Texas Trial of the Century

By Jan P. Bergmanson, O.D., Ph.D., and Leigh Anne Green, B.A.
JANUARY 2000

This mock trial presents conflicting arguments about the safety of refractive surgery. Find out the jury's verdict.

The varied opinions regarding laser refractive surgery were voiced in the "Texas Trial of the Century," held in conjunction with the Cornea, Contact Lenses and Contemporary Vision Care 15th Annual Symposium on December 5th, 1998, in Houston, Texas. Practitioners, predominantly from Texas (85 percent), but also from other states (13 percent) and abroad (2 percent), attended a meeting organized by the University of Houston College of Optometry's office of Continuing Optometric Education Department (Director, Niki Bedell). The highlight of the meeting was a thought-provoking debate regarding the detriment, or lack thereof, to the corneal tissue and vision after laser refractive surgery.

The trial was officiated by "Judge" Kent Buckingham, O.D., J.D., who is a pre-eminent malpractice trial lawyer with several multimillion dollar settlements to his credit, and both law and optometry degrees from the University of Houston. The "jury," composed of 50 randomly selected optometrists who were in attendance at the meeting, was presented with a series of questions prior to the trial in order to survey their pretrial opinions. A heavily decorated optometry and ophthalmology coalition consisting of Brien Holden, Ph.D., D.Sc. and Dwight Cavanagh, M.D., Ph.D. led the prosecution. They came to the trial claiming that laser refractive surgery too frequently poses significant harm to the pristine corneal tissues that over millions of years of evolution, have evolved to their present, near-perfect form. However, the defense team, also an optometry and ophthalmology coalition with the experience of thousands of successful surgeries on their records, was led by local experts, John Goosey, M.D., and Richard Baker, O.D. This excellent defense team made a strong case advocating the safety and success of laser refractive surgery.

The prosecution and the defense were each allowed two witnesses to assist in making their case. The prosecution's first witness provided the jury with her experience and dissatisfaction with a photorefractive keratotomy (PRK) laser surgery, which had a less-than-ideal outcome. The prosecution's second witness, an ophthalmologist and lawyer, provided legal insight and challenged business ethics regarding laser refractive surgeries.

The defense provided two fact witnesses who convincingly testified to the safety of the laser procedures. The first witness was an ophthalmologist who routinely performs laser refractive procedures and feels confident about the safety of such procedures. The second witness, who also happened to be an ophthalmologist, was very pleased with the outcome. After both sides presented their case and offered closing comments, and witnesses had been introduced and questioned by both sides, the jury was asked to deliberate over a coffee break.

Pre- and post-trial questioning consisted of questions asking the jurors about background data and probed them for their opinions regarding the case at hand. The practitioner survey indicated that the majority of refractive surgery patients were taken from the contact lens wearing population. However, it's unlikely that all of the refractive surgery candidates would be recruited from only contact lens failures, as often is being claimed. This belief clearly demonstrates that laser refractive surgery proves to be a tough competitor for the contact lens market. To compete effectively, the contact lens market needs to position itself as a compelling solution for patients who are in need of a convenient, safe and precise vision correction modality.

According to a survey conducted at this mock trial, the typical patient considering laser refractive surgery is 31-40 years of age and tends to have a sizeable disposable income available for nonessential items. Among the jury members themselves, 11 percent were patients of laser refractive surgery, whereas 31 percent were current contact lens wearers. Presumably, an approximated 60 percent of the jurors were wearing spectacles or no form of vision correction at all.

Pretrial questioning determined that 84 percent of the practitioners involved had previously referred a patient for refractive surgery. After having heard the factual arguments, this number decreased to 58 percent when practitioners were asked the same question again after the trial, "Would you now recommend laser refractive surgery to a patient?" Therefore, a significant 26 percent had second thoughts regarding laser refractive surgery after the prosecution's facts and their witnesses presentations. However, this meant that the majority of the jury (58 percent) still felt confident enough to continue to refer patients for laser refractive surgery. When presented with the question of whether they felt that complications occurred in too many cases for the surgery to be regarded as safe, a majority opinion of 56 percent answered "no." Even though the defense maintained the majority vote of the jury on these issues, the prosecution swung the majority opinion from 84 percent to 58 percent when they asked practitioners if they would refer patients for laser refractive surgery. It could therefore be argued that the prosecution was the moral victor in this trial. The eminent members of the prosecution certainly felt this to be their victory, but naturally, the defense proclaimed a victory of their own since the majority was still favorable to laser refractive surgery, both as being a safe procedure (56%) and as being one that a practitioner would refer their patients for (58%). The results of the practitioners questions are listed in the sidebar on the page 44 (sample size = 50).

This mock trial allowed for educated and informed opinions to be voiced, and created convincing arguments for and against laser refractive surgery. This event was a rare meeting of some of the most distinguished professionals in the field, making for an exceptional educational experience. We thank all of the participants for making the event such a memorable and educational one.

The extensive involvement of optometry in laser refractive surgery and care is evident, and speaks for its wide acceptance in the Texas community.

Dr. Bergmanson is a professor of optometry and director of the Laser Laboratory and the Anatomy and Pathology Laboratory at the University of Houston.

Leigh Anne Green is a fourth year optometry student at the University of Houston, currently working with Dr. Bergmanson.