Arizona verdict for pilot provides lessens on Lasik.

In a case that plaintiff attorneys say offers important guidance for future litigation, an Arizona jury awarded substantial damages to a promising young commercial pilot grounded for life after Lasik surgery. Although he still has at least 20/20 vision, side effects from the surgery impaired his ability to see clearly at night. (Post v. Univ. of Arizona, No. C-2001-1817 (Ariz., Pima County Super. Ct. May 9, 2002).)

Like most people who undergo the procedure, Steve Post sought Lasik for convenience; glasses corrected his vision sufficiently for him to fly. But unlike most plaintiffs in Lasik cases, who claim that their vision was damaged by the way the procedure was performed, Post claimed that his injury resulted from poor preoperative screening.

Post had attained the rank of captain of a United Airlines 737 jet by age 32--several years earlier than the usual. According to his lawsuit, he would probably have flown a 747 by his mid-40s if not for his Lasik surgery. After the procedure, he took a test run as a cockpit passenger before returning to work. He experienced so much glare from airport landing lights during the flight that he voluntarily underwent testing through his employer and was found unfit to fly.

In Lasik--technically, "laser-assisted in situ keratomileusis"--a laser beam sculpts the cornea to change its shape and refractive power. Light entering the treated area goes directly to the retina, sharpening the patient's vision. If the pupils are not measured properly before surgery, treatment will not reach the entire cornea, and the patient will perceive light entering the untreated area as glare. These patients may also experience vision problems like starbursts and halos, said Post's attorneys, Robert Beal and Ted Schmidt of Tucson.

Beal said proper screening of Lasik patients requires measuring pupils in dim light--in a windowless room with only a door cracked--so that they will open fully. But Post's pupils were measured in a room with windows on a bright Arizona day. The screening technician testified that the venetian blinds were closed, but Post recalled that they were not, said Beal.

Post's pupils dilated to 5 millimeters in his screening, Beal said, but in dim light they opened to 6.25 millimeters, and in dark conditions--like those encountered by a pilot flying at night--they opened to between 6.5 millimeters and 7.5 millimeters.

This difference, Beal said, illustrates the most significant point of the case: "One shoe does not fit all. Dim light may be fine for screening most Lasik patients, but people in some professions--neurosurgeons, long-distance truckers, pilots--should be tested in truly dark conditions. Time must be taken to analyze each individual patient."

Attorney Aaron Levine of Washington, D.C., chair of ATLA's Laser Eye Surgery Litigation Group, said Post illustrates why plaintiff attorneys should carefully consider the potential for damages when evaluating laser surgery cases. He estimated that 10 percent to 15 percent of all Lasik patients are dissatisfied with the procedure because they have some negative outcome, such as blurred vision, and in many cases they still have to wear glasses. But fewer experience significant loss of vision, he said--perhaps 3 percent to 4 percent--and most successful litigation is confined to these cases. Post's claim was particularly strong, Levine said, because his occupation required perfect vision.

Lasik has become enormously popular, even though the surgery is almost always elective and its cost--typically between $1,000 and $5,000--is not covered by insurance. Levine credited this popularity to massive advertising campaigns by Lasik surgeons.

"People must understand that Lasik is cosmetic surgery," he said. "They will get no improvement over corrected vision, they stand a substantial chance of decreasing their vision comfort, and there is at least some chance of a serious mishap--just so that they won't have to wear glasses for a while."

Levine added that no one knows the long-term effects of Lasik because the procedure is so new, but that many scientists believe the surgery weakens eyes and may make the patient more susceptible to problems like glaucoma.

What is clear, he said, is that so far Lasik is "more about marketing than medicine."