Medical Error Interviews
Troy McKnight: Laser eye surgery safety has a huge blind spot

Troy McKnight: Laser eye surgery safety has a huge blind spot

May 25, 2020

When I first heard of laser eye surgery many moons ago, my first reaction was suspicion - on the face of it, it sounded very dangerous.  But after years of exposure to laser eye surgery advertisements, it squirmed its way on my list for consideration so that I didn’t have the bother of contact lenses.

After interviewing Troy (a pabout his experience having his vision permanently damaged, and hearing what he’s learned about laser eye research and the ophthalmologist industry, I will never ever get laser eye surgery. The risks are just too great -- especially the suicide inducing pain of corneal neuralgia, where it feels like pins are constantly being poked into your eye.

If you’re thinking about getting laser eye surgery, listen to what happened to Troy, and then take that into account in your decision.

Show Notes:

W5 Documentary:

https://www.ctvnews.ca/ctv-national-news/video?clipId=1654087

Dentist awarded damages for eye procedure:

 
RETINAL LASER COMPLICATIONS

Troy's Facebook page:

 
Patient website-retinal laser complications:
 
 
0:04:00 Troy (not his real name) grew up on a farm in Saskaetchewan in a normal family - great childhood, good parents who instilled good morals
0:05:00 Troy did have some flus as a child, but otherwise healthy until recently - he went to university and got a degree and become part of the rat race - he had a pretty good career with good friends and relationships
0:06:00 Troy wants to share his experience and what he's learned about laser eye surgery, including retinopathy, the procedure he had - Troy also wants to talk about the Canadian Medical Protective Association (CMPA), as its related to laser eye surgery
0:07:00 Troy has done a lot of research - Troy says lasers are dangerous weapons - the Geneva Convention has banned them in warfare - but lasers are approved by Health Canada and are used by lots of doctors
0:08:00 Troy's consent form for the procedure listed a lot of potential harms - a lot of information our brain processes, comes through our eyes - so if our eyes are injured by laser, it is an unnatural injury, unlike dirt, grim, etc
0:09:00 The retina does not heal, it has not evolved a regenerative capacity - there are a few different types of laser used in laser surgery - like in cataract surgery
0:10:00 The retina sits at the back of the eye - as we age, the retina can sometimes pull away from the back of an eye
0:11:00 This can cause 'flashers', a flash of light - it happens to a lot of people as they age
0:12:00 But Troy had 'floaters' in his vision and that's why he went to an opthamalogist in the first place, something he wishes he had never done - his floater was only in his right eye, and that was back in 2017
0:13:00 In retinalopathy, they will shoot the laser around the floater, the theory is that it will seal the tear (aka floater) so it does not grow larger and cause detachment - Troy had no problems with that procedure
0:14:00 In 2019, the opthamalogist tells Troy he has a small tear in his left eye
0:15:00 Troy thinks most people will have floaters, and will have some retinal tearing later in life - the procedure Troy had done was to stop the the tear from getting bigger, but another procedure tries to destroy the floater, but there is a risk to the optical nerve
0:16:00 During a laser procedure, you are awake, and if you move your eye during the laser, it can permanently damage your eye - Troy didn't want the 2nd procedure, but he was convinced
0:17:00 The procedure hurts, it is painful - the reason for the retinalopathy procedure is to prevent further tearing or detachment of the retina, but one of the risks of the prodecure is retinal detachment
0:18:00 Troy asks himself now, why did he sign the consent without asking questions
0:19:00 The consent form includes to circles representing the eyes to indicate where the procedure was performed - once the laser procedure is done, it is forever - there is no undoing it
0:20:00 From the 2019 laser procedure, Troy knew within a day or two someting wasn't right - he had visual disturbances - one moring he woke up in darkness, and as he moved his eyes, a fireworks explosion - that was disturbing
0:21:00 Troy also experiences symptoms when moving from bright sunlight to indoors, called 'while flickering lights' because his cones and rods (in his eyes) are misfiring - these happen every day, and flourescent light also set it off
0:22:00 Troy went to the doctor and was told they would go away in a month - then every time Troy went back, the doctor kept extending the date...3 months, 6 months -- but within the first week the doctor suggested Troy pay $100 to get retinal pictures
0:23:00 Troy wonders why the retinal pictures weren't done beforehand - even when he got the retinal pictures done after, he had trouble finding someone to read them - then he realized all these opthamaologists use lasers in one form or another, so they can't say there is a problem with lasers, when they themselves use lasers on patients - so its difficult to get a clear answer, so Troy has had to piece together what happened to him
0:24:00 Troy ascertained the doctor had made 4 strikes with the laser, but 3 of them were too close to the center of his eye, within his peripheral vision, so that's why he has these strange visual phenomenon
0:25:00 A problem common to all laser procedures, Lasik, cataract, etc, is dry eye - with retinopathy procedure, the laser passes through, and damages, the cornea to get to the retina, but the cornea usually heals - the eye is its own biosphere to protect against virus, dirt, etc - but when the cornea is dirsupted, it can cause dry eye, a major problem
0:26:00 Without proper lubrication in your eye, it is forever exposed to all kinds of infections - so Troy has to be very careful with his left eye, always has to clean it - so dry eye is a potential side effect of all laser procedures
0:27:00 Headaches, soreness, infections from dry eye - the toughest part for Troy is the flickering light in his vision - his father was a welder, so Troy wears welder grade sunglasses outside, so that when he moves inside, the difference isn't as big, and his symptoms aren't as inense
0:28:00 The welder lens is called a #5 lens - it was through experimenting that Troy discovered it helped him - as the sun goes down, the effect on his vision diminishes
0:29:00 It is most prevalent in the middle of the night - Troy says Lasik and PRK procedure patients have a lot of trouble at night, especially driving as they see star bursts, so it makes it impossible for them to drive at night - these are elective surgeries
0:30:00 The drops for dry eye costs $35 a month, and it will be needed forever - so not really saving money over buying glasses that can last for years...and your eyes don't hurt
0:31:00 Troy is sharing so other people know about these potential problems - as he researched, he found there wasn't much info about the procedure he had done (retinapathy), but he did find some research on Lasik and PRK - and there are 100s of 1000s of people suffering and committing suicide - there is a horrible illness called corneal neuralgia caused by Lasik
0:32:00 Troy says there is a great program on W5 (tv show) called Deadly Vision about the risks of Lasik - Troy says anyone who watches that and still wants Lasik is crazy - corneal neuralgia is like needles sticking into your eye all day long, extreme pain - a meteorologist in Detroit committed suicide a few weeks after Lasik surgery - a millionaire in Ontario was in so much pain he took his own life
0:33:00 A young man in military, took his own life because of corneal neuraglia - Canada says its 1 in 10,000, and there are 80,0000 procedures a year, so that's 8 people - but nobody knows the real numbers because there are no independent studies - and cataract surgery is like Lasik, so the same risks apply
0:34:00 Most cataract surgery is on senior citizens, so any symptoms they have attributed to old age - Troy thinks people should understand the risks of that surgery
0:35:00 Troy says we have to remember that all this info comes from the corporations that make the laser equipment - most of the opthamalogists operate as independent and there is a lot of money they are making, but there is no indepedent accountability - most of the eye clinics operate outside the provincial jurisdictional and regulatory system
0:36:00 If you go to a private eye clinic and then have a problem and go to the ER, they will tell you to go to the private clinic, except the private clinic doesn't offer after care - they make money off the procedure, but if you need after care, you have to go to the regular system - the only thing they can offer is anxiety meds
0:37:00 Troy thinks unless you have an emergency, be careful about having an eye procedure
0:38:00 Some people have had success with the procedures, but there is also the risk - Troy wants to warn people, they should think twice because there is little info about retinopathy risks
0:39:00 A former approving FDA official said publicly that laser eye surgery should be outright banned - his research shows complications up to 30% - but the eye doctor say less than 1% - the Canadian Opthamology Association says corneal neuralgia is 1 in 10,000
0:40:00 There are all kinds of other problems - dry eye, vision problems, blindness - so 1 in 3 people are going to have a problem - talk to people with Lasik procedures, and many will tell about dry eye - Troy tried to tell the CNIB (Canadian National Institute for the Blind) about the laser injuries, but they didn't care
0:41:00 Troy knows of a woman who started to go blind after Lasik surgery, the doctor gave her a business card to the CNIB and said good luck with that
0:42:00 There is a lot of money in the business, as they advertise a lot on Facebook, there ads are always popping up - there is a class action lawsuit in Canada against one of the Lasik companies, LasikMD, for corneal neuralgia sufferers - but it doesn't include the other providers of Lasik
0:43:00 Troy thinks the government should be looking into the quality of work and research by the manufacturers - the research is often funded by the company that will make money off the product - Troy thinks Health Canada would be keeping people safe
0:44:00 But you will hear a lot of people who had successful Lasik surgery - while the retina doesn't heal, the cornea has evolved to heal itself, and that's why there is success - but some people's cornea doesn't heal
75:00:00 Apparently there are more nerves in the eye than any where else in the body, and that is why corneal neuralgia is so painful - but where is the data and research - there are probably millions of people around the world suffering from Lasik procedures
0:46:00 Troy has some recommendations, wishes someone had told him before his procedure - he likens it to taking your car to the mechanic and he shows you the broken part they will fix or replace, and won't do more work without your approval
0:47:00 Troy thinks a picture of the retina should be taken before deciding on the procedure so the doctor can show you exactly what and where the problem is
0:48:00 It only takes few minutes, they all have retinal cameras in their office - its your right to ask for that - and agree to whatever areas you want treated
0:49:00 Also consider if the area is within your field of vision - providing a retinal picture before the procedure is not part of their standard operating procedure
0:50:00 Retinal pictures after the fact have little use - Troy doesn't know if he was charged per laser strikes (4) or if for the whold procedure
0:51:00 It took 2 minutes, but it cost $500 - but there is no undoing Lasik surgerey
0:52:00 Troy has seen pictures of people who have had thousands of laser strikes - laser attaches the retina to the back of the eye
0:53:00 The medical malpractice set up in Canada is different than other G7 countries - Canada has more medical errors than the others - it is almost impossible to sue a doctor in Canada
0:54:00 A lawyer told Troy that any harm listed on a consent form is there because it has happened - Troy says it is important you have informed consent - in Canada, each provincial health agency pays the CMPA with tax payer dollars
0:55:00 Lawyers has $5 billion of tax payers dollars, and they have hired almost every major law firm in Canada, so they can't represent you
0:56:00 So finding a lawyer if very hard - and they want to make sure they are going to be paid, so it has to be a horrific case - a lot of the award in a malpractice is for lost future wages, so a lawyer needs a client that had a high salary
0:57:00 Back in early 1900s, the law was made to constrain a medical malpractice awards to a small amount - it is also hard to find an expert witness, as doctors are reticent to testify against each other
0:58:00 But the CMPA will hire 5 or 10 experts, because they know that if you lose, you have to pay all their legal fees plus their expert fees - that will bankrupt you - Troy calls it triple jeopardy: tax payers pay doctors and pay CMPA and pay your own legal costs
0:59:00 If you lose, you also pay their legal costs - so its not surprising that only 60 cases go to court, but only single digits win their case - so the chances of winning are so low, that it makes it virtually impossible, statistically zero.
1:00:00 Troy says people shoud avoid getting elective laser eye surgery - Scott says he'd thought about having Lasik, but 10 minutes into hearing Troy's experience and research, he's decided he's never getting laser eye surgery

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Scott Simpson

Counsellor + Patient Advocate + (former) Triathlete

I am a counsellor, patient advocate, and - before I became sick and disabled - a passionate triathlete. Work hard. Train hard. Rest hard.

I have been living with HIV since 1998. I was the first person living with HIV to compete at the triathlon world championships.

Thanks to research and access to medications, HIV is not a problem in my life.

I have been living with ME (myalgic encephalomyelitis) since 2012, and thanks in part to medical error, it is a big problem in my life.

Counseling / Research

I first became aware of the ubiquitousness of medical error during a decade of community based research working with the HIV Prevention Lab at Ryerson University, where I co-authored two research papers on a counseling intervention for people living with HIV, here and here

Patient participants would often report varying degrees of medical neglect, error and harms as part of their counseling sessions.

Patient Advocacy

I am co-founder of the ME patient advocacy non-profit Millions Missing Canada, and on the Executive Committee of the Interdisciplinary Canadian Collaborative Myalgic Encephalomyelitis Research Network.

I am also a patient advisor for Health Quality Ontario’s Patient and Family Advisory Council, and member of Patients for Patient Safety Canada.

Medical Error Interviews podcast and vidcast emerged to give voice to victims, witnesses and participants in this hidden epidemic so we can create change toward a safer health care system.

My golden retriever Gladys is a constant source of love and joy. I hope to be well enough again one day to race triathlons again. Or even shovel the snow off the sidewalk.

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