January 17, 2005

Keeping Sight of the Risks

Nottingham Evening Post

When Dave heard about laser eye surgery he thought he would be finally free of his spectacles. He had been hampered by glasses since he became long-sighted at the age of 18.

"It got to the stage where glasses were just getting in the way," said Dave, a keen sportsman.

So five years ago, impressed by reports of how laser eye treatment could correct long- and short-sightedness, Dave approached a firm offering the surgery.

In 1999, he paid 3,200 for the operation on his eye, in which a section of his cornea, the clear covering over the eye, was removed.

The doctor who performed the surgery, known as laser in situ keratomileusis (LASIK) told him it had been a success.

But now he is fighting a legal battle, claiming the procedure damaged his sight.

"All this hype about how you could throw away your contact lenses and spectacles was not true," said Dave, 53, from Arnold. "I am worse off now than I was before the operation." Dave claims the firm did not explain the risks of the operation to him and the procedure has left him with a condition known as an "irregular astigmatism".

It means his vision has become very variable, changing in different light conditions and when undertaking different tasks such as reading, watching television or driving.

The result has been a continuous search for glasses that allow him to see comfortably in most situations.

"I have had at least ten pairs of spectacles since the operation and spent more than 3,000," said Dave. "I have had other problems too, a lot of headaches, visits to the GP and physiotherapy on my neck and back.

"I only have completely clear vision outside on a bright sunny day. I am furious about it." Dave believes many patients may also have been misled by firms wanting to sell them laser eye surgery.

And now the National Institute for Clinical Excellence, the NHS watchdog, has issued new guidance warning patients about the possible risks of laser eye surgery.

The watchdog has said there is not enough proof the procedure is safe in the long term to allow it to be used routinely in the NHS. It reported: Evidence on LASIK suggests it is effective for selected patients with mild or moderate short-sightedness but evidence is weaker for its effectiveness in severe short-sightedness and long-sightedness.

There are concerns about the procedure's long-term safety and evidence does not appear adequate to support its use within the NHS without special arrangements for consent and further research.

Professor Bruce Campbell, Chairman of the Interventional Procedures Advisory Committee, which considered the issue, said: "We know that vision gets worse in a few people after LASIK and eye specialists are also concerned about possible long-term side-effects.

The watchdog reviewed results of studies into laser eye treatment and interviewed experts and organisations. It found up to eight out of ten patients with low to moderate problems with their vision achieved perfect sight after the procedure. Where their visual problem was classed as moderate to high this figure fell to between one quarter and one third.

NICE also reported problems including growth of tissue on the cornea, effects on night-vision and glare.

The procedure is not currently offered on the NHS and while the NICE guidelines allow it to be provided as part of a research programme, health service managers are unlikely to introduce in the light of today's report.

Professor Harminder Dua, honorary consultant at the Queen's Medical Centre, said: "I do not think this will give reassurance to NHS managers. The investment is substantial and the risk of litigation is high." However, Prof Dua believes the procedure is safe if doctors are well-trained and patients are carefully selected.

"I do the procedure fairly regularly but I have a high incidence of turning people down," he said.

"If there is a risk I will not do it and I advise them not to have it done." Prof Dua, who is also the vice president of the Royal College of Ophthalmologists, said he is concerned that some doctors are not adequately trained and they view treatment as a "commercial enterprise".

The LASIK treatment has generated a steady stream of clients, including Dave, for Nottingham solicitors, Freeth Cartwright.

Paul Balen, a partner at the firm, is concerned the decision by NICE not to recommend laser eye treatment on the NHS may lead more people to seek help from private firms, where treatment may not be safe.

Mr Balen said: "It is critical before any patient agrees to this kind of operation and hands over money they make sure they have the right condition and they are aware of the risks."

Posted by Admin at January 17, 2005 12:57 PM