by Ellen Dean Wilson Correspondent

Advertisements that credit a laser in-situ keratomileusis surgeon with a certain number of cases or promise a rate of visual acuity are ruining the industry, refractive pioneers say. And for the hapless patient, some ads are so misleading that they can cause the selection of the wrong doctor or procedure.

 

Daniel S. Durrie, MD, a member of the American Academy of Ophthalmology Executive Committee for Refractive Surgery, said ophthalmology organizations or the Federal Trade Commission should review certain types of LASIK ads.

 

He wondered why ads for medicines must have “a whole page of disclaimers,” but LASIK surgeons and centers are not required to. Patients are often not warned of possible results, such as halos at night, said Durrie, associate clinical professor, University of Kansas, Kansas City, who is in private practice at Hunkeler Eye Centers, Overland Park.

 

Stephen P. Ginsberg, MD, in private practice at Kensington Eye Center, Kensington, Md., said that the number of procedures is “kind of a Catch-22,” because better surgeons tend to take tougher cases.

 

Some center ads give statistics for all its surgeons together, including inexperienced ones, and some ads even list surgeons who do not practice in that area, he said. “Everyone is trying to out-experience the others,” he said.

 

“Anyone can claim they’re an expert,” said I. Howard Fine, MD, clinical associate professor, Oregon Health Sciences University, Portland, in private practice at Oregon Eye Associates, Eugene. “They can take a course, then claim they’re a LASIK expert.”

 

Paul Weber, risk manager at Ophthalmic Mutual Insurance Co., the AAO’s insurance plan, said he hasn’t heard of any legal cases focused on advertising. His organization reviews members’ ads before they are published, he said.

 

“Everyone claims he or she has done 10,000 cases, everyone has done it first, and everyone is the best,” said Frederic B. Kremer, MD, director of the Kremer Laser Eye Center, King of Prussia, Pa. “By ophthalmologists letting this get out of hand, it undermines the whole profession.”

 

Kremer takes action when he sees ads he thinks are misleading — he calls the surgeons or has an attorney contact them. “It usually works,” he said.

 

What spectacle wearer could resist a recent Laser Vision Institute ad? “98.7% of Dr. Tanchel’s patients enjoy 20/20 vision or better!” it says. Nancy A. Tanchel, MD, of Vienna, Va., told EyeWorld that that figure came from a survey of patients in the past several months. Although she agrees that her recent results have been excellent, she said, the survey for company officers “was not meant for publication.” It had not been analyzed and checked as she would have done for a formal study.

 

She said that she has no control over ad copy. “The people who write the ads are not medical,” said Tanchel, an assistant clinical instructor at University of South Florida.

 

She said that the percentage could be misleading to, for example, a –15–D patient who is less likely to reach 20/20.

 

Steve A. Arshinoff, MD, lecturer, University of Toronto, has had similar experiences. “I’m often arguing with the manager of my center,” he said. “The companies don’t like to deal with ethics, just cash flow.”

 

Arshinoff, who often sees post-LASIK problems, said most LASIK ads are “intentionally deceiving. The more the centers are run by management companies, the more deceptive the ads,” he said. “They sold hamburgers last week.”

 

Francis W. Price, MD, clinical instructor, Indiana University, Indianapolis, who is in private practice with Corneal Consultants of Indiana, Fort Wayne, said advertising that lists surgeons who actually work in another part of the country should be illegal. “One retinal guy in town says he’s done thousands of laser procedures,” but the procedures were not LASIK, he said.

 

“It’s a shame. I’ll lay it all on the government and the lawyers. They gave doctors the right to advertise,” Price said. He said that low-price LASIK advertisements do not explain that an inexperienced surgeon is often the only one who will work this cheaply, he said.

 

“They’re often comparing apples and oranges,” said Peter S. Hersh, MD, director of the Cornea and Laser Eye Institute at Hackensack University Medical Center and an ophthalmology professor at New Jersey Medical School.

 

“I don’t think the ‘20/20 or better’ or ‘20/40 or better’ are useful, because there’s no basis upon which they’re vetted,” said Hersh, of Teaneck, N.J.

 

Joe Krupa, corporate communications director at Icon Laser Eye Centers, said his firm does not use physicians in advertising. Instead, it tries to interest potential patients and get them to call its toll-free number, staffed by 80 well-trained workers.

 

He said that some patients are very concerned about physicians. If they ask about doctors, they are given a complete list of those at their local centers, not merely the best ones, he said.

 

“If they say they’re excellent surgeons, they’re held to a higher [legal] standard,” said Aaron M. Levine, JD, of Washington, D.C., chairman of the LASIK Malpractice Group of the American Trial Lawyers Association. “They could be implying a warranty.”

 

He said that no cases so far have been based on a breach of promise, although it is a possible tactic. “You need words” to litigate that type of case; the misrepresentation in some surgery offices is nonverbal, he said. “You walk into the doctor’s office and see a big basket of glasses people don’t need anymore, and a picture of Tiger Woods,” he said. TLC is the organization that snared Tiger Woods as a patient and spokesman.

 

Richard Abbott, senior ophthalmic practice secretary at the AAO, said ads that list a surgeon’s number of cases or a percentage of visual acuity achieved are “misleading and deceptive.” There is no “magic number” of cases, and percentages without the patients’ pretreatment acuities are worthless, he said.

 

Lee T. Nordan, MD, assistant clinical professor, University of California at Los Angeles Jules Stein Eye Institute, in private practice La Jolla, said, “Reputable people’s numbers are down due to this advertising,” He said ads cannot represent a surgeon’s skills accurately, because “you always end up lying by omission.”