Eye corrective procedure that went very wrong
Myopia is the medical
term for nearsightedness. People with myopia see objects more clearly when they
are close to the eye, whereas distant objects appear blurred or fuzzy. This can
have terrible effects on the lives of people who suffer from myopia. For
example, if wearing glasses won’t help them, then they can’t drive a motor
vehicle or even ride a bicycle. Many can’t even watch TV unless they are up
close to the screen.
To understand myopia,
it is necessary to know how the main parts of the eye's focusing system: the
cornea, the lens, and the retina work. The cornea is a tough, transparent,
dome-shaped tissue that covers the front of the eye (not to be confused with
the white, opaque sclera). The cornea lies in front of the iris (the colored
part of the eye). The lens is a transparent, double-convex structure located
behind the iris. The retina is a thin membrane that lines the rear of the
eyeball. Light-sensitive retinal cells convert incoming light rays into
electrical signals that are sent along the optic nerve to the brain, which then
interprets the images.
In normal eyes,
parallel light rays enter the eye and are bent by the cornea and lens (a
process called refraction) to focus precisely on the retina, providing a crisp,
clear image. In the myopic eye, the focusing power of the cornea (the major
refracting structure of the eye) and the lens is too great with respect to the
length of the eyeball. Light rays are bent too much, and they converge in front
of the retina. This inaccuracy is called a refractive error. In other words, an
over focused fuzzy image is sent to the brain.
Eye care
professionals have debated the role of genetics in the development of myopia
for many years. Some believe that a tendency toward myopia may be inherited,
but the actual disorder results from a combination of environmental and genetic
factors. Environmental factors include working with computer monitors or other
instruments that emit some light (electron microscopes, photographic equipment,
lasers, etc.); emotional stress;
and eye strain.
The diagnosis of
myopia is typically made during the first several years of elementary school
when a teacher notices a child having difficulty seeing the chalkboard,
reading, or concentrating.
People with myopia
have three main options for treatment: eyeglasses, contact lenses, and for
those who meet certain criteria, corrective eye surgery. In this article, I am
going to deal only with corrective eye surgery.
Radial Keratotomy (RK) was introduced into the United States in 1978.
The RK technique consisted of radial corneal incisions made manually with a
blade. It
involved cutting spoke-like incisions to flatten the eye's surface mainly to
correct nearsightedness.
- Fluctuating vision
- Halos around lights
- Under-correction
- Over-correction
- Cornea infections may end up in vision loss
- Scar of the flap incision also may end up in
vision loss
- Light sensitivity
- Poor night vision
RK’s path began with a
Russian-developed experimental technology in the 1970s to widespread adoption
in North America which is now considered an unchecked medical innovation that
most eye doctors ophthalmologists view as reckless. RK is now virtually obsolete as
a primary vision correction procedure for these reasons and because of advances
in laser vision correction procedures. Most experts now agree that the widespread adoption of RK
surgery has led to thousands of permanently damaged corneas, resulting in
ruined careers, limited lifestyles and, in some cases, depression and suicidal
thoughts.
Those who questioned it at
the time were ostracized. A Texas eye
doctor named Dr. John J. Alpar, who publicly questioned the ethics behind his
industry’s widespread adoption of an unregulated, untested procedure, says he
was “hated” by his colleagues at the time. Of course they hated him because his
public concerns would result in the loss of business if the RK procedure was
deemed to be a risk that their patients shouldn’t take. It was a case where
greed trounced common sense.
In a 1985 medical journal
article, Dr. Alpar argued that despite its infancy and the resulting mysterious
long-term outcomes, RK was being promoted by many ophthalmologists in newspaper
and magazine advertisements with claims that at that present time were not
completely justified.
Dr. Alpar said, “It was
never a safe operation. RK patients should never have been subjected to this
unnecessary suffering. I still see patients whose eyes are screwed up
considerably because of RK.”
Going into uncharted medical waters is always uncertain and is made
all the more treacherous with the growing number of potentially risky
procedures taking place in private clinics outside the control and surveillance
of hospital and peer review committees.
But who can the victims of
such procedures turn to? In the aftermath of permanently damaged corneas,
uncorrectable vision, a lost career and subsequent depression, one such victim
in Canada sought help from every medical authority in Ontario he could think
of. Health Canada, in a 2011 written
response to his inquiries, directed him to the province, which is responsible
for the ‘administration and delivery of health-care services.’ The Ministry of Health and Long-Term Care
sent him to the College of Physicians and
Surgeons. His complaints to the college, which is charged with oversight of
the medical profession, had been dismissed, along with those of two other
former RK patients. This is a classic
example of passing the buck.
Brent
Jesperson is a former Toronto dentist who gave up his profession in 2009 due to
failing vision from radial keratotomy procedures he underwent in the early
1990s. He has filed a $12-million lawsuit against his former Toronto ophthalmologist,
Dr. Yair Karas, alleging negligence. In an interview, Karas said he would
address the allegations in court. He says that he’s performed radial keratotomy, or RK, on 10,000
patients including police officers, firefighters, pilots, judges and clergy
during his 36-year career and that he has “no regrets” about performing
RK on thousands of patients during his 36-year career. Of course he would say
that. He is being sued by Jesperson for his negligence.
Despite
the doctor’s bravado, Jesperson isn’t the only patient that this doctor had who
has claimed that he too has suffered from the doctor’s RK procedure.
Gilbert
Roy a 25-year-old worker in a steel fabrication shop, liked the nightlife and
bars and hated his thick, ungainly glasses. In 1993, when
he heard about the promise of RK, he ignored the warnings from his optometrist
not to risk the relatively new procedure and went to see Dr. Yair Karas the
doctor who recently said, “I have no regrets about performing RK on thousands
of patients during my 36-year career.” He certainly will have a great deal of
regrets if many of them go after him with a class action suit foe many millions
of dollars.
When Roy first saw Dr. Karas, he
expressed some concern about the RK procedure.
The doctor said in return, “You are the perfect candidate for RK.” Well
he certainly was a perfect candidate for the doctor.
Soon
after surgery on both his eyes, Roy complained to the doctor that he could not
see well outside in the dark or indoors with poor lighting. The doctor then
told him, “It is temporary. It will be fine. Don’t worry. You trusted me when I cut your eyes. Just
trust me. Your eyes are going to get better."
Guess what. They didn’t get better.
They got worse. He
now pops three Tylenols a day to get through the pain and discomfort in his
eyes and while working in poor light at the industrial plant. He eventually had
to quit his job.
A
doctor who gives reassurance to a patient who has second thoughts about a risky
procedure that was undertaken, a procedure that was condemned by fellow doctors
is not unlike the spider that is about to pounce on the fly trapped in its web
when it says to its victim, “Trust me. You will be fine. Don’t worry. You
trusted me when you ventured into my web.” We all know what happens to flies
when they venture into a spider’s web.
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