LASIK Letdown Surgeons mute their claims of success as lawsuits mount and authorities clamp down
By Carla McClain ARIZONA DAILY STAR
The first signs that something is going wrong with the hottest elective surgery in the United States - LASIK eye surgery - are emerging here and nationwide.
A "gold-rush mentality" developing around the quick, pay-up-front surgery to correct nearsightedness and farsightedness is being blamed for a jump in medical malpractice lawsuits filed by dissatisfied - in some cases, devastated - LASIK patients, now estimated at 5 percent of all cases.
Among them is a young, highly paid Southern Arizona pilot for United Airlines whose flying career was destroyed after LASIK surgery performed in Tucson severely damaged his night vision.
Now declared unfit to fly the jets that were his passion and his livelihood, Steve Post, 33, remains in shock a year after the surgery he hoped - as so many do - would simply liberate him from glasses and contact lenses.
"When I first realized the problems were not going away, as they said they would, I was in a lot of turmoil," said Post. "I thought, 'My God, is this the end of my career?'
"I was a captain in the world's largest airline. I loved my job, I was set for life. There has been a lot of difficulty accepting that this really is the end of my career. It's been very hard to let go."
More than half of all Americans suffer the kinds of vision problems LASIK can correct, making them - like Post - prime candidates for this non-essential, heavily promoted but sometimes risky surgery.
With the likes of superstars Tiger Woods and Troy Aikman touting the joys of LASIK-improved vision in glossy ad campaigns seen everywhere, it is no surprise that more than 2 million Americans this year will demand to have their eyeballs burned and scraped by high-tech lasers in the hopes they too can chuck their glasses or contacts.
That makes LASIK - technically Laser-Assisted in-Situ Keratomileusis - by far the most popular elective surgery in the United States, easily surpassing breast implants, nose jobs and fat suction.
Considered cosmetic - not "medically necessary" - surgery, LASIK is rarely covered by insurance. So patients pay out of pocket, at $1,000 to $2,000 an eye, for an outpatient procedure that takes about 20 minutes, making LASIK a high-volume $2.5 billion industry in this country, and a major money-maker for any doctor or clinic that does it.
But as bad outcomes and lawsuits start to hit the nation's radar screens, federal authorities have warned physicians to tone down their advertising promises and start telling patients about the risks they face.
In fact, in its LASIK surgery advisory, the U.S. Food and Drug Administration warns the public about "slick" LASIK advertising, and then states:
"You are NOT a good candidate for LASIK surgery if you are not a risk taker. . . . Certain complications are unavoidable in a percentage of patients."
While more than 95 percent of LASIK surgeries produce good results, delighting many patients, both the FDA and the Federal Trade Commission are alerting the public that up to 5 percent emerge with temporary or permanent complications, including worse vision than before surgery.
And up to 15 percent of all LASIK patients require what the surgeons call "enhancements" - follow-up procedures to correct problems and complications, usually at the patient's cost.
"The biggest complication we have is not hitting the mark - the patient does not get perfect 20/20 vision or needs a correction," said Dr. Ajay Sanan, a Tucson eye surgeon who underwent yearlong specialty training in LASIK and other corneal surgeries.
"But that happens in such a small minority of patients. The very worst that can happen - losing vision that is not recoverable - occurs only 0.3 percent of the time.
"Unhappy patients are extremely rare. LASIK is an extraordinarily successful procedure. I had it done myself and I would do it again. You won't find another surgery with such a high rate of success."
But Sanan did say that LASIK's high success rate combined with the "perceived simplicity" of the surgery "does make it a good corporate profitmaker."
"And if you work in an area of declining reimbursements from HMOs - as we do here -this does fill the gap, financially," he said.
Doing four to five procedures a week, Sanan keeps his LASIK volume relatively low, with minimal advertising.
"That was one of the things that appealed to me about him. I'm just not into all that hype that goes on," said Sue Gold, a Tucson operating room nurse, who had her severe myopia - nearsightedness - corrected by Sanan in March.
Forced to wear glasses or contacts since she was in first grade, Gold now no longer does.
"It was amazing, truly amazing for me," she said. "Now I wake up in the middle of the night and look at the clock and I say it's 2:30, it's 4:30 - because I can see the clock. I never could before.
"This has been a very, very positive experience for me. But you have got to do your homework. You must be absolutely sure about the person who is going to do your surgery."
Clinics like Sanan's are not the kind causing the problems with LASIK, says a Tucson medical malpractice attorney, Steven Copple, who has noticed a significant increase in complaints from unhappy LASIK patients.
"Somebody out there has determined this is a good way to make money, so you have these 'LASIK mills' cropping up, all these freestanding clinics that runs lots of ads and run lots of patients through - some do 20 a day - and everybody makes money," Copple said.
"This is not an ophthalmologist helping people, it's a big marketing venture. And the more people you run through the mill, the more likely someone is going to get hurt. It's assembly-line medicine. That's why I think we're starting to see the beginnings of a problem with LASIK."
In one of the worst cases to date, a Buffalo, N.Y., man last year was awarded $1.2 million after a surgical blade cut his cornea and iris during the first step in the LASIK process. A Philadelphia jury awarded $800,000 to a woman with permanent double vision after LASIK.
Patients angry with their results have formed an Internet-based support group - www.Surgicaleyes.org - where more than 1,300 cases of severe damage from laser eye surgery have been logged, according to the Web site's founder, Ron Link.
In Tucson, several attorneys are now reporting LASIK complaints coming in at the rate of about one or two a month. But so far, they are rejecting most cases.
"It's always someone who is worse off after the surgery than before - it's people losing a good deal of vision," said Tucson medical malpractice specialist Ron Mercaldo.
"I would take these cases if patients were being blinded, but that's not what happens. They are losing a few degrees of vision, and they have probably signed huge consent forms listing every possible risk. That's what often happens with elective surgeries.
"Nevertheless, there is no doubt there are a lot of dissatisfied patients, a lot of complaints. The injuries just aren't big enough to take to court."
Many Tucsonans became familiar with LASIK when KVOA-Channel 4 newscaster Frank Field had it done live on camera in February at the University of Arizona-affiliated LASIK Center.
After a lifetime of thick glasses and bothersome contacts to cope with his severe nearsightedness, Field broke down when he opened his eyes immediately after the surgery, and could see the faces of people in the room with him, and the time on the wall clock.
Field called the surgery an "amazing gift" in a testimonial on the LASIK Center's Web site.
That is exactly how Steve Post, the United Airlines pilot, felt a year ago right after his LASIK was done, also by Dr. Robert Snyder, the UA's chief of ophthalmology and head of The LASIK Center.
Given a quick vision check immediately after the surgery, he was stunned to be able to read the vision chart at 20/30 vision - without glasses.
"It was 'wow, I can see that. Holy cow!'" Post remembers.
"I felt so excited about it. I remember walking up the street to go to dinner later that day and thinking, 'wow, I can see everyone's faces.' It was just incredible. I was thrilled to death."
Though sentenced to glasses and contacts to correct his poor distance-vision since he was 17, Post was never hindered in his fast-track flying career. He joined United at 24 and zoomed to 737 captain by 31 - about 10 years before most pilots do.
"I didn't have to have it (LASIK) to fly. I was just pretty frustrated with having to wear glasses all the time," he said.
While weighing going under the laser, Post did his homework, spending a year researching the surgery and the surgeons. He settled on Snyder at the UA - one of the two top LASIK surgeons in Tucson, his research found.
What went wrong for Post is one of the most common problems producing bad outcomes associated with LASIK surgery, according to his account.
The surgery itself, performed by Snyder, was not the problem. It went flawlessly, he said.
Rather, Post believes he was erroneously evaluated before the surgery by a technician and an optometrist, who pronounced him an "excellent" candidate for LASIK surgery.
In short, he alleges they failed to accurately measure the size of his pupils - one of the vital criteria for LASIK surgery. Patients with very large pupils often suffer severe problems with night vision after the surgery - what are known as "starbursts, haloes and ghosting" around lights.
It is a phenomenon that destroys the ability to see objects clearly at night.
One of the most common and debilitating complications of LASIK surgery, the problem is usually blamed on technicians not trained well enough to do accurate measurement, or clinics too eager to take on too many patients, even risky ones.
A year after his surgery, with no improvement in his night vision, Post has been permanently medically grounded by the Federal Aviation Administration. He will never fly commercial planes again.
Instead, he has returned to his home in Sierra Vista, where he does volunteer work with troubled youth, has become licensed as a foster parent, and has trained his dogs for therapy work in nursing homes.
"I'm trying to see this as an opportunity for change, to do some work I would not have done. But I'd be lying to say I'm not affected by what happened," he said.
Post has sued University Physicians, The LASIK Center and its LASIK team. His attorneys, Robert Beal and Michael Redhair, contend the defendants were negligent in evaluating him and failing to properly explain the risks associated with LASIK.
In a statement released Friday, University Physicians responded that "all of the UPI personnel involved in Mr. Post's care and treatment at The LASIK Center provided appropriate care. Additionally, Mr. Post, like all LASIK patients, was fully apprised of the risks and potential complications of LASIK surgery, and he consented to having LASIK performed.
"No further comment can be made, since this case is currently in litigation."
* Contact Carla McClain
at 806-7754 or at cmcclain@azstarnet.com
-- Anonymous, June 10, 2001