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Last Updated: Wednesday, 15 December, 2004, 00:01 GMT
Routine NHS laser ops ruled out
Most laser surgery is carried out in the private sector
Laser surgery should not be routinely given to short-sighted patients on the NHS, a watchdog has said.

The National Institute for Clinical Excellence (NICE) said the procedure was effective for people with mild to moderate short-sightedness.

But it said there is too little evidence to show its long-term safety for it to be widely used.

Surgeons who perform eye surgery said they were "disappointed" by the NICE's recommendations.

The NICE is the independent organisation responsible for providing national guidance on treatments and care for people using the NHS in England and Wales.

It said that since short-sightedness can be corrected in a risk-free manner by wearing glasses or contact lenses, any risk linked to surgery was a real concern.

We need to know more about these potential problems
Professor Bruce Campbell, NICE

It said if doctors did feel short-sighted patients should undergo laser eye surgery, they must ensure they understood the potential risks associated with the procedure.

A report from the All-Party Parliamentary Panel of Enquiry into the Safety of Eye Laser surgery in the UK, also published on Wednesday, called for stricter regulation of laser surgery clinics.

It said the Healthcare Commission should take on the role of regulating the industry.


NICE members looked at research relating to a type of laser surgery, known as laser in situ keratomileusis (Lasik).

The procedure involves a local anaesthetic being put into the eye, which remains open throughout.

A flap is cut in the cornea, the clear covering over the front of the eye, so the cornea's middle section is exposed. The laser is then used to remove a small amount of this section, depending on how much correction is needed. The flap is then folded back down and kept in place with natural suction.

NICE experts said studies showed 63% to 79% of operations on mild to moderately short-sighted patients resulted in normal '20/20' vision, suggesting the procedure was effective for these patients.

But in patients with moderate to severe long or short-sightedness, the evidence of benefits was less strong, with only 26% to 36% of procedures resulting in normal vision.

It also found there was insufficient evidence to show Lasik could be effective in the treatment of long-sightedness for it to recommend its use on the NHS.

It said Lasik was linked to complications in some patients. Problems included weakened corneas, which can require further surgery, infections and glare or 'halo' effects around objects at night.


Professor Bruce Campbell, chairman of the Interventional Procedures Advisory Committee at NICE, said: "Lasik offers improvement to people who are moderately short or long-sighted.

"This is a problem that can easily be corrected by spectacles or contact lenses, so any risk of damage to the eye by Lasik is a real concern.

"Although many people have had Lasik treatment there is very little information about how many suffer complications or suffer damage to their eye as a result."

He said NICE would carry out further reviews of this procedure, and other types of laser eye surgery, to try to find out more about long-term effects.

The way in which this guidance has been presented for patients is very poor and will only end up alarming patients
Sheraz Daya
Queen Victoria Hospital, Grinstead

Professor Campbell added: "We know that vision gets worse in a few people after Lasik and eye specialists are also concerned about possible long-term side-effects.

"We need to know more about these potential problems."

Christopher Neave, chairman of the Eye Laser Association, which represents private companies who provide the treatment, said: "We applaud the level of interest and awareness shown by NICE but we do wish to make it clear that, since 1990, some 280,000 people in the UK have been treated and we estimate that fewer that 0.1% have experienced persistent problems."

Sheraz Daya, director of the Centre for Sight at Queen Victoria Hospital in Grinstead, West Sussex, said he felt NICE members were speculating about potential long-term dangers without any evidence.

"Eight million eyes have been done around the world. And we haven't seen any evidence of a public health problem," he said.

He added: "The way in which this guidance has been presented for patients is very poor and will only end up alarming patients."

Why laser surgery may not be safe long-term

Safety fears over laser surgery
29 Aug 04 |  Health
Laser eye surgery complaints up
26 May 03 |  Health

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