Laser Eye Surgery threatens public health care and many patients

Promo never mentions failure or complication rates, much less the risk to our health system

By: Dr. Gordon Guyatt

  "Do you have difficulty walking because of pain in your hip? Our experienced surgeons have a record of 10,000 successful hip replacements. For only $25,000 you'll receive a new hip, and pain-free walking."
  Canadians would be shocked to see such an advertisement. But consider this actual ad for laser eye surgery from a Toronto company, ICON. The ad suggests that a friend you bring along will get surgery at no cost.
  "Lasik for free! First person LASIK vision correction both eyes $1,998. Second person $0.00."
 

The FDA says if you are not a risk taker, laser eye surgery is probably not for you

  Canadians receive their health care within a highly regulated, public system. Hospitals are non-profit organizations and do not charge patients directly. Physicians negotiate their fees with the government, and cannot charge patients extra, or offer them bargains. Pharmaceutical companies are private, for-profit organizations, but advertising their products directly to the public is illegal.
  What would Canadian health care be like if companies could set up for-profit clinics and advertise freely? Laser surgery, designed to eliminate the need for glasses or contact lenses by correcting abnormalities of the cornea, has given us a taste of for-profit health care. The result is not pretty.
  As for glasses or contact lenses, OHIP doesn't cover laser surgery. As a result, companies can set up private clinics, and charge what the market will bear. Furthermore, because laser treatment is a surgical procedure and not a drug, the companies can advertise directly to the public.
  The result has been the rapid development of a large-scale industry. Over a million Americans and up to 100,000 Canadians underwent laser surgery last year. Until recently market experts were predicting continued rapid growth in the laser surgery market.
  Exactly what happens to people who undergo the procedure? For the most popular method, a surgeon uses a knife to cut a flap in the surface of the cornea, the clear covering of the eye. Pulses from a computer-controlled laser vaporize tissue beneath the flap, flattening its curve to correct nearsightedness or steepening it for farsightedness.

Laser surgery horror stories
  The carefree growth of the laser industry ended last spring when investigators began to report that up to 50% of laser surgery patients experience abnormalities of night vision. It didn't take long before laser horror stories, including reports of patients with major visual impairment, began to hit the press. You can find over 40 stories of individuals with long-term serious visual problems as a result of laser surgery on a website called "surgical eyes" (www.surgicaleyes.com). The controversy escalated last October when the American Food and Drug Administration unveiled a website of laser surgery information. The FDA website (www.fda.gov/cdrh/lasik) emphasizes the small risk of serious complications, the larger but unknown risk of problems such as loss of night vision, and the altogether unknown risk of long term complications.
  The FDA's conclusion: if you are not a risk taker, laser eye surgery is probably not for you.
  Why has laser surgery played out as a public debate, instead of a careful consideration of risks and benefits in the doctors office? The answer is money, and lots of it. Until price wars erupted in the last 6 months, the typical patient bill for the 20-minute procedure was $2,000 per eye.
  The result was the rapid development of a new industry, with a number of companies setting up laser surgery centres and employing ophthalmologist surgeons to conduct the procedure. These companies have the resources for advertising campaigns that trumpet the benefits of laser surgery, offer gimmicks like the chance to win free surgery, the 2 for 1 deal, or an endorsement from Tiger Woods, and always fail to mention failure rates or complication rates. At least one company is hiring patients to act as laser advocates.
  The money has also drawn ophthalmologists away from delivering conventional eye care, and into public defence of laser surgery. Dr. Michel Popp, a Quebec ophthalmologist who runs his own laser eye surgery clinic, defended laser surgery on a CBC national radio program.
  In response to criticisms of unbalanced laser surgery advertising, Dr. Popp noted that he wouldn't expect Air Canada to list its crashes in the last year as part of its ad campaign. Similarly, he maintained, it is unreasonable to expect laser ads to include the complications.
  Dr. Popp is right about Air Canada, and the same could be said for selling cars, deodorant,or washing machines. But a mistake in a health care decision has far more serious consequences than a mistake in purchasing a car or washing machine, as many people who have opted for laser surgery have discovered.
  In making health care decisions, Canadians deserve balanced information and advice about risk and benefit from physicians whose interests are the patients well-being, and not their own incomes. What we don't want is the consequences of for-profit medicine: doctors and health care companies substituting a sales pitch for the true story about what we have to gain, or lose, from a treatment decision.

Dr. Guyatt is a founding member of the Medical Reform Group, and an MRG spokesperson for most of the last 20 years. He is a Professor of Medicine at McMaster University. A version of this article appeared in the Hamilton Spectator, March 19, 2001.

Links
- www.hwcn.org/link/mrg
- www.hwcn.org/link/ndpadfa

Posted: April 02, 2001

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