Laser eye surgery is becoming common practice in Ireland, but patients need to do their homework, and should be wary of bargain- basement clinic prices. Fiona Tyrrellreports
With a massive increase in demand for laser eye surgery, fuelled by SSIA windfalls, and the arrival of business-led clinics offering treatments, the Irish refractive eye surgery sector is undergoing phenomenal changes.
Five years ago there were just four clinics specialising in the field of laser eye surgery; now there are more than 20 centres nationwide, with 11 in Dublin alone. An estimated 30,000 procedures have been carried out in the State and an average of 8,000 procedures are performed ever year nationally.
Technical advances, improved economic circumstances and celebrity endorsements have led to an international boom in the industry. Millions of people have had their lives improved by the treatment.
The Irish refractive eye surgery industry has "mushroomed" recently, primarily thanks to SSIAs, according to Prof Michael O'Keeffe, opthamologist at the Mater Private Hospital.
He says his clinic is 60 per cent busier compared to the same period last year and it seems that a new clinic opens up for business every week somewhere in the country.
This phenomenal growth in the laser eye surgery sector does not come without its problems and a number of established eye surgeons have warned against the growth of so-called business-led clinics offering refractive surgery.
O'Keeffe expresses his displeasure at what he terms the "huge commercial element" creeping into the sector.
He claims that refractive surgery has become the most commercialised sector of medicine and fears that doctors are losing their clinical independence.
Describing the sector as "murky", he insists that if it is not cleaned up, the whole area is "heading down the slippery slope".
Typically, the newer commercial clinics are owned and operated by business people and the doctors are "imported" from the UK to carry out the surgery, often being flown in and out of the country over a 24-hour period, according to O'Keeffe.
Doctors are just employed to do the surgery and both the assessment and follow-up are done by non-doctors, he says.
Aside from concerns about continuity of care at some clinics, such set-ups raise concerns about clinical independence.
If a doctor arrives into a clinic and 15 patients are waiting to undergo a procedure, it's very hard for a doctor to turn around and say some patients are not suitable, he explains.
There is no regulation of the area at all.
"There are doctors coming in who are not even on the specialist medical register and there are questions about whether some are covered by the medical protection society," according to O'Keeffe.
The growth in the industry in the UK has got to the stage where some clinics are describing it as a "walk-in" procedure consultation, with assessment and procedures being carried out on the same day. Many newer clinics in Ireland offer discounted prices through newspaper, magazine and even TV adverts.
Dr Arthur Cummings, consultant ophthalmologist at the Wellington Eye Clinic in Dublin, also expresses concerns about the new direction the sector is taking and warns people against being seduced by glossy adverts and discount prices.
"Big problems" emerge when an elective surgical procedure is "regarded as a commodity", he says.
Many of what he describes as the "discount clinics" offer cheap eye surgery and some make unfounded and misleading claims, he says.
People considering laser eye surgery "need to ask themselves why they are cheaper", he says.
"Is the clinic taking short cuts, does it provide good aftercare and what treatments are on offer?
"If you were going to make your first parachute jump, would you use the cheapest parachute or would you try and find the best one you possibly can?" he asks.
He cites the case of a laser eye surgery patient who returned to a clinic for follow-up care but found the clinic no longer existed.
"If anyone tells you the procedure is risk free, walk out."
While all surgery has risks, Cummings argues that a consultant-provided service can deal with these risks better.
Cummings insists that few people end up paying the advertised discount price. People are enticed by the offer of laser surgery for €900 an eye, but they often end up paying double that.
This practice, known as "bait and switch", involves attracting potential patients with a discount price but, following the assessment (usually free), the patient is told they are suitable, but not for the advertised price, because their refractive error is too large, they have astigmatism or they need to be upgraded to wavefront treatments, he says.
Nevertheless, laser eye surgery is a fantastic procedure that can change you life, according to Cummings.
When choosing a clinic, speak to as many people as possible who have had it done, and try to talk to some who have had it done a number of years previously to assess the continuity of care offered.
Avoid going to clinics that offer only one form of treatment and speak to your own optometrist, who will have a very good idea of what is going on and will often offer guidance.
Go to a clinic which offers proper assessment, with a full eye examination. You should meet the doctor who is going to carry out the procedure before the day of the procedure. You should also have a check up with this doctor the day after the treatment and a year after the procedure.
The clinic should also offer 24-hour emergency cover.