Excerpt: Warning letters after eye surgeries Bay Area patients told doctors reused blades

By Julie Sevrens
San Jose Mercury News
5.23.00

A Bay Area eye center has notified 2,700 patients that they could have been exposed to infectious diseases because the blades used in laser surgery may have been routinely reused on other patients before being discarded.

Letters have been sent to patients of the LaserVue Eye Center alerting them that disposable microkeratome blades were routinely reused on patients undergoing laser eye surgery at the company's San Francisco and Santa Rosa locations.

For more than two years, doctors at both sites reportedly rinsed the equipment -- which is used to cut flaps in a patient's corneas -- in a water solution before using them again, even though medical protocol calls for blades to be thrown away after use.

Furthermore, the blade holders were sterilized only after every fourth patient, a violation of medical guidelines, according to a state health department investigation.

The department requested that the firm send letters to its patients informing them of the practice of reusing the blades. The doctors have since stopped the practice, and the state medical board is reviewing the case.

It is possible, though the chances are very slight, that infectious diseases such as hepatitis B and C as well as the AIDS virus could have been transmitted in this manner.

"A fourth-grader would understand you need to follow at least these basic sterilization procedures," said Geoff Gordon-Creed, a San Francisco attorney who has filed a class-action lawsuit against the center and two of its physicians.

Drs. Sanjay Bansal and Swati Singh told health department investigators they reused blades in an attempt to give patients the best eye care possible. The physicians contended that they only reused those blades that served them well in prior surgeries, and that they threw away any that had visible blood on them.

"That was the reason why the blades were being (reused) -- for precision purposes -- not to compromise the procedure in any way or put anyone at a health risk," said Patrice Smith, a spokeswoman for LaserVue. "Much of the procedure is in the blade itself. The ability of the blade to cut well."

Other eye surgeons said they were appalled by the practice of reusing surgical blades and believe the LaserVue case is rare among eye clinics.

"There's no excuse for it," said Dr. Gary Kawesch of the Laser Eye Center of Silicon Valley, which has offices in San Jose and Pleasanton. "The concept of not sterilizing is something that is a very basic principle of surgery. The potential for disease transmission is huge."

Most clinics discard the microkeratome blades after performing laser surgery on a single patient, Kawesch said. Very few surgeons he's aware of reuse blades, but when they do they sterilize them between patients. Most eye surgeons use ethylene oxide gas or steam to sterilize blades.

The blades, he says, cost $40 to $65 apiece, and one is used to complete the laser surgery on both eyes of a patient.

"I feel that for the fees patients are paying they deserve a fresh blade," Kawesch said. The surgery costs about $5,000 for both eyes.

Manufacturers recommend in their literature that blades be used only once, then thrown out, according to Dr. Hamid Sajjadi, who performs laser eye surgeries at the Ellis Eye Center and Silicon Valley Eye Laser Center.

Although diseases are more commonly transmitted through blood, there is evidence they can spread through contact with tears and other conjunctival tissue, said Dr. Jon Rosenberg, medical epidemiologist with the state health department.

The first patients began receiving their letters earlier this month, and many remain in a state of disbelief.

"I thought it was a joke," said Debbie Shubin, a Sebastopol mortgage broker who paid $4,400 to have her eyes operated on last year. "I could not believe that Dr. Bansal, with all of these diseases that are out there, would reuse an unsanitary blade on more than one patient."

"I would never have had the surgery had I known he was going to be reusing blades," she said. "I don't know anybody who would put themselves through that."