FOR SHEER EERINESS, NO SITUATION I"VE HEARD OF IN RECENT MONTHS had more impact that of the airforce pilots flying beside the doomed Cypriot airliner that would soon crash and take the lives of all aboard. They reported seeing no pilot, and a co-pilot slumped over the controls.

If I may risk taking the analogy too far, refractive surgery last month suffered its equivalent of such a disaster: the announcement of a record-setting $7 million LASIK malpractice award out of New York, at the heart of which was a case of suspected keratoconus. The buzz generated in the ophthalmology community is understandably at a high level; what the consumer media and the LASIK fearmongers of the world will do with this remains to be seen. But right now, we're all essentially flying by with no more ability to determine right or wrong, culpability or innocence than those fighter pilots had to determine the state of that unfortunate airliner.

An aviation expert recently said that there is never a single cause for a plane crash. It's probably also true that in the vast majority of malpractice suits—despite what plaintiff's attorneys want to claim and juries seem to want to hear—there is not a single cause for a malpractice award.
But just as the infamous 2002 LASIK award to an Arizona airline pilot highlighted the need for better understanding of and preop assessment of pupil size and subsequent changes in treatment zones, the best long-term outcome that the industry can hope for is a push toward better technology for detecting keratoconus suspects.

How serious a risk is post-LASIK ectasia due to inadequate preop assessment of the cornea? Within a certain range, fairly minute. But how wide is that range? It depends on whom you ask. But one thing we now know is that it's wide enough to drive a jury of not-your-peers (read: patients) through. And the industry can't leave surgeons in that position for long.

Educating the public about the risk of ectasia may not serve short-term profit margins, but it would make for a healthier refractive surgery market in the long term. Even more important, educating the public about what the profession and the industry are doing to solve the problem in terms of dollars devoted to research, and progress in improving technology, would also make more informed patients (read: jurors).
Would be worth the investment, even if it's $7 million.