A leading hospital-based eye surgeon has slammed the practices of some private companies providing eye laser surgery in Ireland.
Mr Michael O’Keeffe, consultant at the Mater and Temple Street Hospitals in Dublin, claims some of these clinics operate on the basis of "stack 'em high and sell’ em cheap" and are selling what is a complex and sometimes hazardous procedure as if they were selling “cans of beans or handbags.”
He also expressed concern about the level of follow-up care offered by the commercial clinics.
However, one of the major commercial eye laser surgery clinics has totally rejected Mr O'Keeffe's claims. Dr Steve Schallhorn, Chief Medical Director of Optical Express, which has four clinics in Ireland, stressed that it would not be in their business or medical interests not to try to do everything right and offer the best results and highest quality of care.
He told irishhealth.com that their results would compare very well to those of any hospital eye surgery department and defended the company's marketing practices and follow-up care.
Mr O’Keeffe was one of the first consultants to perform laser surgery in Ireland in the early 1990s. He says this type of surgery has since exploded and there are now a number of private companies providing this service.
“Eighty-five per cent of this type of surgery is now done in commercial clinics. The problem in laser surgery now is that it has gone out of the hands of ophthalmologists and is in the hands of commercial interests,” Mr O’Keeffe told irishhealth.com
“These clinics usually hire in doctors to do the surgery. The doctors often come in, do the job and then go. Sometimes, the clinics do get the doctors to come back to see the patients for follow-up but they generally do not provide proper follow-up for these patients.”
Mr O’Keeffe says advertising from these clinics creates the illusion that eye laser surgery is totally complication-free and that it is always going to be absolutely perfect, and this can never always
be the case with a surgical procedure. "Patient expectations are being put through the roof by these clinics.”
Mr O’Keeffe says while competition is a good thing, he feels it has now got to the point where eye laser surgery has now bypassed the ophthalmologist in a hospital and “in my view it is now in the wrong hands.”
“Maybe I’m a dinosaur but I believe the patient should be seen initially by a specialist, treated by a specialist and the same specialist and nobody else should do your follow-up care.”
Mr O'Keeffe is critical of what he sees as the practice of offering "cut-price" rates for eye laser surgery.
“You should offer the best procedure needed for a particular patient and if that procedure costs €1,500 or €2,000 or more then that is the procedure you should offer. Patients should not be paying less money if the real procedure they need is more expensive.”
Mr O’Keeffe says patients attending commercial clinics should insist that they are seeing a doctor for their examination and that the doctor they might initially see is the one who will be doing the surgery. They should insist that they are seeing qualified ophthalmic surgeons for follow-up.
“They should insist on getting the best procedure they need and object to paying less money for an inferior procedure. We are talking about a patient’s eyes here, not a can of beans or a handbag.”
Mr O’Keefe says as these clinics are run on business principles “The only reason they may be cheaper is that they can use cheaper labour and they can cut down on things like follow-up visits. “They tend to work on a volume basis – "stack ’em high and sell ’em cheap.”
He claims he has no vested interest and is not trying to “protect his patch.”
“I have a good practice. I have been doing laser surgery for years and I have plenty of work. I am not worried about these clinics taking patients away from me.”
Dr Schallhorn rejected Mr O'Keeffe's claim about eye surgeons being "hired in" to do laser surgery. "In our case, the vast majority of procedures are performed by resident fully-qualified ophthalmic surgeons."
He said that while surgeons who do the procedures can provide the follow-up care, the bulk of the this care is provided by trained optometrists who are in communication with the surgeons, and IT had an important role to play here. Optical Express believes this to be the most appropriate way of following-up patients, he said
Dr Schallhorn rejected Mr O'Keeffe's assertion that having a doctor providing all the care is the best model. "I think it is a self-serving notion that a doctor should provide it all - an optometrist can deliver excellent follow-up care."
He said he believed Mr O'Keeffe's view is narrow-minded and did not take account of the benefits of multidisiplinary care, nor did it take account of the need to provide proper access to refractive surgery for all who needed it.
Dr Schallhorn rejected Mr O'Keeffe's comments about marketing practices whereby cheaper and inappropriate procedures may be offered.
"We do not perform any procedures that would be inappropriate for the patient. Why would we? That would not be in our business or medical interests."
He did not see anything wrong with clinics being run as commercial businesses. "That is what it is. We have to make a living. Mr O'Keeffe is in business as well. Presumably he does not carry out procedures for free."
He said contrary to what Mr O'Keeffe had asserted, a rigorous informed consent procedure is adopted and patients are fully informed about any possible adverse outcomes.
Dr Schallhorn said Optical Express clinics are run to the highest possible standards. They have an international medical advisory board of eminent doctors who oversee clinical governance of the clinics, and a rigorous quality improvement system examines outcomes.
He said patient feedback was also used as part of the quality improvement process.
I agree. I got laser surgery done over 10 years ago in the USA and was very happy with the results. It was a commercial clinic but I saw the surgeon for before and after care. Of the approximately 10 people i know who did it, two required extensive follow-up care, including a second operation, so it is vital to have a doctor over-seeing it.
I had laser surgery performed in one of these clinics and it was a total success and the aftercare was excellent. I know a number of people who also had this surgery performed by the same doctor and they had no problems.
I have three daughters who have had laser eye surgery, all of which were very successful. When I finally decided to have laser eye surgery recently, I contacted one of these clinics. When I phoned, the person who took my call asked me several questions to check if I would be a suitable canditate. Unfortunately my age was against me, so I was very disappointed. As I see it, this clinic could easily have had me come in to check me out, which would have wasted my and their time.
Approximately three, perhaps four years ago I attended a Dublin hospital where I was seen to by a consultant. I was told I had a leak at the back of my right eye, but that nothing needed to be done at the time and to make a further appointment for six months later. I never did see the consultant again, but was seen on two more occasions by somebody else. Since then every six monthly appointment was cancelled, until finally they didn't even bother to contact me any longer. Having had so many cancelations over the last few years and being aware that my eyesight has deteriorated, I have now decided to go to a private hospital to have my eyes seen to and I have an appointment for late May. At least I will be seen to properly ( hopefully) I don't have much in the way of cash, but my eyesight means so much more to me than money ever could.
Mr O'Keefe sounds like he is trying to keep the health system like it was - years of waiting and bureaucracy where a tiny few eventually get seen at great expence and the majority suffer on frustrated. People are voting with their feet. I personally know many who have been much happier to have their laser surgery done in a busnesslike way outside the most unbusinesslike hospital system.
I agree with this article. For such surgery I would prefer to attend a fully equipped private hosptal with experienced surgeons who would perform the right surgery for me instead of a 'one-size-fits-all' commercial clinic.
Of course. After all it's competition isnt it? Perhaps that is exactly what this country needs for ALL healthcare. A kick up the proverbial.
Stormin: "Mr O'Keefe sounds like he is trying to keep the health system like it was".
Why oh why would one of the top doctors in the country want a rubbish health care system?
O'Keefe always stresses the dangers of eye surgery and the complications it can cause, that's it. He has no vested interest, he's not going to be out of a job if the health service gets better or worse. He has the task of fixing messed up jobs from private clinics, a member of my family is in this situation at the moment.
Michael O’Keefe is absolutely correct on a number of points: The industry is not regulated and there is therefore a danger that some of these commercial clinics are business driven and cutting corners as well as eyes so to speak…. For example, it is essential that a qualified Ophthalmic Surgeon (on the Specialist register of the Irish Medical Council) is available for both pre-op and post-op care. However, I don’t think it is fair of him to tar all of the clinics with the same brush. For too long, the hospital clinics had a monopoly business and could charge what they wanted for laser eye surgery. Competition is good for the consumer and now means they can pay up to 1,500 euro less for surgery elsewhere.
My family is indebted to the skill and integrity of Michael O'Keeffe. We have many years experience of the man as both public and private patients.
I have 100% confidence in the integrity of the man.
I referred a friend to him who had an astigmatism. The friend attended a commercial laser eye clinic and was told that they could have the procedure done. With all the same information Mr. O'Keeffe advised that the risks out weighed the potential benefits. This did not come down to money it was simply advise from a man whose sole interest is what is in the best interest of the patient.
Michael O'Keeffe is an internationally respected ophthalmologist. I hope no reader needs to ever call upon him for his expert advice but if you do there is no other person I could recommend and I researched the options both domestically and internationally.
My doctor had the audacity to claim I had a good result from eye laser surgery. I had LASIK over 4 years ago and am still suffering hugely with dry eyes and a posterior vitreous detachment in my left eye.
I see many posters are taken in by the word 'competition'. This is a word beloved of cost-cutting fly-by- nights. You can have competition between sellers of tins of beans or corn flakes. It is very naive to think that competition works to a patients advantage where health care is concerned.