How safe is laser eye surgery?
By Lisa Baker
On television makeover shows, there are no complications.
You shake hands with the surgeon, sit down for a few quick
and painless laser zaps, toss away your coke-bottle glasses forever. Hug the
surgeon on your way out.
Celebrities do it; star athletes do it. Nobody complains.
And that’s because most people who have laser eye surgery
are happy with their outcomes.
But those who’ve suffered trouble after radial keratotomy,
or laser surgery, say they’ve found themselves part of a growing brotherhood of
misery. Some have suffered massive damage, others side effects so debilitating
that they’ve had to give up driving or step back from successful careers.
Brenda Ross, a Molalla woman who went public with her
botched eye surgery last month, says her support group for those who’ve never
recovered from their surgeries now has about 110 members, 50 from Oregon and 60 from Washington state.
It was her complaint to the Oregon Board of Medical Examiners
that resulted in a 30-day suspension of surgeon Stanley Teplick’s license last
Ross settled a lawsuit against Teplick in 2002 for an
undisclosed sum. He has been the target of four other malpractice lawsuits
filed in Multnomah County—a fifth is pending—and two in Marion County.
But Teplick is not the only laser eye surgeon spending a lot
of time with lawyers. At least seven in Oregon have been the target of legal
action as a result of surgeries that went awry. Some have been named in more
that one lawsuit.
Most of the complaints have a central allegation in common:
that surgeons went ahead with the operations despite clear signs that the
patients didn’t fit safety guidelines.
Ross, whose suit claimed that Teplick simply cut too deep
during surgery, says she will require a cornea transplant to recover the lost
vision in one of her eyes. Another former Teplick patient, Robert Henry, a
shipping and materials manager for Lattice Semiconductor in Hillsboro, required
cornea transplants in both eyes to regain his vision but lost his lawsuit
In fact, Teplick’s representatives point out that while many
lawsuits have been filed, most were either dropped by the plaintiff or lost in
court. Of those filed in the two counties, two have resulted in a settlement,
according to court records. In the meantime, thousands of Oregonians have had
eye surgery, including high-profile Portland personalities who’ve promoted
Teplick. KPAM radio host Bob Miller was one of them.
Miller says it’s been several years since he and his wife
underwent surgery with Teplick and both are thrilled with their results. “I
haven’t had a lick of trouble and neither has she,” he says.
Mark Petrillo, executive director for Teplick Laser Surgery
Centers, says that out of 1,000 cases, “you will have one or two where the
outcome is not perfect…” Some variables, such as individual rate of healing,
are unknowable, making for the inherent risk that exists in all surgery, he says.
“And the fact is, the guidelines that go into things like establishing
candidacy (for eye surgery) have changed over the years. You can look at
patients from the early 1990s and we’ve learned a lot since then. But that’s
the way medicine goes. You learn as you go…it’s an evolving art form.”
When the result of the surgery isn’t what the patient hoped,
Petrillo says, “There’s always an attorney out there to state that we did a bad
He says Teplick is the victim of two Portland attorneys,
Greg Zeuthen and Larry Baron, who are making an industry out of suing laser
Zeuthen and Baron represented plaintiffs in four lawsuits
filed against Teplick in Portland, including Ross. But they say they have filed
a total of 40 laser surgery lawsuits in the past five years—about 20 against seven
northwest doctors, another 20 against doctors as far away as Florida and Alaska.
The two have won settlements in five of eight cases filed in
Portland, plus one in Lane County.
Zeuthen says it’s not a case of simply going out and
drumming up business. He says the growing number of claims is the result of
surgery gone bad, especially those surgeries attempted when the technology was
new or when doctors put profit motive above patient safety.
In the late 1990s, many surgeons had contracts with laser
manufacturers to perform a certain number of procedures per month, with a
portion of the profits going to the manufacturer as lease payments on the
laser, Zeuthen says. It became imperative, he says, to get as many patients
through the door as possible.
Now, although those contracts are no longer in vogue, many
surgeons still opt for a high-volume practice that involves up to three
operations per hour. “I’ve seen doctors who’ve done over 20 a day,” Zeuthen
It leaves little time for meaningful screening,
conversations about possible side effects, and even less time for
post-operative care, he says. And, he believes, it opens the door to error.
Barbara Berney, president of Vision Surgery Rehabilitation
Network, a foundation comprised of former surgical patients who’ve suffered
damage as a result of eye procedures, says patients are told that the failure
rate for eye correction surgery is one to two percent, but that figure fails to
take into account side effects.
And side effects, she says, can be debilitating and
life-long. They include loss of night vision, clouded vision, sensitivity to
light, and eyes so dry they feel—in Berney’s words— “like the top of a blister
being peeled off with every blink.”
She believes many of the effects could be eliminated if
doctors would restrict surgeries to those patients who strictly fit the safety
guidelines—guidelines that define a good candidate as one with mild to moderate
vision problems, normal-size pupils, adequately thick corneas, and no
pre-existing conditions such as dry eye. “When the guy who determines who’s a
good candidate also does the surgery, you have a problem. Basically, if you’ve
got two eyes and a pocketbook, you’re a good candidate,” Berney says.
The American Association of Ophthalmologists (AAO) is also
concerned about lack of adequate screening. In 2002, the organization published
a report spelling out safety guidelines in part because so many surgeries were
being done outside the ideal, AAO spokesman Peter Greene confirmed. The AAO’s
report termed the occurrence of side effects such as loss of night vision as
Robert Tibolt, a Salem ophthalmologist, says he believes
that the surgical system is being corrupted by doctors who’ve opened
“factories,” operating on as many patients as possible. He says patients of
these doctors sometimes end up in his office, suffering pain and injury and
“There are some doctors who put their values aside in the
quest to make money,” Tibolt says. “And it’s a tragedy. They end up doing
things that just should not be done.”
Larry Rich, an ophthalmologist with Oregon Health Science University’s Casey Eye Institute, agrees. He says there are enough people
suffering from eye surgery complications that he devotes one day each week to
their treatment. “Candidacy is where it is—the judgment call—and there are some
physicians who will bend the standards or don’t pay enough attention to the
quality of pre-operative situation to avoid problems. They do patients who
aren’t good candidates, and those are the ones who end up with not great
Rich says it was especially flagrant during the first years
of radial keratotomy, when “buccaneer eye surgeons” would operate routinely
outside of accepted guidelines.
The referral system, in place to ensure that patients who
aren’t good candidates don’t end up under the knife, has been compromised,
according to some ophthalmologists. They say certain co-management agreements,
where laser doctors pay a portion of their surgery profits to referring
optometrists, give optometrists a financial incentive to recommend surgery.
Meanwhile, protections for eye surgery patients are
Most laser surgeons now work outside of hospitals and
therefore can’t be threatened with the loss of hospital privileges, Tibolt
says. Complaints to the state Medical Board are confidential until the board
takes action, which can take a long time. Meanwhile, prospective patients don’t
know the doctor is under suspicion. The same is true for complaints to professional
organizations, he says.
“There are enough loopholes here that a few artful dodgers
can make a lot of trouble.”
BrainstormNW - October 2005