For anyone with a few hours and a few hundred pounds to spare, glasses and contact lenses can be a thing of the past. Advances in laser technology mean that both long and short sightedness can now be treated and, in many cases, totally corrected through laser eye surgery. And all it takes, just like a medical Stars in Their Eyes, is a stroll through the magic doors of any one of the 77 corrective laser eye surgery establishments currently registered with the National Care Standards Commission…. plus cash, a cheque or a valid credit or debit card, of course.
Still relatively young, laser eye surgery is sometimes portrayed as simply another type of cosmetic surgery, but this is far from the truth. The range of fees payable for laser eye surgery – from £495 per eye for Lasek treatment at Optimax through to £1650 per eye for Wavefront LASIK with Laservision – reflects the increased demand and competition within the sector.
The procedure was developed by ophthalmologist Dr. Steven Trokel in Germany in 1987 and the first UK clinic opened at Clatterbridge Hospital in the Wirral in January 1991. Whilst treatments have developed over the past decade, the basic procedure remains the same and the industry claims over 100,00 procedures are performed in the UK each year.
A high frequency laser is used to cut the cornea and shape it to allow light to focus properly on the retina, and the changes made during surgery are irreversible. In very rare cases, complications can lead to corneal ectasia, where fluid pressure builds up on the eye. Patients can need a corneal transplant to correct the condition. Other complications, such as dry eyes and night vision problems that can affect ability to drive or work in the evening or in dim light, occur ‘relatively frequently’, according to a recent review by the American Academy of Ophthalmology.
A report produced by ‘Health Which?’ in February of last year catalogued a range of complaints from those who had experienced negative effects as a result of laser eye surgery. Whilst some were temporary, other case studies cited long tem effects. It stated: ‘Patients shouldn’t be taken in by claims about the safety and success rates of laser eye surgery. Whilst most do benefit from laser eye surgery, nobody knows the real number who have disastrous or disappointing results although we do know litigation is increasing. Complication and success rates vary from clinic to clinic and surgeon to surgeon. Patients need more honesty about so-called minor complications and the fact that many who have surgery still need glasses or lenses.’ It concluded: We’d also like all companies to publish their complication rates and results and have them independently audited so that patients can make an informed choice.’
Current regulations require not the person conducting the procedure, but the clinical director for the registered clinic, to be qualified in, in this case, refractive eye surgery. In practice, this means that the patient – who might naturally assume that the person responsible for changing the shape and size of their cornea using pulses of high frequency light is a qualified surgeon – may in fact be operated on by a GP or similar with no formal training in refractive surgery.
There are no specific qualifications in such surgery and the only legal requirement for doctors performing laser eye surgery is that they are registered with the GMC. In fact, any doctor employed by a refractive surgery chain can operate after a laser surgery course of just a few days.
So as a consumer, where does that leave you? What can you do to find out whether you are getting value for money from your surgeon? Or what their complication rate is? And how can you find out what the basics are for pre and post care? Quite simply, you can’t.
In May 2002 the Department of Health provided additional reassurance to those considering a nip and tuck by announcing proposals requiring cosmetic surgeons be medically qualified and have attended a postgraduate course before being allowed to operate. And since April 2002 minimum standards for cosmetic surgery have been applied by the National Care Standards Commission.
But despite the fact that negligence claims involving laser eye surgery against doctors belonging to the Medical Defence Union (the largest insurer for UK doctors) have more than doubled in the last six years, recent figures released by the union show that claims over laser eye surgery have increased by 166 percent in six years, and now account for a third of all ophthalmology claims.
Nevertheless, rather than wear glasses or contact lenses for the rest of their lives, an increasing number of people are opting to spend money on a one-off surgical procedure which, in the majority of cases, eliminates the need for glasses or lenses of any sort.
In April, a new regulatory body – the Commission for Healthcare Audit and Inspection will become responsible for the laser eye sector. There appears to be a general agreement from interested parties – including the National Care Standards Commission inspectors, the Royal College of Opthalmology, and members in the laser eye industry – that more detailed, tighter, basic regulation would be welcomed. We must wait and see whether CHAI can deliver.