Infections after Lasik surgery raise concerns
August 26, 2002

By Laura Beil
The Dallas Morning News

Three outbreaks of infection following a popular eye surgery have smudged the operation’s spotless public image.

Lasik, which reshapes corneas with laser beams, has allowed more than 2 million Americans to shed glasses and contacts. Doctors consider the surgery so benign that patients commonly get both eyes corrected in one day. Most other vision surgeries fix one eye at a time, in part so both eyes won’t be damaged should something go wrong. With Lasik, customers tend to worry more about side effects to the wallet than the eyes.

But in 2000 and 2001, patients in Texas, California and Georgia came away from Lasik with eye infections — the first recognized Lasik-associated outbreaks since the surgery was approved in 1995. Previously, doctors had described only a single infection here and there.

“We know of no outbreaks until the last two years, when we’ve had three,” says Dr. Kevin Winthrop of the California Department of Health. Dr. Winthrop and his colleagues recently investigated the outbreak in his state that left three women with permanent vision damage.

Patients in Texas recovered without serious consequences, doctors say, and the Georgia investigation is still under way. In all, the three episodes affected 35 people. In each case, experts believe the culprit was a common kind of bacteria known as mycobacteria, although scientists in Georgia couldn’t verify their suspicions.

The infections were discussed at a recent meeting at the Centers for Disease Control and Prevention in Atlanta.

The Texas outbreak occurred first. In September 2000, a patient at Scott & White Memorial Hospital and Clinic in Temple began suffering from pain, tearing and inflammation four months after Lasik. The eye surgeon soon discovered six other patients with similar symptoms and stopped performing the surgery. Concerned, he called Scott & White’s infectious disease experts to investigate.

Then in April 2001, four women who underwent Lasik in Southern California began to experience blurring, burning and itching shortly after their surgery. In response to the outbreak, the American Academy of Ophthalmology e-mailed its members in May 2001, asking whether anyone had seen mycobacterial infections.

Another outbreak would soon begin. One woman had come to doctors at Emory University in Atlanta for an eye infection, and noted that she knew of other patients suffering the same symptoms. All had Lasik performed by one surgeon in central Georgia.

The Georgia Division of Public Health investigated, eventually finding 24 people who suffered mycobacterial eye infections in the summer of 2001. Meanwhile, the ophthalmologist got out of the Lasik business.

In each case, the physicians were reputable surgeons who didn’t realize something about their technique could allow contamination.

“I don’t think this is something where we have to run the Lasik physicians out on a rail,” says Dr. Gary Holmes, the infectious disease specialist who led the investigation at Scott & White. “They’re doing a good service.”

In Temple, the surgeon had been chilling syringes of saline — used to wash the eyes — in unsterile ice. The source of infection in the other two outbreaks was never found, although disease investigators say they have strong suspects.

Lasik, an acronym for laser-assisted in situ keratomileusis, can cost about $1,600 to $1,700 per eye, depending on the surgeon. The chance of infection following Lasik remains tiny compared with the risks from other surgeries. The outbreaks last year, for instance, affected fewer than 30 of the more than 791,000 people who got Lasik that year. The distinction, Holmes says, is that many higher-risk procedures are a medical necessity. People want Lasik because glasses or contact lenses bother them, he says.

“You need to think seriously about how necessary this is,” Holmes says — whether the small risk of complications is worth spectacle-free eyes.

Eye surgeons point out that these outbreaks seemed to occur when the doctors revised common Lasik practice.

For example, the California surgeon was using his laser to correct farsightednesses, but had to pass the beam through a soft contact lens to make it work.

A post-Lasik infection “is a very, very rare thing,” says Dr. Robert Steinert, a Harvard Medical School ophthalmologist, and member of the American Society of Cataract and Refractive Surgeons. “It’s not inherent in the procedure itself.”

He is not entirely surprised that the outbreaks would have occurred only recently, following years where only an occasional patient got an eye infection. Although Lasik became available in late 1995, demand has soared in the past three or four years. Surgeons are becoming so comfortable with the surgery, he says, they might be fashioning it to their own tastes, making tweaks that unwittingly introduce routes of infection.

The three outbreaks, he says, should remind surgeons that “you’ve got to think very carefully about modifying a procedure that works pretty well.”

Steinert says he also doesn’t see the outbreaks jeopardizing the strategy of operating on both eyes at once. Some surgeons have, off and on, debated the risks and benefits of so-called bilateral surgery for many years. He believes that the procedure is still so safe that the chance of mishap “has been calculated to be lower than the risk you take driving in for the second treatment.”

As long as surgeons are mindful of infection control, these outbreaks shouldn’t continue, says Dr. Anthony Johnson, an Emory ophthalmologist who helped investigate the Georgia incident.

Ophthalmologists, Johnson says, “need to try to maintain the same standards of infection control as we do in a hospital.”

He hopes that the outbreaks — two of which have been described in medical journals — will serve as a warning to his colleagues. “As we get more and more in the literature,” Johnson says, “and more in a position to talk about this and find the problems in the Lasik procedure, Lasik becomes better over time.”