Cooperations for a Safer Refractive Surgery

As indicated before, there may occur different kinds of subjective visual side effects after refractive surgery. These visual side effects may be halos, double vision (ghosting), loss of contrast sensitivity (foggy vision), starburst and glare (=> images section). As a result of these side effects, there may also occur psychological problems because the patients underwent a surgery that was medically not necessary and voluntarily put the health of their eyes at risk. Because of the high success rate of refractive surgery, the high commercialization and the correspondingly one-sided, euphoric coverage in the media the patients suffering from side effects feel discriminated. The media coverage has become, however, a little more critical by now.

As refractive surgery becomes increasingly popular experts warn that the problems associated with these operation procedures are often underestimated [11].

Moreover, patients often don’t live close to the specialists, which makes it difficult to discuss issues, get psychological consultation and medical care specifically designed for the treatment of symptoms caused by refractive surgery. Lack of the latter, in particular, causes significant costs for the patient who often has to travel long distances to medical institutions specialized in the treatment of the side effects he’s suffering from.

This project is aimed at providing objective information about refractive surgery prior to the operation and offering help after the operation, if the result was not satisfying. We’d like to assist in getting in contact with people sharing a similar experience but also with people and institutions offering help. This concept has already been very successfully realized in the USA by the Vision Surgery Rehab Network.

The situation today

The chart shows the statistic of LASIK surgeries in Germany, Europe, USA with a prognosis to 2009. The analysis of these data leads to the assumption that the number of refractive surgeries will highly increase in the coming years.
Despite the relatively high success rate of such operations, there will always be a residual risk of substandard operation results. This means that the number of patients affected will also rise sharply. By providing objective information prior to the operation (and no advertising event) the "patient" shall be given the possibility to decide whether or not he or she wants to assume the risk. As we observe an information deficit we find it absolutely necessary to provide an information platform. The project aims at setting up the following cooperations:

Cooperation with patients and people affected

Involvement of an increasing number of supporters and affected people in realizing this internet platform or in the association "Operation Auge e.V." and showing possible solutions.

Cooperation with optometrists / contact lens fitters

Today, we know that special spectacle lenses and contact lenses can reduce the so-called visual side effects or even eliminate them in some cases. Optometrists and their associations that can help in this matter are asked to cooperate with us.

Cooperation with refractive surgeons

Responsible surgeons must function as patients’ advocates and use their competence to show the patients safe solutions and future developments. We intend to cooperate with refractive surgeons and their associations on subjects like specialists for postoperative treatments and eliminating the effects of complications, collection of statistics or quality management.

Several members who suffered from complications after IntraLASIK, LASIK, LASEK, PRK, Epi-LASIK consulted different refractive surgeons, trying to find a specialist who could fix their problems. Two excellent refractive surgeons are Prof. Dr. M.C. Knorz from Mannheim, Germany and Prof. Dr. T. Kohnen from Frankfurt/Main, Germany who belong to the "TOP 50 Opinion Leaders" in the world.

Cooperation with ophthalmologists

Ophthalmologists are asked to judge the actions of the refractive surgeons more critically from now on and make themselves more familiar with the issue.

Cooperation with psychologists

When patients observe visual side effects like halos, double vision (ghosting), loss of contrast sensitivity (foggy vision), starburst and glare after a refractive surgery, they often don’t feel taken seriously. This often causes psychological crises requiring professional help. This makes a cooperation with specialized psychologists and their associations vital for us, so that we are able to offer the necessary support.

Cooperation with the media

For the future we hope for a more objective coverage of the benefits and risks of refractive surgery in the media. We believe that the media needs to become more aware of its role in the presentation of refractive surgery. Thus, their coverage on this issue needs to be more properly investigated.

Cooperation with health insurance companies

If complications occur after refractive surgery, costs for health insurance companies can rise. When patients hand in estimates according to GOÄ (scale of medical fees) to the health insurance companies, they should be refered to websites like this one by "Operation Auge e.V."

Cooperation with public institutions

In the interest of the welfare of the general public the national ministries of health should take on a supervisory function regarding the mentioned problems, just like the American Food and Drug Administration (FDA) in the USA. For instance, the laser devices and diagnostic techniques used for refractive surgery need technical control and review.

Cooperation with specialized lawyers

Some patients suffer from such severe complications that they can’t afford to pay for postoperative treatments or the preparation of special contact lenses which may become necessary. In the worst case the visual side effects like halos, double vision (ghosting), loss of contrast sensitivity (foggy vision), starburst and glare after a refractive surgery can be irreparable and incorrectable, leading to restrictions in the professional and private lives of patients. For this reason it may be very important to enforce a claim against the refractive surgeon in charge. That’s why we are determined to improve the cooperation with lawyers and their associations. In this respect there are still numerous legal questions that need to be answered.

[1] Pop M. Photorefractive Keratectomy Versus Laser In Situ Keratomileusis. Ophthalmology 2000;107:251-25

[2] Sekundo W et al. Six-year follow-up of laser in situ keratomileusis for moderate and extreme myopia using a firstgeneration excimer laser and microkeratome. J Cataract Refract Surg 2003;29:1152-1158

[3] Hersh PS, Fry KL. Bishop DS. Incidence and associations of retreatment after LASIK. Ophthalmology. 2003 Apr;110(4):748-54.

[4] Pop M, Payette Y. Risk Factors for Night Vision Complaints after LASIK for Myopia. Ophthalmology 2004;111: 3-10

[6] Tabbara KF, Kotb AA. Risk factors for corneal ectasia after LASIK. Ophthalmology. 2006 Sep;113(9):1618-22.

[7] Rabinowitz YS. Ectasia after laser in situ keratomileusis. Curr Opin Ophthalmol. 2006 Oct;17(5):421-6.

[8] Randleman JB. Post-laser in-situ keratomileusis ectasia: current understanding and future directions. Curr Opin Ophthalmol. 2006 Aug;17(4):406-12.

[9] Klein SR, Epstein RJ, Randleman JB, Stulting RD. Corneal ectasia after laser in situ keratomileusis in patients without apparent preoperative risk factors. Cornea. 2006 May;25(4):388-403.

[11] Alio JL et al. (2000) Journal of Refractive Surgery 16, 523.

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