Recognising surgery's place

One of Britain's top corneal specialists Ð Sheraz Daya, medical director for the Centre for Sight in East Grinstead Ð is excited. He is just about to perform the first UK Lasik procedure using Bausch & Lomb's Zyoptix 100 Excimer laser, which combines Wavefront technology, iris recognition identification and tracking software.
Beforehand, however, he sings the excimer's praises to optician in his small office at the West Sussex clinic. The Centre for Sight surgeon also wants to encourage more optometrists to 'get involved' by referring patients to the refractive sector.
But first the new technology, and in particular the Z100's iris recognition capabilities. With its origins in military security, it is now attracting even more publicity after home secretary David Blunkett's reference to the biometric technology in his ID card proposal.
Daya says iris recognition is one of the new laser's key advantages, but for a much more basic reason.
'One of the problems we've always had with laser eye surgery is security, and ensuring you treat the correct eye of the correct individual,' Daya confides. 'There are checks and balances we all go through [prior to surgery], but this technology makes it that much safer.'
Just how safe is well documented in Bausch & Lomb's publicity material; as no two irises are the same, the Lasik treatment is unique to each patient.
Daya also explains that the wavefront technology enables the ophthalmic surgeon to make sure the treatment is carried out more accurately on the cornea.
'We realised this long ago, so what we did to compensate was to mark out the patient's cornea while they were sitting upright, then rotate their head when they were lying down so they were correctly aligned and were ready to be treated. This technology gets rid of all those steps.'
Despite the undoubted advances in surgical technology in his nine years of working in the refractive surgery field, he remains strongly opposed to procedures being incorporated into all-embracing high street offers.
'The high street chains will hate me for saying it, but I don't think that the surgery should be done in the high street. That's my own personal opinion.'
Daya emphasised the importance of continuity of care in a national broadcast earlier this year. He was involved in BBC TV's Watchdog item on refractive surgery that, many agree, helped stem the rising tide of patients interested in laser eye treatment. Nevertheless, Daya is unrepentant.
'It's a surgical procedure,' he maintains, 'and there's a relationship that you build up between the doctor and the patient. You can't expect to have that on the high street.'
It is that continuity of care that is the crucial difference between the clinics and the high street, he claims.
'In the high street the emphasis is quite different. You're looking for volumes and you're selling a product whereas many doctors who run their own centres or who are in centres, this is their livelihood.
'Obviously it is a business for [doctors] too, no question about it, there is a commercial interest as well, but ultimately this is what they do for a living and they're involved intimately.'
Daya's Centre for Sight is not a member of the Eye Laser Association, which he refers to as a high street body that has been 'conjured up by Boots, Ultralase and the Eye Clinic'.
'I don't need an organisation to tell me about medical standards Ð we set them. Or advertising standards, as we're bound by a code of practice and ethics by the General Medical Council.'
So what about optometrists? Do they have a role to play the refractive sector, especially regarding referrals?
'Yes they do,' he says. 'But they have to be appropriately trained and they need to have the appropriate amount of interest too.'
Daya says that level of interest is quite variable in the UK. He believes optometrists need to embrace the sector and get involved, although he admits that it is also up to people like himself to make them feel welcome, and find a niche for them within the bigger picture of refractive surgery.
However, that niche must be an involvement in a transparent process, he says, where the patient knows exactly what he or she is paying for when attending the optometrist, and why they are being recommended to a particular laser eye centre.
'In general I think there has been a great deal of suspicion from patients and I think they're worried about a lack of transparency.'
He says since the bad publicity laser eye surgery received earlier this year things have improved, and 'lessons have been learnt', but patients remain cautious.
Daya and the Centre for Sight will shortly be involved in a pilot programme with a group of optometrists from the south east in a Bausch & Lomb-organised scheme which may, if successful, be rolled out nationally later next year.
'[The pilot] will be aimed to iron out any difficulties,' he reveals, 'and try to find a way for optometrists to be incorporated into the process.
'Refractive surgery is here to stay. We're all eye care professionals Ð we all need to be involved in this sector.'