Have Eyes, Will Travel: Cosmetic Eye Procedures May Risk Vision

By Paddy Kamen

Wealthy people have been traveling for medical or pseudo-medical treatments for centuries: think ancient Roman spas, ‘taking the cure’ at European hot springs, or seeking the salutary effects of dry climates. But what would motivate a Canadian woman to travel to Panama to artificially change the colour of her eyes? 

According to a CBC News report, dated Jan.17, 2012, “Beatriz Murillo, 36, traveled from Toronto to a clinic in Panama and paid $8,000 to have a silicone disc placed on top of her irises to lighten the colour from brown to green.” The article states that Murillo has become virtually blind as a result of complications following on the surgery.  

Vanity motivates a large number of people to participate in what has become known as medical tourism. Josef Woodman, author of Patients Beyond Border[1], estimates that more than 50 per cent of medical tourism procedures are cosmetic. These include face-lifts, tummy tucks and cosmetic dental work. Popular non-cosmetic procedures include organ transplants, orthopedics, in-vitro fertilization, dentistry and even gender reassignment surgery. 

The clinic where Murillo went under the knife declined an interview with Envision: seeing beyond magazine, but a Mississauga-based ophthalmologist, Dr. Ike Ahmed, was able to talk about some of his experiences dealing with aftercare from similar procedures. 

“I know of five cases of iris implants and I have treated three,” says the glaucoma specialist. “It’s unfortunate, incredible and hard to grasp why anyone would put their vision at risk for a cosmetic procedure. Some people seem to think it is like getting a tattoo.” 

Dr. Ahmed says the iris implants have caused corneas to stop functioning and become cloudy from trauma to the eye. “We have seen corneal decompensation and glaucoma. One person developed a cataract as well, and some have had all three issues. One cornea required a transplant. The repercussions from this procedure are very serious and can cause permanent loss of vision.” 

Patients who undergo such risky procedures do not generally consult with an ophthalmologist in advance and often put off getting help when problems develop, notes Dr. Ahmed. “But we can sometimes halt disease progression if they seek medical help early.” 

Another cosmetic procedure that originated at the Netherlands Institute for Innovative Ocular Surgery (NIIOS) is the Cosmetic Extraocular Implant. In this procedure, a small, flat, ornamental object is inserted into the conjunctiva – the mucous membrane lining the inner surface of the eyelids and the front of the eyeball. The object, known as a Jewel Eye, is available in the shape of a heart, star, clover, musical note or as a custom design. There are patents pending on this procedure.  

While the website for the NIIOS claims that, “Patient satisfaction is high and no side effects of the treatment have been noticed with a follow-up of more than one year,”[2] Dr. Ahmed is not impressed. “While it is not as potentially serious as the iris implant, it can cause negative reactions.” 

Health care services have become global for-profit industries with hundreds of thousands of medical tourists traveling each year for medical procedures performed abroad. According to Woodman, “In 2011, Americans spent an estimated $15 to $20 billion on procedures abroad, including elective heart surgery, dental work, cosmetic procedures and infertility treatments.” Many countries are getting into the medical tourism business. Thailand welcomes over one million health travelers annually, with India, Mexico and Singapore welcoming hundreds of thousands. And the U.S.not only exports health seekers but also welcomes 600,000 each year.[3] 

Many Americans have come to Canada for eye surgeries, including refractive surgery, which was approved in Canada earlier than the U.S. “We see medical tourism here, with people coming for PRK, Lasik and intraocular lens implants, some of which are not available in the U.S., which is generally behind in terms of optic technologies,” explains Dr. Ahmed. “And most recently, they are coming for corneal cross-linking, a treatment for kerataconus which strengthens the cornea using ultraviolet light and nutrients.” 

Are Canadians traveling abroad for eye procedures? Dr. François Codère, a Montreal-based ophthalmologist and president of the Canadian Ophthalmological Society, says, “I haven’t heard of anyone going outside of the country to get eye care.” He points out that in Canada, even the most expensive refractive surgery costs under $5,000, which makes it hardly worthwhile to incur the expenses associated with medical travel. “And I would certainly not recommend it because the follow-up to surgery is very important. Infection can occur one week to 10 days after surgery. I wouldn’t want to have eye surgery without follow-up medical care.” 

Dr. Codère adds that while there were long delays for cataract surgeries in the past, which may have driven some people to go to other countries for the procedure, most provinces have reduced wait times to less than six months. “In Montreal, over 95 per cent of cataract operations are done within six months so the waiting times within ophthalmology have improved in the last five years. 

Dr. Ahmed says that he has known people who left Canada for eye procedures due to waiting lists. “But only a very small percentage of Canadians go out of the country for eye surgeries. In Canada, we’ve had great pioneers and leaders of the world in surgical technologies and it’s more likely that people will travel here.” 

As for the doctor who performed the disastrous surgery on Beatriz Murillo and other unsuspecting Canadians, Dr. Ahmed thinks he may have realized the error of his ways. “We had a rash of cases where we had to deal with the fallout from his work but the last one was about a year ago. Last I heard he had moved on.”  

And will there ever be an end to people who don’t have the good sense to take their health seriously? Josef Woodman has the last word: “Unfortunately and tragically, the most extremely “stupid” mistakes, though few and far between, are lethal. I know of one patient who traveled to Costa Rica for cosmetic surgery, did not heed her doctor’s advice to stay nearby to recover and to stay out of the sun.  She instead traveled deep into rural Panama, did not attend properly to her wounds, they became infected and she died. Thus, in general, I would say that not complying with doctor’s orders and reasonable measures pre- and post-op is unwise.”  

[1] Published by Healthy Travel Media. www.patientsbeyondborders.com

[3] Figures courtesy of Josef Woodman