22 November 2008
Patients not warned of all laser eye surgery risks
1 June 2007
By Angela Norton: Te Waha Nui Online
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| Dorothy Simpson has to apply eye drops regularly to treat the dryness. |
A woman who suffers from severe “dry eye” after undergoing laser surgery is urging other patients to ensure they know the procedure’s possible complications and side effects.
Since having a $5000 operation in 2004, Ruawai resident Dorothy Simpson’s short-sightedness has been corrected, but she now suffers from sore and inflamed eyes.
She says it often feels like she has a foreign object in her eye, her night vision has become blurry and she has difficulty keeping her eyes open.
Dry eye happens when the eye’s natural ability to produce tears is reduced or lost. While it is rarely sight-threatening, it can be very uncomfortable.
Simpson says her eyes felt normal before the laser surgery, more commonly known in New Zealand as Lasik.
She now needs gel-like eye drops and wrap-around glasses to provide relief. Although she knew she would still need reading glasses, she didn’t think she would end up with another pair to combat dry eye.
“If you have to wear wrap-around glasses, you’re back to where you were before the operation,” she says.
Simpson says despite all the Lasik success stories, patients need to pay close attention to complications and side effects.
“You only get one set of eyes and I think it’s not a decision to be taken lightly.”
Dry eyes inevitable
Auckland Eye Institute dry eye specialist Dr Trevor Gray, who does Lasik procedures but did not perform Simpson’s surgery, says he tells all Lasik patients they will have dry eyes to some extent following surgery.
“Everyone’s eyes are slightly drier after the laser treatment because of the way the nerves are cut,” he says.
“The vast majority, 95 per cent, will settle down within three months, wean off the drops and then be happy. Only a minority will develop ongoing issues.”
He says some patients are more susceptible to dry eye following Lasik, including older people, females, those taking certain medications such as birth control pills and anti-depressants, and those undergoing hormone replacement therapy.
Simpson says she was not warned of her increased risk, which existed because of her age, gender and post-menopausal state.
Dr Gray says he definitely warns patients of these risks in pre-surgery consultations.
His colleague, Dr Peter Ring, performed Simpson’s surgery.
He says if she came to him for Lasik today with the same pre-existing circumstances, he would still not give her specific warning for chronic dry eye risk because he believes her results to be unique.
Simpson says she is surprised dry eye is not properly tested for before the operation.
Dr Gray says dry eye is not routinely checked because the tests have proved to be unpredictable in identifying people with a significant problem.
“You can do [the tests] but most people regard them as so variable they have little role,” he says.
Simpson says: “People think [my situation] is a one-off occurrence, but there are many others with the same problem.”
Dr Gray says five to 10 per cent of his own Lasik patients require extra dry eye prescriptions following surgery.
“I’ve seen patients who haven’t had any surgery and come up with the exact same symptoms as Dorothy, so it’s not necessarily the laser that has caused this, although time-wise there’s obviously a link between the two,” he says.
Lasik successful for most
Simpson is aware Lasik and similar procedures are successful for most people.
When considering the surgery, she consulted several of the Eye Institute’s previous patients, including close family, who gave it good reviews.
She was given a consent form with a brief overview of possible complications, including dry eye, which she read prior to signing.
A week after surgery, Simpson had already begun to have sight problems. She used more eye drops because her vision was intermittently distorted and foggy.
Punctal plugs were inserted into her lower tear ducts in an attempt to conserve tears, but the condition has continued, with little hope for remedy.
During Lasik, a small flap is cut in the eye’s cornea and raised. The cornea is then reshaped to correct the vision problem, and the flap replaced.
Lasik patients get dry eye because the severed corneal nerves take time to regenerate.
Improvements in surgery technology
At the time of Simpson’s surgery in 2004, the corneal flap was cut with a blade. The newer Intralase method of Lasik uses small pulses of light to cut the flap instead.
Dr Gray says: “Certainly over the last three to four years, since Dorothy had her surgery, there have been significant improvements in technology and treatment.”
Intralase, the only method used at the Eye Institute today, reduces the risk of dry eye, but does not eliminate it.
