BOA chalks guidelines, post Lasik surgery controversy
Rita Dutta - Mumbai

Patients to undergo screening tests and informed about complications

In the wake of the debate surrounding Laser In Situ Keratomileusis (LASIK) surgery, the Bombay Ophthalmic Association (BOA), comprising around 700 ophthalmologists, has drafted guidelines in the interests of patients and ophthalmologists performing Lasik surgery.

Lasik surgery is in the eye of a storm after R B Vajpayee, Professor of ophthalmology at the Rajendra Prasad Centre, stated that Lasik is inappropriate for Indians as their cornea was found smaller than that of the western population.

The guidelines suggests that the doctors make patients undergo a ’screening test’ before deeming them fit for Lasik surgery. The screening involves a pachymetry test to check the thickness of the cornea and topography test used to measure its curvature. Suggestions have also been made not to perform Lasik if the topography detects kerotoconus and thickness of the cornea is below 520 micron.

Says Dr Nagesh Athanikar, president, BOA, “Lasik is a technological advance procedure patronised by refractive surgeons the world over. However, Lasik is a double edged sword, which, if used properly, can produce excellent result, and, if misused, can lead to extremely unhappy patients.” There are around 1,000 ophthalmologists practicing in Mumbai out of which not more than 40 conduct Lasik surgery in 15 different centres. The guidelines suggest that surgery should be under taken after 18 years of age as the power is not stable till that age and the patient should be off contact lenses prior to Lasik surgery as the patient might be suffering from keratoconus or corneal opacity.

Caution is advised for females who are pregnant and breast-feeding and patients with moderate to severe dry eyes. For the proper selection of patient the refractive surgeon is asked to perform accurate refraction of the patients’ eye and a thorough slit-lamp examination to rule out lenticular changes and a detailed retinal examination to exclude degenerative changes.

The guidelines also asks the doctor to inform the patient prior to the surgery about the possible risks of having halo, glares, dry eye and night vision after the surgery.

“For two months following the surgery, all patients complain about the dry eye as the corneal nerve that is cut takes time to recover. Patients also complain about halo, glares and night vision mainly during driving,” says Dr Nikhil Gokhale, corneal specialist and member of BOA.

The guidelines suggest doctors to refrain from giving false promises to patients. “Lasik is no magic and doctors should tell the patients that they might have to do another surgery for some residual error and they even might have to wear glasses after the surgery,” says Dr Athanikar.

“BOA is not vested with power to take action against doctor not abiding by these rules, however it would definitely fight for the doctor if any complications happen in spite of following these guidelines,” promises Dr Athanikar.