A Pain in the Eye That's Forever 

Lasik and its failures

Page 3 of 7

This statement is surprisingly deceptive, coming from a university-backed facility. In fact, LASIK does weaken the eye. First, the surgeon slices a thin flap across the eye's center with a disposable blade. Then, while the flap is folded away, the doctor reshapes the eye with a laser. (Treating nearsightedness, for example, involves flattening the curve of the cornea.) Afterward, the flap is smoothed back, the eye is bandaged, and the healing begins. But the eye is unquestionably weaker, and that's why contact sports are off-limits for LASIK patients and why Clarke Newman, a fellow of the American Academy of Optometry, says it's still a matter of debate whether eyes ever fully heal.

Asked to comment on this apparent deception, Dr. Maziar Haririfar, the optometrist who runs the Refractive Surgery Center, asserted via e-mail that the statement was intended as a comparison only. In other words, LASIK does indeed weaken the eye, but less than radial keratotomy (RK), the type of vision- correction surgery it replaced.

Consumers seeking a more candid and detailed assessment of the risks of LASIK might just as reasonably visit EyeSurgeryEducation.com -- a credible- looking Web site provided by the Eye Surgery Education Council. Its link to "LASIK Surgery Screening Guidelines for Patients" seems to provide a scientifically rigorous discussion of who may and may not undergo LASIK. Yet certain risk factors covered by the FDA's guidelines, such as pupil size, go completely unmentioned here.

While the council's site downplays the problems associated with LASIK, privately its backers struggle for solutions. Two weeks ago in San Francisco, members of the American Society of Cataract and Refractive Surgeons, the sponsors of the council, spent four days attending symposia, research presentations, and courses devoted to handling a multitude of post-LASIK "complications" and "nightmares."

The Eye Surgery Education Council launched the ESEC site and guidelines in the spring of 2002, at a time when LASIK sales were lagging. Thus the guidelines would appear to have a dual purpose: to inform consumers but also quell fears and attract new business.

Dr. Doyle Stulting, guidelines coauthor and chairman of the society's Refractive Surgery Clinical Committee, suggested that nonexperts have no business questioning the guidelines. Besides, he said, the news media is prone to overemphasizing the importance of pupil size. "There are many other parameters that are probably more important in determining who will have a good outcome," he said. "If we were to mention everything that has to be done in an exam, we would have to write a hundred-page book." Stulting acknowledged, however, that pupil measurements are always considered at his own office.

Consumers who have considered all the risk factors and still decide to proceed with refractive surgery will want to find a good surgeon. Looking for a doctor certified by a reputable professional organization is one way to make such a choice. Respected medical organizations typically confer these titles to indicate a certain degree of professional mastery.

Take for example Dr. James J. Salz in Los Angeles, who literally wrote the textbook on laser eye surgery. He is a researcher and laser industry consultant, and has been an expert witness for plaintiffs in LASIK malpractice cases. In his own practice, he has a reputation for telling patients they're not good candidates for the surgery even when other surgeons insist that they are. Salz is certified by the American Board of Ophthalmology, a form of accreditation that is not for slouches.

Another organization, the American Board of Eye Surgeons, has a certification process that requires lengthy clinical reviews. Its process is so rigorous that so far the board has certified only five LASIK surgeons in the entire state of California.

Then consider Dr. Glenn Kawesch, an eye surgeon who practices LASIK in Southern California. Kawesch clearly excels at marketing. His slick multimedia Web site features an impressive array of endorsements from a virtual Who's Who of celebrity San Diego. The site's "Meet the Doctor" page proudly displays a logo that reads "CRSQA Certified," implying endorsement by the Council for Refractive Surgery Quality Assurance.

In fact, contrary to this marketing claim, Kawesch is no longer certified by the council. Citing confidentiality concerns, CRSQA officials would not give a reason for the doctor's decertification. Court records, however, may provide an inkling. Over the last five years, 26 malpractice and fraud lawsuits were filed against Kawesch in the San Diego courts. Patient after patient contended that they were lured into LASIK by Kawesch and his staff, only to find out afterward that they weren't good candidates. One patient, Richard Jacobs, complained of never being told his cataracts could cause trouble. Dean Nathans, meanwhile, blamed the doctor for causing night blindness, poorer vision, and reliance on hard contact lenses. Ernie Vaca said the doctor's staff identified a corneal warping disease called keratoconus but assured him it was okay to proceed with surgery anyway, without mentioning that the FDA explicitly warns against LASIK for people with that condition. The list goes on and on.

On June 4, 2002, the office of California Attorney General Bill Lockyer petitioned for an interim suspension order against Kawesch, charging that he posed an imminent public danger. Medical Board of California spokeswoman Candis Cohen said the petition was denied by an administrative law judge, but the case is not yet closed: An accusation hearing is set for June 30 of this year.

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