epithelium)
2. An explanation why cross-linking procedures with corneal abrasion can't currently be performed/marketed in the US.
3. A reference to the results from studies that have concluded that the corneal epithelium should be removed for the procedure to work. For example, this study(@ [Hayes Article http://www.ncbi.nlm.nih.gov/pubmed/18361990]) by Hayes et al which concluded that "Complete removal of the corneal epithelium is an essential component of riboflavin-UVA crosslinking therapy."

Suggested Text:

The corneal epithelium is usually surgically abraded beforehand in order to increase penetration of the riboflavin into the stroma(citation needed). Preliminary studies have shown that this helps enable adequate penetration of riboflavin and thus the effectiveness of treatment(hayes study).

In the US, FDA regulations do not currently allow procedures that include the removal of the corneal epithelium to be marketed (or performed? citation needed).

C3-R, a "vitamin" classified on-epithelial treatment method is available in the US outside clinical trials. Unfortunately, one study has concluded that this approach is likely much less effective than when using the removal technique(Hayes Study).

Andrew Powers (talk) 07:08, 27 January 2009 (UTC)

As also discussed above, it is not correct to say FDA regulation do not allow procedures that...to be marketed. This is just not correct. Legally, this is allowed. Arpowers has not provided any points to counter my comments above in "C3-R Corrections".

The Hayes article is discussed above in "C3-R Corrections" with my prior comment and has numerous flaws as cited and discussed above. Arpowers has not provided any information to counter the cited flaws in the study cited above (Yuen et al). Scubadiver99 —Preceding unsigned comment added by Scubadiver99 (talk • contribs) 05:59, 5 February 2009 (UTC)

response

To use something off-label is in fact correct, but are you trying to tell me that you could market a procedure that removes the corneal epithelium in the US outside of clinical trials? Isn't this what 'off-label' is all about? Marketing is considered labeling.

The reason I know that c3-r is a 'vitamin' classified treatment is because I heard it directly from Wachler's assistant... they also told me they couldn't do the removal technique outside of trials... That is how I figured out this whole gimmick in the first place. —Preceding unsigned comment added by 75.25.174.48 (talk) 08:42, 5 February 2009 (UTC)

Also the Yuen et al citation you are using is a comment on the Hayes study. Just that a comment, which is merely an opinion. And I believed a biased one as I see Wachler on the list of authors. Moderators can find it here: http://www.ncbi.nlm.nih.gov/pubmed/19006714

As a response to your point, porcine models are widely accepted in the scientific community.

I have removed the edits by Scubadiver99, because it was irrelevant, unsupported, and only partially correct. (physicians can perform procedures off-label, but cannot market them as marketing is considered labeling)

Andrew Powers (talk) 08:59, 5 February 2009 (UTC)

FACT-BASED CLARIFICATION

As I stated earlier, it is clear that Arpowers has an ax to grind, despite his denials. His arguments prove a clear bias, which is fine. Bias is bias, not everyone can be objective. His response consists of ASSERTIONS with no factual EVIDENCE. So by your opinion and accusations, EVERYTHING boxer wachler is biased? Where is your proof? I suggest you look at his cv on his website. he was the former director of UCLA's Jules Stein Eye Institute, won numerous awards, published tons of peer-reviewed articles in the field, delivered 100s of scientific lectures etc, etc. Arpowers has no data, only disparaging comments that come from no fact-based position and he conveniently ignores all the scientific contributions boxer wachler has made to the field over the past decade. That's right past 10 years as a contributor to the field of ophthalmology. If you wish to defame character, that's up to you, but I suggest you be careful because legally that puts you on risky footing and opens you up to exposure.

As for your reference 55 about FDA regs, no where in that reference you provided does it say anything about what you are asserting. Again, only assertions no proof. Therefore delete is recommended.

"marketing" is not considered "labeling". Off label procedures are legally allowed and can be marketed. If Boxer Wachler wished to perform epi removal and market it, yes, that is completely legal. Again, Arpowers is only asserting, no proof.

Yuen et al peer-reviewed and published response includes Drs. Chan and Boxer Wachler. Three doctors have cited flaws, significant flaws in Hayes study. Most notable is that Hayes study used DEAD PIG eyes and did not use the same crosslinking protocol used in epi on procedures on LIVING HUMANS. Pig cornea anatomy is vastly different than human cornea anatomy, most notable is the epithelium is twice as thick in pigs corneas as humans for example. Twice the distance for ribo to penetrate to get to stroma in pigs than humans. Hayes studied apples and then erroneously applies conclusions to oranges. Significant flaws prevent Hayes study having relevance to epi on crosslinking in HUMANs. Perhaps if pigs were having epi on crosslinking if could have valid points, but not to living humans.

Scubadiver99

Unnecessary detail

There is no need for the article to go into the level of detail that is engendering the passions above. Patients' ophthalmologists are there to advise them on this, not a general-purpose web-based encyclopaedia. I have trimmed back some of the detail in the section in the hope that we can avoid these problems. Perhaps I can ask you both: what level of detail do you each think is appropriate for an article of this length (50K), and aimed at Wikipedia's general lay audience to carry? —BillC ^talk 08:35, 6 February 2009 (UTC)

Bill, good question. I think the current level of detail is appropriate for the lay public. Scubadiver99 —Preceding unsigned comment added by Scubadiver99 (talk • contribs) 15:57, 6 February 2009 (UTC)

When are the trails for "epi on" going to start ? have they completed ? thats why DR BBW is doing it ? —Preceding unsigned comment added by 149.254.57.136 (talk) 01:08, 8 February 2009 (UTC)

I've been following this discussion and it seems this Hayes study is now being quoted completely out of context. I have removed it and the preceding sentence. —Preceding unsigned comment added by 189.182.108.137 (talk) 06:11, 10 February 2009 (UTC) Anyone wants to comment on this study ? http://www.ncbi.nlm.nih.gov/pubmed/18361990?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed —Preceding unsigned comment added by 149.254.58.219 (talk) 00:02, 11 February 2009 (UTC)

Signing posts

Can participants here please sign their talkpage posts: type four tildes (~~~~) at the end of your post and it will be automatically converted to a signature and timestamp. There is also a button above the edit box that will do the same thing. Thank you. —BillC ^talk 08:11, 11 February 2009 (UTC)

Article By MedCompare on Cross-linking

I wanted to add this article by MedCompare in the discussion: http://www.medcompare.com/featuredarticle.asp?articleid=409

In light of this I would like to add back the edits that scubadiver99 removed again:

1. The difference between the CXL and C3-R procedures (i.e. removal of corneal epithelium)
2. A note that the crosslinking procedure is currently in clinical trials in the US
3. A reference to the results from studies that have concluded that the corneal epithelium should be removed for effectiveness. For example, this study(@ [Hayes Article http://www.ncbi.nlm.nih.gov/pubmed/18361990]) by Hayes et al which concluded that "Complete removal of the corneal epithelium is an essential component of riboflavin-UVA crosslinking therapy."...

to quote Wollensok who pioneered this procedure: "The removal of the epithelium is essential for the homogeneous diffusion of riboflavin into the corneal stroma. Without epithelial removal (like in C3-R) the biomechanical effect is less than 50% of the standard crosslinking procedure."

With no replies to this note, I will add this section again in a day or two.

Also I think that anyone wanting to credibly participate in this discussion should reveal their real name and background or not participate at all

Andrew Powers (talk) 08:22, 19 February 2009 (UTC)

Good work AP, to me there has been great desperation from the "epi on" camp all along which is clear to see for everyone that there is over selling going on from them - its the whole world who know this as everywhere they are doing epi off.

About the "Names" used, yes if the content written is suspect then question the author in what their motives are. However Wikipedia allows me to type this with out having a "User Name" - as long as I can do this I will until the rules change, and by that time we must all register to write here. With out registering and being able to write here is a feature on Wikipedia and so allowed by default. We don't know if any of the names here are real, we don't have to have our passports checked to get an ID here or write here with out one, it is (only) the net after all.

Anyway not to let this detract from the purpose of this discussion page and the more important topics here.— Preceding unsigned comment added by 149.254.51.255 (talk • contribs)

Indeed, Wikipedia allows anonymous editing of talk and article pages by default. However, it is still required to sign talk page posts (by typing four tildes: ~~~~ at the end of the post). Things will get very confusing on here very rapidly if people do not do that. Thank you for your consideration. —BillC ^talk 16:55, 22 February 2009 (UTC)

Obviouly it has not confused you Bill, why do you take it that it will confuse others ? Lets not play "Silly buggers" I was not told that their is requirement - look I'm typing away with out a requirement. Besides a "ID" does come up, if you look at the end of a message. Thats enough for me to write here otherwise I would not be able to.

Your ID did not come up at the end of a message. It is there because I went back into the history, found out who said what, and added the {{unsigned}} template afterwards. I will not have time to do that every time. The guideline on signing posts can be read here: WP:SIGN. Please consider signing your posts, I'd appreciate it, thanks. —BillC ^talk 23:32, 22 February 2009 (UTC)

How do I know that the guideline was not added after I posted last ? or you did it ? it only says its a guideline for "good practice" - they arn't going to arrest anyone - but If it makes you happy I sign as Robin Hood

Companys are not Associations or Groups

In light of unraveling that Epi on is/was getting marketed a lot, I am going to remove the boston sclerals site and the Snergey eyes and also a blog - all of where are not "associations or groups". What is the matterwith these people, can't they read !— Preceding unsigned comment added by 149.254.51.255 (talk • contribs)

Removed c3-r from alternative names

As this is a trademarked term (http://tess2.uspto.gov/bin/showfield?f=doc&state=4002:681s7c.2.1) and a separate procedure from the one developed in Germany, that is undergoing clinical research.

Andrew Powers (talk) 09:33, 24 February 2009 (UTC)

I replaced both CCL and C3-R as crosslinking is well known by both terms regardless of trademarking status. In fact, the trademark confirms C3-R was the very first name for this procedure which pre-dates even CXR and CCL.

I also removed Hayes reference. For reasons, please see my detailed reasons outlines about as to why it was removed earlier. Scubadiver99 —Preceding unsigned comment added by Scubadiver99 (talk • contribs) 04:38, 25 February 2009 (UTC) I also edited language on epi removal and added reference for peer-reviewed study by Wachler et al regarding results of intact epithelium. Scubadiver99 (talk) 04:59, 25 February 2009 (UTC) By the way APowers, your Feb 19 comments of merely repeating your prior same points and ignoring the criticisms of those same points is not a productive move for moving this article forwardScubadiver99 (talk) 05:04, 25 February 2009 (UTC).

Look - trademarking a name means nothing, it was good for marketing, CR3 has not been proven - this is what your avoiding or dancing around - its soooo clear to see !!! signed RH

this quote is deceitful, as this study from Chan has been disproved ALREADY (please see te link above) "Some view the corneal epithelium removal as necessary in order to increase penetration of the riboflavin into the stroma[54] while a peer-reviewed study in patients showed crosslinking with intact epithelium was efficacious.[55]" (some real good great bull there!)

There is a desperation here by Scubby, and real big desperation to pevert things. I think he should be banned and banned a long time ago. Why didn't DR BW attened the CXL congress ? he didn't the years before either, what is is scared off ? Dr's laughing at him ? This muppet (Scubby) really needs watching !! signed RH

Civility

Please keep the conversations on this page civil. —BillC ^talk 18:19, 27 February 2009 (UTC)

Frustrating

Civil? This is getting really frustrating. The people who are advocating science and 'facts' are not getting paid to edit this article like scubadiver99 is. I don't understand why it is so hard to edit this article and really believe this lack of moderation is undermining Wikipedia as a resource for medical information. Who is scubadiver99 and why hasn't he or his sock-puppets been banned? Maybe even a full name & background?

My arguments have been well cited and I have spent time making sure they are factual. I have given my name and background (and been threatened). I even reported the 'commercial motivation for edits' on the board...

Who has the power to change editing privileges on this article? BillC I will be civil, but I'm requesting some action be taken on this.

Andrew Powers (talk) 23:59, 28 February 2009 (UTC)

First off, Wikipedia really isn't a good resource for medical information, and makes that explicitly clear in WP:MEDICAL. Why would you trust advice that might very well have been made up by a bored schoolchild? Secondly, it's too bad that no one took any notice of your complaint at WP:COIN. Promotion of specific doctors and methods in this article has been a long-standing issue (see for example Wikipedia:Suspected sock puppets/Scubadiver99), although it is not limited to Brian Boxer Wachler. I understand why you are frustrated. Semi-protection of the article would significantly reduce the questionable editing, but I wouldn't hold out much hope for that. I'll try to get some more eyes on the article and see if that helps. Delicious carbuncle (talk) 01:09, 1 March 2009 (UTC)

If Wikipedia is not a good source for medical information, it should be clearly said by it being visible to any visitors to Wikipedia from the strat and on the start of any article on a subject- not a link to a page about it pull out as and when some wants to. Otherwise Wikipedia is trying to market themselves as something important but when the heat is on, they cave in and saying "oh but it say here that we are not medical information, take a look at this page which we have not made you aware off". The reason people are trying to twist the truth on Wikipedia pages like Scubby is, is because on search engines wikidepedia comes up more often than not.—Preceding unsigned comment added by 149.254.51.225 (talk) 14:46, 2 March 2009 (UTC)

There is a disclaimer link at the bottom of each and every page. While I agree with some of your points, this isn't the place to debate the issue. Delicious carbuncle (talk) 14:36, 4 March 2009 (UTC)

If Wikipedia allows Scubby to do this (for the Dr he markets) they are just as bad as Scubby. Does Wikipedia want to be the laughing stock of the world with also Dr Scubby doo ? May be Wikipedia takes money from Scubby ? There has been a catalog of bogus info. from Scubby over a very long time. Dear Scubby, you must think we are stupid, the Dr you promote must think that too, and so only has contempt for us our fellow patients which we are trying to bring awareness to such new depths people will go to (hence the scubber driver (scubby to us) name used here) signed RH —Preceding unsigned comment added by 149.254.51.225 (talk) 14:46, 2 March 2009 (UTC)

Please stop referring to User:Scubadiver99 as "Scubby". It makes your comments seem more like personal attacks, which won't help to solve this issue. Thanks. Delicious carbuncle (talk) 14:41, 4 March 2009 (UTC)

I have been following this dialogue and it seems that some parties have become rather emotional over this topic. I think it's best to maintain objectivity to provide clarity. In reviewing the cited articles, it's clear to me the data indicates that crosslinking with and without removal of corneal epithelium shows efficacy to patients. I would like to echo BillC's recommendation about civility. Corneadoc (talk) 03:33, 4 March 2009 (UTC)

reply to corneadoc

Corneadoc, didn't you along with scubadiver99 write/edit the Brian Boxer Wachler wikipedia article? Citing him as one of the "Best Doctors in America"? And didn't you try to get me banned for insinuating there was some wiki gaming going on?

Well, I'm glad you decided to join the conversation Dr. Wachler but unfortunately I believe your opinion is biased.

Andrew Powers (talk) 08:05, 4 March 2009 (UTC)

I've started a sockpuppetry case at Wikipedia:Sockpuppet investigations/Scubadiver99. Delicious carbuncle (talk) 15:02, 4 March 2009 (UTC)

Arpowers, sorry to disappoint you (yes there is more than one cornea specialist). I will be sure notify Dr. Boxer Wachler of your colorful discussions about him. I will also be sure to point out your libelous comments that you made about him as well in earlier comments that was already pointed out to you. Corneadoc (talk) 00:04, 5 March 2009 (UTC)

Are you saying that you know Boxer Wachler? If so, what's your relationship? Delicious carbuncle (talk) 03:50, 5 March 2009 (UTC)

CorneaDoc - can you stop the rhetoric, what patients want is proof and there are none valid, just rhetoric, can you show the opposite and of the same amount, of the links to studies already posted ? if not you are just talking "hot air", being a "know it all" pulling things out of "thin air"- how can "epi on" be the same as Epi removed to allow for better B2 diffusion in to the cornea ? - logic says the two are different, as they are from the out set and in studies already. This rhetoric is not a joke to us and has shown that there is over selling going on by a "fallen" Dr. Can any of you guys let me know about reporting this to the advertising standards authorities, I think a police arrest should be made Signed RH

I think we all have an interest in being sure accurate information is being represented. I have been around for a very, very long time, even before the days of myopic keratomileusis (a pre-lasik procedure) that some surgeons were performing and was not very effective. So I have seen alot come and go by the waistside. It is quite frankly hard to ignore the data that show patients are receiving benefit from crosslinking (regardless if the epithelium is or it not removed). Please see references #55 and #56 (I added 56). Summarizing the science is not supposed to be emotional as it seems to have become on this topic. If everyone can keep his or her "cool", we can all achieve what wiki is here for. Does that make sense to everyone? Corneadoc (talk) 02:16, 6 March 2009 (UTC)

Corneadoc, in case you missed my question to you above, let me ask again: Are you saying that you know Boxer Wachler? If so, what's your relationship? Thanks. Delicious carbuncle (talk) 03:18, 6 March 2009 (UTC)

This must be the greatest low on this discussion page with this utter nonsense - CorneaDoc, 56 - which you say you added, IS NOT A PER REVIEWED ARTICLE - HAVE YOU GOT THAT ? it is rhetoric, it is just marketing rhetoric and its a standard excuse and easy brush off in all you say. 55, has been disproved (and there was parts missing in how conclusion was jumped to - the longer version of the studies need to be read) by http://www.ncbi.nlm.nih.gov/pubmed/18361990?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed

THE ABOVE HAS BEEN POSTED BEFORE Another thing is, anyone can say they are a "CorneaDoc" - Drs because of responsibility use there real name and give what their education is also in conjunction with a real name (you don't even seem to think you should, which only goes to show you up even more - otherwise you have no creditability, you have none from the "wool being pulled over our eyes" shallow replies you give here - what depths you will go to is staggering. Did Dr BW do animal testing before offering epi on to patients ? or even do a comparitive study ? PLEASE ANSWER OUR QUESTIONS IN FULL< AS OTHERWISE YOU ARE PART OF THE PROBLEM signed RH —Preceding unsigned comment added by 149.254.51.17 (talk) 21:40, 6 March 2009 (UTC)

Delicious Carbuncle, no where does it say that only peer-reviewed articles can be posted on wiki. The Pinelli study is valid - it was controlled and groups were matched statistically preop. Unfortunately, his results do you support your obvious bias for epi-off crosslinking. The bias of you RH, and Arpowers against epi-on is more transparent than a new factory window. Scubadiver99 (talk) 04:54, 7 March 2009 (UTC)

Please re-read whatever prompted your accusation - I haven't made that statement. My only recent involvement here is to try to bring some resolution to the disputes that swirl around one small portion of this article. The comments by "RH" (who hops from IP to IP and refuses to sign their posts properly) are disruptive personal attacks as far as I'm concerned. I requested that the article and talk page be protected, but that was denied by an admin who didn't appear to grasp the situation. I will attempt to get some more admin eyes on this and the related sockpuppetry case so we can actually address the content concerns productively. Delicious carbuncle (talk) 17:12, 7 March 2009 (UTC)

Peer reviewed article is far more respected ok ? do you get that ? Besides the overwhelming evidence is for epi off in comparison, for epi on is negligible. That needs to be said on the article, what do the others say ? RH

Note: This talk page has been temporarily semi-protected. I encourage the editor who sometimes signs as RH to read WP:CIVIL. Having a username generally makes communication easier for other editors. Editing as an IP (i.e., without a username) is allowed, but the same rules and guidelines apply. In the meantime, could someone summarize the cross-linking dispute concisely and without attacking other editors so we can get this resolved? Thanks. Delicious carbuncle (talk) 18:19, 8 March 2009 (UTC)

Delicous Carbuncle, I stand corrected. My comment was in reponse to RH. Nonetheless, the comment is still valid.

I agree with you Delicious Carbuncle, there is clearly a problem with resolving this section. If an outside party reviews the comments in this Discussion, I think it will clear that there is a similar tone and attack style of both RH and Apowers against myself and anyone who puts forth information that shows another version of crosslinking works. How can it be investigated if this is the same person using an alias? It's very suspect and itself smells of Sockpuppetry, don't you think?

Additionally, the unprofessional, personal "attack dog" nature of RH and Apowers' comments cannot be ignored - they don't seem consistent with spirit of Wiki community. I think that is largely the problem. Do you agree? Perhaps RH and Apowers' comments stem from some kind of personal "intolerance" to others who have a different opinion. BillC what are your comments about this situation? We clearly need outside help. Scubadiver99 (talk) 16:37, 9 March 2009 (UTC)

Perhaps it would be more helpful, as I requested above, to briefly summarize the dispute. I doubt anyone is going to want to wade through the bickering, accusations, and counter-accusations on this talk page. For the record, I don't think "RH" and user:Arpowers are the same person (although you are aware that I believe you have used numerous accounts to push your particular view). Delicious carbuncle (talk) 16:51, 9 March 2009 (UTC)

Summaries

I'll give my summary view, if neither of the engaged parties will do so just yet. It is of course, my opinion, and I am no authority in keratoconus, ophthalmology or even medicine.

The dispute is centred around a recent treatment for keratoconus, in which the cornea is treated with a riboflavin solution, and illuminated with ultraviolet light for some minutes. The treatment encourages bonds to form in the cornea, strengthening it, and halting, or even reversing the effects of keratoconus. The dispute is principally over whether the corneal epithelium should be abraded before this treatment, or not. The on-Wiki dispute mirrors a real-life disagreement between practitioners. The treatment was pioneered in Germany, where the "epi-off" method is favoured, while in the United States, one prominent ophthalmologist by the name of Brian Boxer Wachler (BBW) favours the "epi-on" method. The epi-off party look askance at BBW's marketing of the epi-on method, question whether such marketing is at odds with American medical practice (such as in vivo human trials) and whether he has the right to name, even trademark, the treatment. BBW, in turn, has been defending himself in the technical press. I have avoided directly naming the treatment as this is also one of the facets of the dispute: the epi-off party prefer the name "CXL", while BBW prefers the name he has trademarked: "C3R".

The resulting on-Wiki dispute has become fraught, and at times uncivil, leading to a temporary semi-protection of the article talk page. Scubadiver99 (talk · contribs · count) has been accused of sockpuppetry and conflict of interest editing.

That is my current understanding, and I welcome correction and comment. —BillC ^talk 00:12, 10 March 2009 (UTC)

my comment

My viewpoint on this conflict is centered around the overwhelming amount of evidence supporting the fact that the epi-off method is much better than the epi-on method. While Scubadiver99 and corneadoc continually suggest I have added no evidence to support claims, I feel that I have supported myself amply.

Here is the supporting citations for the 'epi-off' camp:

http://www.medcompare.com/featuredarticle.asp?articleid=409

This is an article citing Wollensak, the creator of this procedure who states that: "The removal of the epithelium is essential for the homogeneous diffusion of riboflavin into the corneal stroma. Without epithelial removal (like in C3-R) the biomechanical effect is less than 50% of the standard crosslinking procedure."

http://www.ncbi.nlm.nih.gov/pubmed/18361990

This published article summary discusses a formal study carried out to measure of epi-on versus epi-off. Concluding that: Complete removal of the corneal epithelium is an essential component of riboflavin-UVA crosslinking therapy as superficial epithelial trauma and tetracaine administration alone are not sufficient to permit the penetration of riboflavin into the corneal stroma. Failure to achieve adequate stromal absorption of riboflavin may impair the efficacy of the crosslinking process.

Additionally, I am a medical device professional and I have a good understanding of the difference between medical literature and marketing materials. Most articles provided to support the opposition come directly from websites created by Brian Boxer Wachler or his affiliates.

*My opinion: From my exposure to FDA regulations, it is my assumption that the "C3R" procedure was created to get around certain FDA marketing regulations for unapproved device indications (i.e. recommended uses)...

Having the procedure be epi-on means that it is a 'vitamin' treatment and therefore not required to be approved by FDA.

This allows the 'C3R' procedure to be marketed in the US and at a high margin because there are little or very few competitors.

Rich and startling history of XIX century surgical attempts

A wide array of attempted treatments is described in Ramón Castroviejo's article Keratoplasty for the Treatment of Keratoconus. As I understand, Castroviejo was the major inventor of modern keratoplasty. Maybe he too could be mentioned. There's an article about him at Spanish Wikipedia. --CopperKettle 16:19, 10 March 2009 (UTC)

Good find, CopperKettle. Interesting. —BillC ^talk 19:39, 10 March 2009 (UTC)

As to the CXL\C3R\whatever-its-named-riboflavin+UV-treatment, it is for some reason added in the Corneal transplantation. I think it is irrelevant there. --CopperKettle 21:24, 10 March 2009 (UTC)