For Some, Lasik Has a Downside
Call it the hidden side of the Lasik juggernaut: a patient who suffers sight-threatening complications after laser eye surgery, a center that engages in what one couple regards as “bait and switch” tactics, and several California surgeons who reused disposable blades without sterilizing them between patients.
The popularity of laser eye surgery to treat nearsightedness and the heated price wars spawned by competition have resulted in burgeoning numbers of patients reporting what some ophthalmologists say are preventable--and in some cases serious--complications. As a result, some experienced laser surgeons are developing a new sub-specialty: treating patients with Lasik-related complications.
One of the busiest of this new fraternity is Roy Rubinfeld, a Chevy Chase, Md., surgeon who is director of training for TLC, one of the Washington area’s busiest and most expensive laser centers, and a competitor of Lasik discounters.
Rubinfeld estimates he has seen more than 100 Lasik patients with problems in the last 18 months, most of them referred to him by other doctors.
“Some of it’s the result of surgeons with bad judgment, some of it’s inexperienced surgeons and some of it is patients who haven’t been educated preoperatively so they know what to expect,” Rubinfeld said.
While most of these patients underwent surgery in the Washington area, Rubinfeld said he has seen patients who have flown in from Europe, South Africa and South America. “For a while the pace was terrifying. One day I saw six patients who were disasters.”
Among the patients Rubinfeld is treating is Mitchell Levy, a Potomac, Md., business owner who underwent Lasik in September 1999 at Millennium Laser Eye Center in Virginia. Levy, who has filed a lawsuit against the center, his surgeon and an optometrist, did not know until after his surgery that he suffered from keratoconus, a serious condition that causes the cornea to bulge and thin, according to Aaron Levine, one of his attorneys.
Keratoconus is detectable by corneal topography, a procedure that maps the cornea before laser surgery. Patients with keratoconus are told not to have Lasik because the surgery further weakens the cornea. “It’s an absolute contraindication,” said James Salz, a clinical professor of ophthalmology at USC.
According to Levine, surgeon Andrew Holzman and optometrist Robert Samit, Millennium’s owner, detected possible keratoconus before surgery but decided to proceed anyway. Levine said Levy is now legally blind, unable to see well enough to drive or to read a newspaper. He is scheduled to undergo a double corneal transplant in January, Rubinfeld said.
Thomas Hogan, the attorney for Holzman, Samit and Millennium, declined comment on the lawsuit, which is scheduled for trial Nov. 6 in Fairfax County (Va.) Circuit Court. In court papers the defendants denied wrongdoing and alleged that any injuries Levy suffered were caused by his “sole or contributory negligence.”
Carol Wood of McLean, Va., said she had a much less serious problem with Lasik but believes she experienced a “bait and switch.”
Wood said she and her husband were drawn to a discount center by ads claiming the center was staffed by experienced doctors who had performed thousands of procedures. They were told, Wood said, that one of these doctors would perform their surgery. But when the Woods arrived for surgery, they discovered it would be performed by a less experienced doctor who told Wood he had “participated in thousands of procedures.” Wood said she never complained about the substitution but was upset by it.
Wood said her husband got “great results” but that her surgery had to be aborted because of a problem. She recently underwent Lasik performed by another surgeon who was recommended by her ophthalmologist.
To Salz, some of the Lasik-related problems he and his colleagues see may be a consequence of less-than-rigorous selection of patients spawned by competition among centers.
“Look at it this way,” said Salz, director of refractive surgery research at Cedars-Sinai Medical Center in Los Angeles. “A full-page ad in the L.A. Times costs $60,000, and a lot of these centers advertise regularly.”
Though they don’t buy full-page ads, at that rate “you can imagine how many cases these discount places need to do” to recoup that cost,” he adds.
Lasik has even resulted in a class-action lawsuit on behalf of nearly 3,000 patients that is awaiting the approval of a settlement by a California Superior Court judge in San Francisco.
The case involves a husband-and-wife team of ophthalmologists, Sanjay Bansal and Swati Singh, owners of LaserVue Eye Center, a chain of four clinics in the San Francisco area. For several years, Bansal, Singh and other doctors at two LaserVue centers rinsed and reused disposable blades and failed to sterilize other equipment between patients, according to court papers.
Reusing disposable blades potentially exposed patients to AIDS, hepatitis, staphylococcus and other infections, the lawsuit contends, and is a violation of standard medical practice and state law.
The class-action suit, filed by several patients of LaserVue, alleges that the couple “willfully and recklessly used unclean blades . . . in an attempt to maximize their profits.”
Last March, the California Department of Health, after consulting with the federal Centers for Disease Control and Prevention, required LaserVue to notify all patients of the risk of exposure to infection from the practice, a risk the department said was small. The practice was halted in June, a month before the lawsuit was filed. The California Medical Board is conducting an investigation.
The proposed settlement, according to Geoffrey Gordon-Creed, the lawyer who filed the lawsuit, would require the doctors to pay each patient $500, which could be used for blood tests for HIV, hepatitis and other diseases. Gordon-Creed said no patients have come forward and said they contracted an infection as a result of the practice.
Fletcher Alford, an attorney for Bansal and Singh, denied that his clients reused blades and other disposable equipment to make more money, but did so to give patients the best care possible. Alford said the couple changed blades after every other patient and reused blades only when there was no visible bleeding. He noted that no patients have alleged they had been physically harmed by the practice.
“The results speak for themselves,” said Alford. “Dr. Bansal made a reasonable medical judgment” by reusing a “quality blade that had worked well in the past.”
(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)
Lasik and “Lazy Eye”
Lazy eye affects about 2% of the population and usually develops in children less than 8 years old. Researchers are performing Lasik surgery on young children with anisometropia, an earlier stage of lazy eye.
Treatment:
Standard treatment involves correcting the refractive errors in one eye by having the child wear glasses or contact lenses. It may also include having the child wear a patch over the stronger eye to force the weaker eye to take over. If treatment is unsuccessful, the child can develop amblyopia, or “lazy eye,” when the condition has continued do long that vision impairment cannot be corrected.
Researchers hope that by using Lasik surgery to improve vision in the weaker eye, they can prevent deterioration in that eye and prompt the child to use both eyes.
This illustration shows how a child with lazy eye views an object with the stronger (right) eye.
The weaker (left) eye is significantly impaired from lack of use, and the brain favors the visual input from the stronger eye.
