An article in the Sunday Business Post, raises serious issues about the regulatory environment around corrective eye surgery practices.

The Business post says that with thousands of laser and lens replacement surgeries taking place in Ireland every year, not everyone is getting the life-enhancing results they wanted.

A British campaigner Sasha Rodoy who had laser eye surgery in 2011 campaigns for tighter regulation of eye surgery and claims to have been contacted by hundreds of unhappy patients from Ireland who have undergone these procedures, mainly at high street chains.

Sasha runs two websites offering disgruntled patients a platform to tell their stories and to warn others of the risks of undergoing surgery at certain clinics. She has been in contact with thousands of patients in Britain and a growing number from Ireland.

Rodoy – who subsequently settled with the company involved and is, therefore, precluded from speaking publicly about her own experience – began by blogging about her own situation. She was soon inundated with comments from others.

”People are being told that they were just unlucky. If that’s the case, why are there thousands out there in the UK and Ireland? she said. Providers of eye surgery in Ireland include consultants working in private practice in hospitals, independent private clinics and the high street chains. Most of the online ire is directed against high street chains.

The market

One of the main players in Ireland, with a network of five clinics here. The firm has been unhappy over a website which is critical of laser eye surgery, and is one of those run by Rodoy.

According to the Business Post the company recently lost a legal battle in Britain to have the website closed down. Lawyers for the Chain claimed that the critical website was being funded by a rival firm. This was dismissed by the expert panel examining the case, which said that allegations made had been designed to ”impugn the honesty and integrity of Rodoy, who was named as the respondent in the case.

High street chains typically advertise incentives to attract business. They partner with other companies that try to win customers with the chance to win free laser eye surgery, or ”two eyes for the price of one. The advertising is a source of concern to Rodoy, but she said she was more worried about aggressive sales techniques used by clinics. ”The main issue is the hard sell. A number of clinics pay some optometrists and so-called refractive technicians’ a commission based on the number of people they get to go ahead with surgery. Or else they are on target-based salaries, said Rodoy.

The Sunday Business Post obtained a copy of the guide given to staff by one of the Chains.The ten-page confidential document contains sales techniques to be used by sales staff. Suggested actions and behaviours are marked in black. Suggested words and phrases are marked in blue, while their recommended best practice phrases and guidance are in red.

Staff are advised to: Take payment in full (if not possible take deposit – the larger the deposit, the less chance of cancellation). This is all occurring before the patient has seen a surgeon. In another section the manual advises staff to: Use statements like: ”What price can you put on your eyesight?, ”Remember you do this for the rest of your life ie Lifetime investment. Alter the deposit to make the finance options work for the patient. Compare finance payments to monthly, weekly or daily spend. Remind of benefits, ie, if sports player put them in that situation

Recommendations published internationally regarding any elective surgical procedure dictate that informed consent from patients is assured in advance. A cooling off period is recommended between the initial assessment and the decision to proceed with surgery.

One patient in Ireland, who has taken a High Court case against the chain, spoke to The Business Post. ”I have been in constant pain since. Invasive surgery should not be a business. ”I was offered surgery, at a reduced price – but had to avail of it within two weeks, said the patient, who added that ”these sales techniques are okay for window glazing, not surgery. This patient’s legal case is one of 19 that have been taken against the same chain since 2009.

Cases

Dublin-based consultant ophthalmologist Professor Michael O’Keeffe said that a typical surgeon might expect to have one or two cases taken against them over a lifetime. Cases have also been taken against individual surgeons. Doctors must register with the Medical Council in order to practise in Ireland, but EU law means poorly trained surgeons who trained in EU countries with lower standards can register with the Medical Council. O’Keeffe said many of the patients he sees who received laser eye surgery in eye laser chains claimed they were not alerted to the risks, or potential complications, in advance of getting the surgery.

Industry

Complications that can arise from laser eye surgery include severely dry eyes and varying level of pain. Some patients can end up with worse sight, while a complication called corneal ectasia can result in a patient needing a transplanted cornea, or an implant. Similarly, some patients are not regarded as suitable for surgery. For example, many surgeons believe that particularly large pupils pose an increased risk. Rodoy said she has spoken to patients who were accepted for surgery by some chains, yet later found out that they were totally unsuitable candidates. ”I’ve heard from people with rheumatoid arthritis; people with large pupils; people with severe dry eyes; and even people with degenerative eye disorders getting surgery. They should never have been operated on, she said.

O’Keeffe said that clinics, which had started out doing laser eye surgery, were now beginning to do even more radical procedures such as clear lens extraction (see panel).

The Irish College of Ophthalmologists (ICO) – which is the recognised training and professional body for eye doctors in Ireland – said it was concerned that direct patient advertising is ”being increasingly used to promote certain elective surgical procedures, with special offers and little mention of the potential risks.

Mark Cahill, consultant eye surgeon and spokesperson for the ICO, said it had made a number of complaints to the Advertising Standards Authority, but that they had not been upheld. The ICO complained that Ticketmaster, a ticket sales and distribution company, was offering customers the chance to win free laser eye surgery as an incentive to buy tickets for events.

Cahill stressed that the ICO was not questioning the standard of surgical care at some clinics – just the advertising. Earlier this month, the consumer magazine Which? published a report after sending an undercover reporter to a number of big-name high street clinics in Britain.

The report concluded that some clinics were not giving customers ”clear and accurate verbal information about risks. There is a push to better regulate the sector in Britain, although progress is slow. The College of Ophthalmology has invited members of the Oireachtas Health Committee, which is chaired by Fine Gael TD Jerry Buttimer, to a policy meeting on these issues on September 24.