Brad Horsburgh: Eye on tourism

THE growth of medical tourism — particularly for eye surgery — raises several concerns from doctor and patient perspectives.

While there are many professional, well qualified eye surgeons who operate overseas, it is important that patients understand potential risks and always seek the advice of their GP or ophthalmologist before embarking on eye surgery overseas.

Many overseas medical tourism facilities operate as commercial, revenue-driven entities. This increases the risk that they may not allocate enough resources to sterilising equipment, for example, or infection control generally. Patients who require attention for complications after their return home place a burden on our local health system.

GPs are often the first port of call for a patient returning from overseas who experiences adverse effects from laser, cataract or cosmetic eye surgery. Side effects such as dry eyes, halos and blurry vision can sometimes last for 6 months or longer after surgery.

Any of these symptoms or more serious issues such as scarring, retinal detachment or corneal damage requires referral to an ophthalmologist immediately.

Cosmetic eye treatments such as iris implants to change eye colour can lead to severe glaucoma and vision loss. Iris implants are rarely performed in Australia and New Zealand, and would not be advocated by ophthalmologists here.

A case described in a letter published in the current issue of the MJA clearly illustrates the dangers.

Our colleagues at the American Academy of Ophthalmology also recently warned of the dangers of iris implants. Given that some global celebrities are reported to have undergone the procedure, extreme caution should be recommended to any patient seeking cosmetic eye changes as it could be at the expense of overall eye health.

If medical tourism continues to grow, we may see “commoditisation” of complex eye treatments using clever marketing, emphasising the latest techniques and technology. Australian ophthalmologists regularly adopt the best innovations, but always with the best patient treatment and care in mind — not as an inducement.

Financial incentives such as finding the cheapest surgery on offer should never be top of mind for a patient considering overseas surgery.

Clever marketing about combining a medical service with an overseas holiday adds another risk for patients — that the person’s real medical needs may be de-prioritised, as the overall “experience” takes centrestage. Patients may not give as much thought to what they are signing up for, or how to best manage postoperative recovery.

There is also a risk of patients having a complacent attitude such as “If I get an operation done overseas and something goes wrong, then it’s not a problem as I can sort it out when I get back home”.

The ophthalmology profession understands that waiting lists for treatment may also be a factor in patients considering overseas procedures.

The Royal Australian and New Zealand College of Ophthalmologists and others groups, such as the Australian Society of Ophthalmologists, regularly advocate for a reduction in public hospital surgery waiting lists and more positions for trainee eye doctors to reduce the need for people to consider these avenues.

Our ophthalmologists maintain a code of ethics which reinforces appropriate pricing and billing practices, and our profession would never wish to see a desperate patient driven overseas because of cost or some other reason.

The rigorous standard of training and accreditation should engender confidence that our doctors can meet the needs of all eye patients.

GPs asked by patients about overseas eye treatments should begin by ascertaining the motivation behind the question, as well as discussing the risks. A referral to an ophthalmologist will ensure the patient can get a proper diagnosis and advice on the best course of action.

Dr Brad Horsburgh is the president of the Royal Australian and New Zealand College of Ophthalmologists.