Sight Effects
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 spring.

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 against Teplick.

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 job.”

He says Teplick is the victim of two Portland attorneys, Greg Zeuthen and Larry Baron, who are making an industry out of suing laser surgery practitioners.

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 says.

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 “relatively frequent.”

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 needing help.

“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 results.”

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 dwindling.

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

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