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Warning on eye surgery as laser claims soar
By Celia Hall, Medical Editor
(Filed: 26/05/2003)


Claims against eye surgeons who perform laser operations to correct poor sight have more than doubled among Medical Defence Union members in the last six years.

The MDU, the largest insurer for doctors in Britain, said that while some of the claims were over faulty surgery, many more centred on patients' "unrealistic expectations" about what could be achieved. The union is warning laser eye surgeons that they "must not, in any way, offer guarantees of cures".

The increase in claims has prompted the union to put up its fees for the second time this year. Private surgeons performing the procedures - which can mean that people no longer need glasses - now face a top rate of £22,000 in MDU fees compared with £6,500 for general ophthalmic surgeons. The fee was raised to £18,500 at the beginning of the year.

The surgery costs about £1,000 an eye and has become increasingly popular in Britain over the past decade with about 100,000 people a year paying for the operations.

The MDU said claims over laser eye surgery have increased by 166 per cent in six years and now account for a third of all claims against ophthalmic surgeons.

Because eyesight is involved, successful claimants could be awarded high levels of damages. In a current case in America an airline pilot who suffered poor night vision after surgery was awarded $4 million (£2.8 million). The case has gone to appeal. Another American case was settled for $1.75 million (£1.25 million).

In February a report in Health Which? claimed failure rates for laser eye surgery were greater than sometimes quoted. Studies have shown complication rates of two to three per cent.

The MDU has asked each surgeon on its books who conducts laser eye surgery to have a meeting with them and today publishes a checklist to ensure that the potential success of the surgery is not "over-sold" to patients.

"While some of the claims are as a result of faulty surgical technique an underlying feature in many cases is patients' unrealistic expectations about what can or cannot be achieved by surgery," said Dr Matthew Robson, clinical risk manager at the MDU.

"It is important for the doctor to counsel possible patients about the risks of the procedure and the possibility of an imperfect result and other complications in order to obtain proper consent," he said.

Dr Robson added: "Laser eye surgery has massively increased in popularity since its introduction in the early 1990s and it is often thought of as a low-risk, straightforward procedure.

"But our experience shows that although ophthalmology as a whole has been a low-risk specialty, negligence claims in this particular area are increasing rapidly."

The MDU is advising surgeons to give patients enough time to ask questions, to tell them about alternatives and to document all conversations. "Merely obtaining a signature on a consent form is unlikely to be considered satisfactory," it says.

If a patients asks how a doctor's results compare with others "you must answer such questions as fully, accurately and objectively as possible".


http://www.moorfields.org.uk/EyeHealth/Anatomyoftheeye

http://www.rcophth.ac.uk/
 

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Hi Bren,

thanks for the post on this.  As I live abroad, this type of article is hard to come by as it doesn't make "world" news on BBC/CNN.

I was/am considering eye surgery as it's a real pain having to swap glasses / mask / sunnies but haven't got around to it as I don't want to have the several weeks layoff from diving - the local doc here recommends 3 months to be on the safe side.

I wonder if the increase in claims is associated to a corresponding increase in the number of people undergoing surgery?

On a more positive note, one of the guys in our club had this done just before Christmas and apart from dry (gritty feeling) eyes for the first couple of weeks, he has had no problems.

I'd be interested to hear from any body else with experience of laser corrected vision.

Cheers,  John
 

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Good friend of mine had both his eyes done at the same time a year or so ago - complete success.  Had to wear shades for a while as he was pretty light sensitive, but after a week or so he was right as rain.

However....  I've been thinking about having it done myself for some time now, but because one of my eyes is mostly dysfunctional (ie no amount of operations will ever enable me to see properly out of it) the opthalmic surgeons won't touch me.  Reason being - if they bugger up my good eye during the procedure, that's me effectively blind.  They won't take that risk.  Which means there's enough of a risk...
 

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Well..................

This is pretty much what Ian and I have been saying on this and other boards for a long time.....including debating with people whose idea of logic is "I had it done and I'm OK therefore it must be safe"

What is also not publicised is that what is considered a technical success may not be what the patient considers a success.  If you have no prescription but your visual acuity is now 6/12 rather than 6/6 as it was before that is recorded as a success.  Haloes and difficulty seeing at night are well documented side-effects and you cannot therefore sue.

One classic AM moment - when asked why opthalmologists or opticians don't have laser surgery, she replied " because they need perfect vision in their job" EXACTLY - D'OH

I personally wouldn't touch laser eye surgery with a bargepole, and I think it is sad that people make decisions that may affect their future health without knowing all the facts.

I'll get off my soapbox now
 

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I have had laser eye treatment and I did an extremely large amount of research prior to having it done, in fact, spending two years researching it.

You cannot just rule something out on the basis that a SMALL percentage of people have problems.  Especially given the massive increase in people having the treatment in recent years.

AM's (the banned one) comment is entirely accurate, anyone in the business of administering eyetests or procedures must not risk eye surgery - why you show derision is confusing because the perfect candidates for laser treatment are people who can accept a less than perfect result and do not rely on perfect vision for their jobs.

Unfortunately a lot of the newer laser clinics will accept and treat anyone.  AM, stated on a forum a while back that she, like myself, did a year of research,  before proceeding and attended counselling before the operation.  I believe the driving force was losing contact lenses on a first holiday dive and wishing to pursue the sport in Britain.  Scary choice to make just to see stuff!

AM has written extensively before on forums about laser treatment and is a good source of information on the criteria for the treatment, i.e. how many years a candidate's eye prescription should be stable for amongst others.

I have reduced night vision but I am told that can take a few years to subside.  I would not consider that as a contra-indication to laser treatment.

Indeed, if I could go back, I would not. I am delighted with my treatment and a recent eye test is indicative that my eyesight is actually marginally BETTER than 20/20 whereas before I could not read even the top letter on the eye chart with both eyes together, uncorrected.

People who are considering this treatment must take responsibility for doing extensive research and they must be able to accept that there are no guarantees of success or improvement.   A bad result is not always intractable and some clinics will re-treat free to attempt rectification of a less than perfect result.

If an eye prescription is worse than -1 dioptre, that indicates a better candidate than someone of better than - 1 dioptre.  

There are also pros and cons between PhotoRefractive Keractectomy, or PRK and LASIK - again it is up to the individual to make an informed choice through research.

I personally recommend Optimax, who will allow potential candidates to meet other people who have already been treated and will even allow you to change your mind at ANY point and get a full refund. You could be lying on the table about to be treated and change your mind - no hassle.  They provide pre treatment counselling and lifetime free aftercare.

Optimax were one of the founder clinics of laser treatment and their pioneering MD laser treated himself around 20ish years ago!  They are very strict on who they will accept and who they won't (based on a defined set of criteria) - this maximises the chances of them always getting good results, unfortunately there are newer clinics who don't care about that and will take your money even when they can't guarantee a successful treatment.

Hope an opinion from someone who has actually HAD laser treatment makes things a bit clearer than the generic articles which are always floating around.  Anyone who has NOT had laser treatment is not really in a valid position to advise people whether they should or should not have the treatment as they are generally not aware of the criteria which make someone a good candidate for a successful treatment.

They are also not aware what it feels like to wake up in the morning and be able to see perfectly!  Good eyesight is something that a lot of people take for granted. You don't know what you've got until you lose it!
 

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Dear WF

I agree with you that this needs to be researched (and by this I mean in reputable medical journals) unfortunately some patients do not do this and listen to the person who says "I had it and it was great so it will be great for anyone".
If you make an informed choice then that is fine, but sadly many people do not.  Ok so it is their fault, but that does not make the consequences any less tragic.

I do take issue with your comment that
[b said:
Quote[/b] ]Anyone who has NOT had laser treatment is not really in a valid position to advise people whether they should or should not have the treatment as they are generally not aware of the criteria which make someone a good candidate for a successful treatment.
 This is patently absurd - if I suggested to a patient that they could benefit from a coronary bypass, then by your logic I would not be in the best position to do so until I have had one.

[b said:
Quote[/b] ]They are also not aware what it feels like to wake up in the morning and be able to see perfectly!  
What do you think it feels like to wake up in the morning with worse eyesight, or still with less than perfect sight, and the prospect of becoming presbyopic in a few years still.  This does happen and it is a documented risk.

Fee
 

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With respect, a coronory bypass is not really a valid analogy of laser treatment.  While I am sure a coronary bypass carries set criteria, so does laser treatment. I am sure a surgeon would be aware of the criteria for coronary bypass patient, what I said was most people who are not doctors etc are not aware of the criteria for a succesful laser result.  Laser patients TEND to understand the set criteria for a successful result.

I really think you may be focusing too much on the horror stories propogated in the media, don't forget the thousands of success stories.

I advise people to make up their own minds - at the end of the day, if someone takes the decision lightly, then, with respect, they must accept the consequences of their actions.  Likewise if we choose to abuse our bodies through diving, we choose to accept the consequences.  

Even sport diving has been found to have detrimental effects on the brains after autopsy.  Sat divers have brain stems not unlike alcoholics. Rapid compression causes damage.  Decompression diving can contribute to lesions on the brain and neurological abnormalities.  Most people are aware of those risks - yet they choose to dive.

In practice, it is extremely rare for laser eye treatment to go wrong, this is in part because of the strict selection criteria of reputable clinics.  The rare occasions where it does go wrong  are blown up in the media, but the media does not report the success stories.
 

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My mates wife had laser surgery done 8 months ago.  She had major problems for the first few months, having to go into hospital for a time.  She is OK now and her sight is now corrected.  She may have been one of the few who have problems.
 
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