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Scotland on Sunday
Sun 26 Dec 2004
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Surgeon warns of laser eye cure risks

Expert claims dangers of treatment not made clear


LASER eye surgery firms are underplaying the risks associated with the operation and doing too little research on its long-term effects, a leading Scottish expert has warned.

Dr Alistair Adams, one of Scotland’s most senior ophthalmic surgeons, believes that as many as one in 10 patients who undergo the corrective procedure ‘successfully’ could develop complications in later life.

But Adams, a consultant at the Princess Alexandra Eye Pavilion, Edinburgh, believes the companies involved are allowing patients to underestimate the risks.

Adams also revealed that he gave up practising an earlier form of laser eye surgery because so many of his patients returned with complications.

Thousands of Scots each year pay around £1,000 per eye to undergo laser surgery in the hope of throwing away their glasses or contact lenses for ever.

But while the number of patients has rapidly increased in recent years, so too have the warning signs. Public health watchdog NICE recently said its use should not be funded by the NHS because too many questions remain unanswered.

Adams once practised a form of laser eye surgery called PRK, or photo refractive keratectomy. It involved scraping through the surface of the eye and reshaping the cornea with a laser. At the time, patients had one eye treated at a time on safety grounds.

Adams, until recently chairman of the special advisory board on ophthalmology at the Royal College of Surgeons in Edinburgh, told Scotland on Sunday: "I did approximately 100 cases of PRK, but I stopped doing it around five years ago because around 10% of people I treated didn’t want to have their other eye done, and were happy sticking with their contact lens.

"That was mostly due to their vision at nighttime, driving in the dark or dim light, as their vision wasn’t as good as it was with their contact lens.

"One or two people had it done with both eyes and could no longer drive at night."

PRK has been replaced with the LASIK technique, which involves slicing into the cornea. It costs between £2,000 and £3,000.

But Adams says he has no intention of performing the procedure himself.

He said: "I have looked at LASIK several times, and have many friends, particularly in America, who say it is wonderful. Patients, generally speaking, are very happy.

"However, I do have reservations about the surgical procedure. With LASIK, between 5% and 10% may have persistent problems and may wish they hadn’t had the surgery done. It is quite invasive, with a slice made in the cornea, for a problem that is actually solvable with contact lenses or glasses.

"I have a question mark over the long-term results, and I think there may well be complications which we haven’t suspected. Already they are beginning to find more complications than they thought."

He added: "One of the defects of the present system is that the majority of these clinics which do the treatment do not keep the statistics of long-term follow-up.

"Unfortunately, it is marketed as being very simple and very safe, and I suspect that probably is just not true. To be fair, a lot of the clinics do offer good information, but patients who are set on throwing away their glasses don’t necessarily take it all in.

"A lot of companies say that 95% of patients have 20:20 vision after the treatment, but that doesn’t tell you that 10% of them might not be able to drive at night.

"Apart from the major risks of infection, there are a significant number of people with dry eyes, double vision or who see halos around lights. In some cases, such as persistent haziness. The patient can be left with an impairment of vision that is permanent.

"Some people’s lives have been turned upside down by having LASIK because of complications that they felt they were not fully informed about."

He added he was concerned at the increasingly popular practice of operating on both eyes at once. "If there was a problem, like an infection, then you might well have it in both eyes," he said.

The Royal College of Ophthalmologists, the profession’s training body, is currently producing guidelines on the LASIK technique and is urging more research. "Current evidence suggests the treatment is effective for selected patients with mild or moderate myopia but the College recognises the importance of more research into the long-term effects," said a spokeswoman.

But Christopher Neave, chairman of the Eye Laser Association (ELA), which represents the largest providers of laser eye treatment in the UK, said that the figure of 10% with complications was simply wrong.

He said: "Since 1990, some 280,000 people in the UK have been treated, and we estimate that fewer than 0.1% have experienced persistent problems. LASIK is a life-enhancing treatment and we believe that it is a discretionary decision by an individual."

He also pointed to independently verified research on patients treated at the Ultralase clinics, which showed that 98% of all its clients achieved driving-standard vision or better.

Neave, who said there was an "outstanding level of clinical care in our industry", said that the risks were made clear to patients both in writing as well as in verbal consultation.
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