Anthony Browne, health editor
Sunday June 4, 2000
The Observer

A top doctor has warned that up to a million people are at risk of disintegrating eyeballs after 'miracle' laser surgery for short sight. Richard Branson and Friends star Courtney Cox are among those who have had this increasingly popular treatment for vision defects.

John Marshall, professor of ophthalmology at St Thomas's Hospital and the UK's top expert on the Lasik technique, said there is growing evidence of long-term damage. He believes it can lead to the cornea being so eroded that it starts bulging, and that parts of the cornea may even become dislodged.

The operation enables those with defects to manage without contact lenses or spectacles. However, according to Marshall, they could end up needing their entire cornea transplanted.

'There have been a number of reports of erosion of tissue, with people having to have their corneas transplanted,' said Marshall, who would not risk the technique himself. He is to publish his warning in a science journal.

Use of Lasik has exploded in recent years after heavy promotion by private eye clinics who offer it as a painless, instant cure for short sightedness. Commercial pressures saw the technique rapidly authorised in the US, though almost nothing is known of its long-term effects.

More than a million Americans have had the operation. Britain's largest private eye surgery group Optimax has performed it 3,000 times in the last 18 months.

'We are very concerned about the massive numbers of people taking Lasik with no follow-up,' said Marshall. The technique, which costs 750 per eye, and is not available on the NHS, takes minutes, is virtually pain-free, and leads to an immediate improvement in eye sight. It uses an expensive computer-controlled machine, which carves out the eye with a laser. When Branson had it done he was back at work the next day.

The old technique - called PRK - caused considerable pain; eyesight remained blurred for weeks. But that technique, tested for 10 years before being authorised, has been proved by countless studies to be safe in the long term.

Lasik involves cutting through the 'fibrils' that hold the cornea together, which never regrow. It also involves scraping off a third or more off the thickness of the cornea. 'If someone cut through a third of the radial wires on your car tyre and replaced them with rubber solution, would you drive on that?' said Marshall. 'There is a possibility that a blow to the eye could dislodge a flap of the cornea. If you got punched in the eye or were playing rugby, who would know what could happen?'.

Even though the technique is brand new, Marshall has so found three cases where patients had to have cornea transplants because they disintegrated after the operation. Patients are rarely warned about the risks. When The Observer phoned Optimax posing as a patient, a consultant said: 'All the research shows it's a safe treatment, a proven treatment.'

Dr Manek Patel, of Optimax, who does Lasik operations, said: 'I can't see any danger. Throughout the world, people are switching to this operation because it is quick, relatively painless and has reliable results.' He predicted that by 2005, Britain would match the US, where 90 per cent of such eye surgery is Lasik.

However, he admitted: 'Nobody knows what the effects after 10 years are. But how would patients wait 10 years for it? Are we supposed to do 10 patients and wait 10 years? Science doesn't work like that.'

Armies around the world have used such surgery to improve the sight of key personnel. But the Australian army has not used Lasik, concerned that soldiers' eyes might be damaged.

David Gartry, a consultant eye surgeon at Moorfields Hospital, who helped draw up the Lasik guidelines for the Royal College of Ophthalmologists, said: 'If you stick to the guidelines there shouldn't be a problem.' However, he confessed: 'No one can say with certainty that 50 years from now, there will not be some sort of problem.'

He also said it was 'almost certain' that surgeons in Britain were going beyond guidelines, taking away between a half and two-thirds of the cornea in patients with extreme short sight. 'That's totally unwarranted. If it's thin, like a balloon, the pressure from behind will make the cornea bulge out and distort the image' he said. 'It's not using it the way it is meant to be used.'

Copyright Guardian Media Group plc. 2000