Health tourism is regarded as big business these days with a growing market both within the UK and elsewhere. Many patients with healthy eyes consider surgery as a viable option to correct their refractive errors where spectacles and contact lenses cannot meet their requirements. However, in many cases costs can be prohibitive with prices of around £7,000 being quoted for a treatment to both eyes.
One such example is of patients either coming to the UK or heading elsewhere in Europe for eye surgery. Scott McGowan, a patient based in Glasgow, did exactly that in September 2017. In this article based on interviews with Scott and his optometrist and from my own notes as his contact lens optician, I aim to explain the background and outcomes of his procedure.
Case study
Scott is a 49-year-old lecturer at the prestigious Glasgow School of Art and has worn spectacles since the age of three.
Pre-surgery
Scott’s refractive error on 06/01/2016 was as follows:
R +7.50/-0.25 x10 (6/6-)
L +7.25/-1.50 x10 (6/6)
Add +2.00DS (N5 R and L)
Scott had become increasingly frustrated with his vision, especially since becoming presbyopic. His right eye was slightly amblyopic. He was an occasional contact lens wearer but generally relied on spectacles for his visual correction. His overall ocular health was generally very good, with occasional bouts of blepharitis associated with acne rosacea.
Post-surgery
Scott attended for his first post-operative eye test at our practice one month after undergoing clear lens replacement surgery in the Czech Republic in October 2017. He had been fitted in the right eye with the Alcon Acrysoft monofocal intraocular lens (+30.00 DS) and, in the left eye, the Acrysof Toric IOL (+29.00DS/ -1.50 DC). Both IOLs had a UV and blue visible light filter. These silicone IOLs with filters are associated with lower rates of posterior capsular opacification and a reduced risk of short wavelength light induced maculopathy.
Post-surgery, Scott instilled Tobradex (a suspension of the steroid dexamethasone and anti-infective agent tobramycin) twice daily for three weeks. He had experienced no post-surgical complications. Anterior examination revealed small corneal incision scars at the temporal limbus of each eye.
His refraction was now:
R +0.75 (6/6-)
L +0.50 (6/6)
Add +1.50DS (N5 R and L)
Scott was absolutely delighted with his refractive result, after a lifetime of being reliant on contact lenses and spectacles. We dispensed him with a pair of single vision spectacles for near vision and for computer use. The patient now takes up the story himself.
Scott’s story
‘Having worn spectacles since the age of three, I have increasingly struggled with poor peripheral vision due to the strength of my lenses. Even though I had been wearing glasses all my life, I found my glasses claustrophobic. Following a couple of head injuries, once walking into a post at the supermarket causing a mild concussion, another time while making some furniture, my wife encouraged me to look again at options.
'I had tried contact lenses which I found gave me a taste of what it might be like to see without spectacles. However, the vision wasn’t quite perfect and I did find the handling rather tricky. I attended a consultation with one of the main eye surgery specialists in Scotland and was told I was suitable for lens replacement, but the cost for the operation for both eyes was way beyond my means at over £7,000. The consultation was exciting though, as it confirmed an operation was possible and that something could be done, if I could afford it. I started looking further afield for alternatives.
‘I researched online and found it was possible to have eye operations abroad. I made contact with Praga Medica in the Czech Republic and their representative called me one night while I was on the train home. I was so delighted to receive this call, not that it was really any proof or validity, but it felt more like a “real thing”. I agreed with Helena to start planning my trip to Prague.
‘By this time, I had already emailed Praga Medica more times than anyone I know. I had concerns about my post-operation vision. I am an artist and was trying to get a sense of what the difference would be post-surgery. I asked if I would still need glasses and the answer was ‘yes’, though just for reading. I would need to go to Prague twice; once to measure my eyes to order the specific lenses I required and once for the surgery. I needed a toric lens for my left eye due to my astigmatism.
‘Trying to find an appointment time with Praga Medica to match up with finding cheap flights from Glasgow was a little challenging, but Praga Medica were so quick responding to my suggested itineraries, that I was able to secure return flights to Prague for less than £150.’
Visit one
‘I hadn’t been to Prague before, and although the public transport system looked pretty straightforward, I opted to have Praga Medica pick me up at the airport and bring me directly to the clinic. Once I entered the clinic I was met by my Praga Medica representative and translator, Dominic. He explained that Praga Medica were not actually the eye specialists but were in fact a company that sourced patients for treatment from outside the Czech Republic.
‘Having a translator at the various eye tests and eye examinations meant the day quickly became increasingly surreal. The translator interjection subtly changed the normal relationship between patient and eye specialist until, at one point, Dominic told me the consultant was going to make me cry. With further explanation, it became clear they were carrying out final tests to check my tears were operating normally.
‘Once I passed the various eye examination tests, I was met by the consultant. She clearly explained the lenses she recommended. I happily paid my £500 deposit and said goodbye to Dominic before being met by my driver from earlier that morning. After the flight back, I made it home to rural Argyll just in time to meet the last ferry.’
My GP
‘A requirement before the operation was to have a quick medical check with my GP. This, I understand, is not standard practice within the UK before such a procedure and I found this very reassuring.’
Visit two
‘I was a little unsure how to spend my time in Prague, I was not entirely confident how fit I would be to walk around after the eye operations. I booked a cheap apartment near the clinic with my family for the week. The itinerary was to arrive in Prague on the Monday. The first eye operation was on the Tuesday, a check up was booked on the Wednesday, second operation on the Thursday, second check up on the Friday and we were to fly back on the Saturday.’
McGowan's family accompanied him to Prague for the week of the operation
The operation
‘On the day of the operation I said goodbye to my family and Dominic met me and took me to the hospital. A plastic shower cap was placed on my head for the operation and my blood pressure was taken. A nurse put a local anaesthetic in my eye and I was asked to keep my eyes closed. I was given a small pill that I was told would make me feel ‘relaxed’.
‘There was something quite meditative being in a room wearing crocs with a plastic shower cap on my head with my eyes closed, listening to conversations around me, largely in Czeck. I started thinking about my eyes, and whether my sight would be really different. Would I see the world with more colour? Would I be aware of the lenses? What would I look like without glasses?’ I felt quite relaxed, maybe a little tired. I was aware of a conversation and someone from the waiting room heading into the next space to prepare for their surgery.
‘I was led through to a kind of pre-op room and the nurse checked that the local anaesthetic was working. I felt good. I was led into the operation room and introduced to the surgeon. This was just like any other operating theatre, and in some ways it reminded me more of a dentist chair.
‘Once the operation started, I was told exactly what was happening at each stage. My right eye was covered and my left eye was gently held open with some kind of clamp. I had read up about the procedure in advance and was delighted to actually see on a monitor my own lens breaking up. It was like looking through a microscope. I then saw the pieces of my lens being removed and at this point my vision became quite blurred and less bright. The surgeon then announced he was inserting the artificial lens. I saw it float in from the surgeon’s tool and immediately I had super clear focused vision.
‘An eye patch was immediately placed over my eye and the operation was over. I had my picture taken with my surgeon (figure 1) and thanked him, got changed and left to meet my family in the local café for a large coffee. I had no pain, no discomfort other than wearing an eye patch, and felt more excited than ever about seeing.’
Home again
‘The second eye went just a smoothly as the first eye. My vision was so much better than before. I must have appeared a bit odd to others as I kept being distracted by shiny bright objects. Everything looked fresh and new. Colours were vivid. I had fun reading car number plates as they zipped by. My night vision in particular was so much better than with glasses. The night lights of Prague seemed absolutely beautiful.’
‘Once I got home I was walking back from dropping the kids off at school and suddenly became aware of another fantastic difference. I noticed the treeline next to the path appeared to move and I realised I was definitely seeing much more “in the round”. I had peripheral vision, which had been largely missing most of my life due to the strength of my lenses. As I walked forward, I could simultaneously appreciate peripheral objects, trees, the road, moving back. This was an unforeseen outcome that I would not have been able to express to my optician as lacking as I had never experienced it. I wonder how different from one another our vision really is?
‘When I wake up in the morning, I don’t need to move my head at all to find glasses – I just open my eyes to the morning light. It’s a lovely feeling if you haven’t previously been able to do it. Having to wear reading glasses was necessary as I was not suitable for multifocal lenses, I admit it has been a little frustrating to adapt to being a little short sighted, but even now eight months later, I am continuing to get a real kick out of… just seeing!’
Final thoughts
Such cases, I would assume, are likely to become more commonplace in the future. All is great if patients have the success that this patient has had. However, what would we do if it all went wrong (see Optician 16.06.2017)? Would our increasingly stretched health service be prepared to help resolve and pay for problems caused by elective surgery?
Graeme Stephenson is a contact lens optician based in Glasgow.
If you want to share your experiences or thoughts on health tourism, contact bill.harvey@markallengroup.com