Ophthalmologists keen to see eye to eye on laser surgery

The Irish College of Ophthalmologists (ICO), the recognised training and professional body for eye doctors in Ireland, has expressed concern about what it regards as the continuing commercialisation of ophthalmology, particularly in the area of laser eye surgery.

During its agm, which will be held in Limerick this week, the college will announce details of a major policy meeting that will tackle the lack of regulations in medical advertising in Ireland.

The meeting, which the college will host in September, will also look at the areas of dermatology and plastic surgery, which have also been significantly affected by the commercialisation of certain procedures.

Laser eye surgery is performed by highly trained eye specialists and, in most cases, the results are satisfactory, according to the college’s chief executive, Siobhán Kelly. However, such surgery poses certain risks, which, in some cases, can cause the eye to regress to its previous refractive error within about six months. If this happens, the patient may need a second operation or may need to start wearing glasses or contact lenses again.

As is common with the performance of any surgical procedure, complications can arise. These can include dry eyes, which can affect vision; poor quality of night vision due to halos and glare, which sometimes affect the patient’s ability to drive at night; and a serious condition called corneal ectasia, which is a weakening and bulging of the cornea.

Severe cases may need to be treated with a corneal transplant or implant.

Mark Cahill, a consultant ophthalmologist at the Beacon Consultants Clinic in Dublin and a spokesman for the college, says the public might assume that if a procedure is openly available on the main street and widely advertised, it must be safe.

The idea that refractive laser surgery is simple and straightforward and has no potential risks or complications is unfair on the public, he adds.

The college says that patient safety and quality clinical outcomes are not always the primary focus within commercial medical organisations, such as main-street chains that offer laser eye surgery. In addition, pre-surgical consultations are often not performed by a medical doctor but by an optician, says Cahill.

In some clinics, surgery is often performed by surgeons from outside the country, who are unavailable for post-operative patient care or complications. A number of eye surgeons who spoke to The Irish Times said they had had to deal with referrals for patients who had experienced complications in such clinics.

Advertising
The ICO says it is concerned that direct patient advertising is being increasingly used to promote laser eye surgery, with special offers and little mention of the potential risks.

Without appropriate standards, such advertising may be inaccurate or misleading, and potentially fail to reveal important risks and complications of treatment. It says regulation of commercial medical advertising is urgently required in Ireland.

According to Mark Cahill of the ICO, the current situation means surgical procedures are being trivialised.The college says it has raised numerous issues and examples of what it regards as inappropriate medical advertising with the Advertising Standards Authority in Ireland (ASAI). These include, for example, companies that offer incentives such as the chance for their customers to win free laser eye surgery.

The college is also critical of what it alleges are fake case studies and celebrity endorsements that have appeared in media advertising for laser eye-surgery clinics. Two years ago the college wrote to the ASAI to voice its alarm that Ticketmaster was offering the chance for customers to win free laser eye surgery.

In its letter to the authority, the college expressed its “strong view that the use of surgical procedures in a marketing promotion is a highly inappropriate development”, and “any risk of significant loss of vision as a result of a competition win/marketing promotion is highly undesirable”.

However, the authority did not uphold the college’s complaint.

It noted that this was an unusual type of promotion and that a surgical procedure would not normally be offered as a prize. It accepted that, on balance, in this particular case, appropriate procedures to protect prospective patients were in place and it did not consider that the provision of the advertising code had been breached.

Despite the lack of success in stopping these advertisements to date, Cahill says the college is determined to push for tighter regulation of medical advertising and to highlight the potential risks and complications of commercial laser eye surgery as a matter of urgency.

In response to a query from The Irish Times, the managing director of Optilase, an Irish laser eye-surgery company, Phillip McGlade, says, "In relation to the commercialisation and need for regulation in the industry, we wholeheartedly agree with the the Irish College of Ophthalmology.

“As there is no regulation at present in Ireland, we have chosen to independently abide by the rules set out by the [Regulation and Quality Improvement Authority] which we are registered with for our UK business . . . Optilase is an Irish-owned business operating in the UK and Ireland.

“We employ only the most highly skilled and trained ophthalmic surgeons, each with over 20 years’ surgical experience. They are both on the specialist registers of the Irish Medical Council and General Medical Council of Great Britain”.

One of the surgeons is a resident of the UK and Ireland, and the other is an Irish resident.

McGlade says the company discloses the full price of treatment to patients on the phone before their initial consultation, and explains that the price is dependent on the technology and treatment involved. He also says it offers full disclosure to its patients at the initial consultation, and before patients decide to undergo surgery they sign a consent form that outlines all the potential risks.

Highest standards
He says the company upholds the highest standards in care and aftercare."We strongly advise our patients to attend all their aftercare appointments . . . In the unlikely event of a complication post-surgery, we operate an out-of-hours on-call service for patients, so they can be seen by a specialist if required. In addition to our surgeons, Optilase has a team of over 20 optometrists who can provide aftercare."

Ophthalmic surgeon Conall Hurley, who is from Cork and works with Optical Express, which has five clinics in Ireland, told The Irish Times that patients of Optical Express are kept fully informed through a consent process.

This includes educational materials, videos about the risks and benefits of, and alternatives to, surgery and a detailed discussion with their optometrist, who addresses concerns and questions.

He says Optical Express believes its benchmark for surgeon performance exceeds those required for the Royal College of Ophthalmology (RCO) certificate in the UK.

“There are no differences in outcomes or complication rates among our surgeons . . . despite no legal requirements to do so, the majority of our surgeons in the UK do hold the RCO qualification.”

Hurley refers to the company’s patient experience questionnaire, which is made available to all patients after their initial consultation and after any post-operative check-ups within 12 months of their surgical procedure.

“This allows us to understand what patients think of the care afforded and the outcome of their surgical procedure,” he says.

With regard to advertising standards and regulation, Hurley says Optical Express works closely with the authorities in every country it works in to comply with their strict guidelines. He says the company is an approved provider to Bupa, Aviva and the NHS in the UK, “providers that demand we undertake a very detailed due-diligence process”.

The ICO conference opens tonight with an eye-health information evening for GPs. There will be a public lecture about eye health on Thursday at 6pm in the Strand Hotel, Limerick. See eyedoctors.ie