Good Vision Is a Human Right
Response by the RSA to the CRST Europe debate on the organization’s stance on laser vision correction as a human right.
How do organisms interact with their world? That was the theme of my undergraduate honors program in neurophysiology. The question almost sounds philosophical in its origin, and it led us to a 2-year investigation of how organisms from the amoeba to the human use sensory perception to navigate their surroundings. It was a journey that explored all the senses—including some that humans do not possess—and it sparked in me a passion for visual sciences that burns bright to this day.
As I read with interest the article “Laser Vision Correction: A Human Right?” in the April issue of CRST Europe,1 I was again struck by the importance of vision, a sense that most of us would prioritize over all others. Vision is the primary means by which we humans navigate our world, and, therefore, the ability to see is fundamental to the human experience. To have some people deprived of good vision by virtue of genetics is unjust, given that we have the means and technology to correct it.
I consider air, food, and water to be human rights. That does not mean that everyone has easy access to them, nor does it mean governments necessarily should pay for access to them. It simply means that these are essential components to being human, as is good vision.
THE IMPACT OF REFRACTIVE ERROR
The impact of refractive error varies based on location. In the developed world, refractive errors impose an involuntary economic tax. Even when these errors are corrected, they subject the individual to a variety of potential problems—susceptibility to infections with contact lenses, fragility of glasses, limits on occupational opportunities, lifestyle challenges, personal safety concerns, inconvenience, and altered appearance—solely by virtue of that person’s genetics.
The impact of refractive error in the developing world is worse. According to the United Nations, three out of every four people with refractive errors in the developing world do not have the glasses or contact lenses needed to correct their vision.2 This is not only unconscionable, it is an economic waste. Think of the benefit to these individuals and their countries if they could see better.
Ophthalmologists are drawn to pathologies because we are trained to intervene and fix them. We spend endless hours attending meetings and researching cataract surgery, keratoplasties, glaucoma therapies, and retinal treatments. This work is crucial, but the number of people we reach with our interventions pales in comparison with the number of people who exist without refractive correction. The Lions Club, the Rotary Club, the World Health Organization, and other laudable organizations have been working for years to deliver refractive appliances around the world. Their efforts are heroic, but their solutions are temporary. Literally billions of people are in need (see By the Numbers).
The call by the Refractive Surgery Alliance (RSA) to frame refractive surgery as a human rights issue was meant to appeal to human decency and the obligation that ophthalmologists have to address this treatable condition. (Editor’s Note: To read the full news release in which this statement was made, visit http://www.prnewswire.com/news-releases/physicians-healing-themselves-300191814.html".)
With state-of-the-art technologies, the visual results of refractive surgery can surpass the vision provided by glasses or contact lenses. Although refractive surgery complications can occur, they are rare and much less common than complications with contact lenses. The overall safety profile with refractive surgery is better than that of glasses, too, because glasses can be lost or broken or become foggy.
Beyond the obvious benefits, the economics of refractive surgery is compelling. Personal costs are reduced, and performance, lifestyle, and occupational fitness are improved.
Had today’s refractive surgery technologies existed before glasses and contact lenses, nobody would question the idea that surgical vision correction should be routine. To wit, imagine a hypothetical scenario in which trauma resulted in a man’s severe leg injury. In this scenario, the man has two choices to fix his condition: (1) to be fit with an expensive prosthetic leg apparatus that would need to be replaced and changed throughout his lifetime or (2) to have surgery to repair and restore his leg to health. For people who are good candidates for refractive surgery, the treatment of myopia is really no different.
The CRST Europe article posed the question of whether laser vision correction is a human right, but some of the comments provided by surgeons in our field changed from a discussion about vision and rights to a conversation about public payments and government reimbursement. Because something is a right does not mean someone else has to pay for it. Economically sustainable (and profitable) models exist to deliver refractive correction on a global basis. Everyone in those models prospers, especially patients.
The economic benefits of refractive surgery make government and third-party payment unnecessary. A discussion of business models is not the focus here, but, even if the business model did require subsidies, the subject of payment is separate from the topic of rights. Further, this discussion could not have been contemplated prior to the existence and refinement of modern-day refractive surgery technologies.
Refractive errors cause unnecessary expense and limit productivity. As a community, we can intervene. Rather than focus on the obstacles, let us turn our efforts to the solutions.
I believe that history will look back at our time and see refractive surgery as a major turning point in human development. It is the first time that we have been able to correct a functionally debilitating congenital defect on a mass scale. Let us hope that history will also be able to look back at our time as the era when good vision was delivered on a global basis. Once it has become the norm, the discussion of rights will not be needed.
Guy M. Kezirian, MD, FACS, for the Refractive Surgery Alliance*
Founder, Refractive Surgery Alliance
1. Straub L. Laser Vision Correction: A Human Right? CRST Europe. 2016;4:30-34.
2. WHO website. Visual impairment and blindness 2010. http://www.who.int/blindness/data_maps/VIFACTSHEETGLODAT2010full.pdf?ua=1. Accessed April 25, 2016.
*Disclaimer: The mission of the RSA is to grow refractive surgery by growing every member’s practice. The RSA is physician-funded and does not accept industry sponsorship. The RSA’s focus is on business development, not clinical issues or politics. The RSA’s view of vision correction is based on the perceived benefit to patients and the ability to deliver refractive correction with current technologies. The views expressed here are those of the RSA and do not necessarily reflect the personal views of each RSA member.