Eye Surgery Ads Scrutinised
The Age
Monday April 13, 1998
The lucrative, and competitive, laser eyesight correction industry in Victoria is about to undergo a shake-up. A code of conduct will be released this week along with an accreditation system aimed at curbing the trivial and often unrealistic advertising of some clinics.
The Royal Australian College of Ophthalmologists is concerned that some advertising is failing to inform patients of the risks of the surgery - as well as leading to overly high expectations that surgery will allow patients to "throw away their glasses forever".
A submission by the college to the Medical Board late last year, warned of "a flood of unlawful, unethical and unprofessional advertisements occurring in Victoria, these advertisements being placed by a relatively small number of ophthalmologists who are blatantly and persistently disregarding the existing liberal rules".
Victorians spend more than $20 million a year on corrective laser surgery for their eyes. But, with each laser machine costing $2 million, and one of the highest ratios of machines per head of population in the world, marketing for patients is aggressive. This week, one Melbourne clinic halved the normal rate of $2000 an eye.
The college's submission was handed to the Australian Consumer and Competition Commission in January, which clamped down on advertising, forcing one clinic to withdraw its statement that in "500,000 treatments there have been no problems".
The commission is meeting with the college this month to discuss further controls.
Mr Sitesh Bhojani, Health Commissioner for the commission, said the commission is "happier rather than happy" with the toning down of eye laser adverstising in Victoria. "We may have to go back and review some of the ads," he said.
The code of conduct will ensure that clinics adequately inform patients of the risks of the surgery. Overseas studies indicate that laser eye surgery carries a measurable risk and, according to Dr Gerald Segal, president of the Australian Medical Association in Victoria, "in very rare cases, you can go blind".
Dr Julian Rait, chairman of the Victorian branch of the college, says that much of the advertising of laser eye surgery trivialises a very complex procedure. "Realistic expectations are not easily achieved through some of the advertising that has appeared . . . some of the advertising could interfere with full informed consent," he said.
"Obviously it's more complex than just 'throw away your glasses' (the slogan of one clinic)."
A review of overseas and Australian data on the complication rate of laser eye surgery by Dr Gerard Sutton, director fo the Sydney Refractive Surgery Centre, found that there is a one in 200 risk of a loss of vision quality following the surgery, a fact that Dr Sutton says "most patients are unaware of".
He adds that there is a "one in 30,000 chance of a disaster occurring during the surgery leading to severe visual reduction", which he says is very low in medical terms. "For the vast majority of patients who are properly selected, the surgery is extremely beneficial, but patients must be made aware of the risks."
Like plastic surgery, laser eye surgery is considered discretionary by Medicare, is not rebatable and does not require a referral from a general practitioner.
Dr Rait said bypassing the referral system meant that patients often chose surgeons on the strength of their advertising rather than on referrals based on their reputation.
Dr Peter Joseph, president of the Royal Australian College of General Practitioners, is concerned that bypassing the family doctor is threatening patient health. "Consumers must make an informed choice. It's not like they are choosing between one shirt and another. With a doctor, the general public is not in a position to adequately know which is the better surgeon," he said. "Nor can they decide whether they, in fact, need surgery or not. That is the role of the general practitioner."
The laws on advertising by the profession were loosened in 1994, with the Victorian Government further liberalising them because it was concerned that lay-owners of medical clinics had an unfair advantage over doctors whose advertising was curtailed by the Medical Practitioners Act. Eye laser clinics in the Australian Capital Territory and New South Wales cannot advertise on television or radio.
Two views
What the advertisements say:
"Its a simple, safe and effective way to free your eyes from glasses and contacts."
"More than 300,000 eyes have been improved by laser surgery and there is not a single reported case of loss of vision due to this process."
"Think for a moment about never wearing glasses or contact lenses again".
What the experts say:
Study of 69 patients found that 25 per cent of eyes had dense scars and required retreatment (after PRK) - Journal of Refractive Surgery
"Scarring and regression are serious complications of excimer laser PRK to correct (severe) myopia" - British Journal of Opthamology 1996
"There is approximately a 1 in 200 chance of a loss of quality of vision ... means the patient's best corrected (with glasses) vision is worse" - Dr Gerald Sutton, researcher into Complications of Lasik Surgery
© 1998 The Age