Eye Surgery

How to Stay Focused on Laser Eye Surgery

Depending on who you believe, somewhere between 1.4 million and 1.7 million people on both sides of the border will undergo laser surgery to correct their vision this year. That reflects dramatic price drops for the procedure: The cost now ranges from $1,000 to $2,400 per eye. And it’s also a result of effective marketing tactics by laser eye surgery clinics struggling to hold onto their share of the market, in what’s become one of the most competitive fields in health care. Almost all of these individuals will have the procedure called laser in situ keratomileusis, or Lasik for short.

“The popularity of laser in situ keratomileusis is due to its ‘wow effect’: visual recovery is almost instantaneous and painless,” claimed an editorial in the British Medical Journal last month.

The hard scientific data to back such claims is limited. But what is available supports the word on the street. Lasik has good results and it’s considered acceptably safe. Serious side effects, such as blindness, are extremely rare.

About one in 20 patients will have complications from the surgery, but these rarely lead to significant visual loss. About 1 or 2 per cent of patients experience a debilitating and permanent vision problem, such as double vision, that cannot be corrected by wearing glasses. A recent Venezuelan study found that the proportion of patients experiencing serious pathologic conditions after Lasik — detached or torn retinas, or perforated corneas — is tiny, on the order of 0.06 per cent. And some of these patients could still have good vision if their complications are detected quickly and treated promptly.

“The critical factor,” Ms. Ouellette told me, “was getting a surgeon with a lot of experience.” She’s right about that. A study of Lasik published last year found that the incidence of surgical complications decreased from about 3 per cent during the first 3 months of the study, to less than 1 per cent during the last 9 months. The researchers concluded that complication rates were reduced as the surgical team gained experience.

For this sort of procedure, what you want is a mill: a centre where they operate on hundreds of eyes each week, and thousands of eyes in the course of a year. That’s not hard to find in Montreal, Toronto or Vancouver. Dr. Richard Leger of Montreal’s Laservue eye clinic says that he and his fellow surgeons are doing a few hundred eyes each week. He’s personally done 3,000 cases in the past year.

At TLC Laser Eye Centers in Toronto, Dr. Jeffrey Machat — who operated on Julia Ouellette — has done well over 10,000 eyes. (He’s also done well by his patients: Dr. Machat last year ranked No. 97 on a list of the richest 100 Canadians.)

Even with this wealth of experience, there are unhappy customers. As the number of people having the procedure climbs, the 1 to 2 per cent left disappointed has been adding up. One of these individuals established a Web site where he invites others to tell their stories of woe. Last fall, the press started listening in and reporting what they heard. As a result, says Dr. Leger, “people are shopping around now more, and asking more questions, people are being more careful.”

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