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Sunday, February 10, 2002 - Page updated at 12:00 AM

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Lasik and the risks: Lawsuits shed light on dangers

Los Angeles Times

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Lasik (Laser In-Situ Keratomileusis)
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Sandy Keller had simply wanted to correct her nearsightedness and stop wearing contact lenses when she had laser eye surgery in September 1999. Instead, she ended up suing her surgeon and optometrist, claiming a botched surgery left her with damage so severe she may eventually need corneal transplants.

The case was settled for $260,000 last fall. "But no amount of money is going to fix this," says the 42-year-old Torrance, Calif., woman, who uses an arsenal of medications in her eyes just to get through the day.

Lasik trouble


More than 4.5 million Americans have had Lasik surgery since 1996 (it's now the most common elective surgery).
::

Patients who have serious complications: 0.5 to 1.5 percent.

:: Patients who need a second surgery to get their vision closer to 20/20: 5 to 15 percent.
:: Patients whose best corrected vision with glasses or contact lenses is worse than before the surgery: up to 5 percent.
Sources: Food and Drug Administration; Market Scope newsletter.

Patients unhappy with the results of Lasik surgery are suing doctors and clinics, complaining the procedure actually worsened their vision and, in the most extreme cases, left them legally blind.

The settlements are encouraging attorneys to pursue additional cases, even as they shed light on the procedure's risks. Five recent lawsuits generated judgments in the million-dollar range, and at least 200 other cases are in the pipeline, according to Washington, D.C., attorney Aaron Levine, chairman of the American Trial Lawyers Association's Lasik litigation group.

A Buffalo, N.Y., man, for instance, won a $1.2 million verdict against the doctor and center where he had Lasik surgery after his eye was cut so badly that he is virtually blind without corrective lenses. A Kentucky jury awarded a 38-year-old woman a record $1.7 million after four laser surgeries left her legally blind in her left eye.

$2.4 billion-a-year industry

Lasik, now the most common elective surgery in the United States, is a $2.4 billion-a-year industry, according to Market Scope, a St. Louis-based newsletter that tracks the eye-surgery business. More than 4.5 million Americans have had their vision corrected with lasers since 1996.

Several factors have fueled the upswing in lawsuits. First, there's always a time lag between when a procedure becomes popular and when problems emerge. Lasik, for example, didn't become widely available until the late '90s.

Lawyers were reluctant to take cases because they weren't knowledgeable about the surgery and because it's difficult to prove damages when there is no objective test to verify a patient's complaints. "How do you prove your vision's worse or you're getting spots in your eyes?" says Paul Martinek, editor of Lawyers Weekly USA.

It also takes time for these claims to move through the legal system. Recent judgments have shown these cases are winnable.

But the lawsuits come at a time when the complication rate is going down, doctors and industry observers say.

The tools used to perform Lasik have been improved, doctors have become more experienced, and they're better at identifying which patients don't do well. People with thin corneal tissue, dry eyes, misshapen eyeballs (astigmatism) or pupils that are large when dilated, for example, are not good Lasik candidates.

Risk often downplayed

From 5 to 15 percent of Lasik patients need a second surgery to get their vision closer to 20/20, and up to 5 percent of patients find that their best corrected vision with glasses or contact lenses is worse than before the surgery, according to the Food and Drug Administration.

Serious complications, which include chronically dry eyes, loss of night vision, seeing double images or halos, fluctuating vision, severe headaches, an inability to distinguish objects in dim light and sensitivity to intense glare, range from 0.5 to 1.5 percent. With more than 1 million people having this done each year, that translates to 5,000 to 15,000 people annually.

"The number of people with long-standing complications could populate a small city," says Ron Link, a former firefighter whose eyes were damaged by laser surgery and who operates a Web site (www.surgicaleyes.org) for people with Lasik complications.

"These people often have to radically alter their lifestyles. Anything a person in civilized society takes for granted, like going to the movies, candlelight dinners, even just driving to the grocery store, can be impossible to do."

Lasik, which is a two-step procedure, takes about 10 minutes to perform and can be done in a doctor's office under local anesthesia. First, a thin flap on the outer layer of the cornea is peeled back. A laser is used to make an incision in the cornea. Cutting the cornea changes its shape. And the shape of the cornea determines where light hits the retina, the light-sensing cells in the back of the eye that control how the eye sees.

Generally, mistakes fall into three groups: errors in programming the laser, which can result in overcorrection or astigmatism; performing surgery on poor candidates; and failure or delay in diagnosing postoperative complications.

Unfortunately, says attorney Levine, "people are led to believe this is no more complicated than getting a tooth pulled."

Glenn Hagele, executive director of the Council for Refractive Surgery Quality Assurance, a consumer watchdog group in Sacramento, says consumers need to be cautious and informed.

"This procedure offers convenience, but there is some level of risk," he says. "People need to be aware of the possible consequences before they consent to go under the knife."

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