Wearing thick-lensed glasses, Brent Jesperson had no problem performing his work as a dentist. Playing sports with the Coke-bottle spectacles on was another matter.
So Jesperson jumped at the chance to undergo the first generation of vision-correction surgery in 1994, especially after his chosen ophthalmologist suggested the risks were minimal.
The “radial keratotomy (RK)” seemed to be a success at first, but over the years his eyesight actually worsened, with blurriness in one eye, glare and impaired depth perception.
Finally, unable to work on patients and feeling depressed and suicidal, Jesperson abandoned his lucrative dental practice in 2009.
This week, a Toronto judge ordered Dr. Yair Karas to pay him $ 5.6 million in compensation for what she deemed a poorly done and misleadingly explained operation.
“His life has changed dramatically now because of his vision problems,” said Justice Darla Wilson of Jesperson. “He cannot work as a dentist, he gets eye strain that causes headaches and he finds he is fatigued.”
The case points to the potential fallout of an elective surgery that was performed on thousands of nearsighted Canadians for years, before being replaced by safer, more effective laser procedures.
But the judgement also found Karas fell short of standards in effect at the time. The ophthalmologist conducted the radial keratotomy negligently and failed to warn his patient of known risks, ones the dentist likely would not have taken, the Ontario Superior Court of Justice member concluded.
“Dr. Karas knew that the work of a dentist required good, clear vision to do fine work in the small, dark spaces of the mouth,” wrote Wilson. “An individual who required excellent vision to work at his chosen occupation would not risk his career for the potential benefit of playing sports without glasses.”
The judge also rejected the ophthalmologist’s defence that Jesperson’s vision problems were largely caused by a bug that flew into his eye in 2008.
Karas, 78, retired in 2016, but the dentist case was not his only brush with the legal or regulatory systems.
He faced at least two other malpractice suits alleging similar problems after RK surgery, though one was dismissed last year for being filed too late.
And in 2006, the College of Physicians and Surgeons obtained a voluntary undertaking from Karas that he would no longer perform radial keratotomy.
Neither Jesperson, Karas nor the doctor’s lawyer could be reached for comment Wednesday.
His life has changed dramatically now because of his vision problems
Neil Sacks of law firm Howie, Sacks & Henry, the Pickering, Ont., dentist’s lawyer, declined to comment on Wednesday.
In a 2013 interview with the Toronto Star, Karas said he had performed 10,000 RK treatments with generally excellent results, adding that it was inevitable a few of those patients would be unhappy. It was also the best treatment available at the time, he noted, one that he taught to other physicians.
“There’s 1,000 police officers in Toronto that got into the police because of what I did, there’s 50 pilots in Air Canada that are flying with my surgery — otherwise they wouldn’t get in — and there is at least 1,000 firefighters in Canada,” Karas told the Star.
Radial keratotomy — invented by a Russian doctor in the 1970s — involves making incisions with a diamond blade in the cornea in a radial pattern around a clear area, flattening the cornea and ideally correcting the myopia.
It began to be replaced in the 1990s by laser-assisted procedures such as LASIK that were eventually shown to have better results and fewer complications.
Jesperson’s vision improved after his initial RK procedure but he still needed glasses and went back a year later for a further operation. His eyesight was almost perfect for a time, but in subsequent years problems gradually developed and worsened, the ruling concludes.
An individual who required excellent vision to work at his chosen occupation would not risk his career for the potential benefit of playing sports without glasses
Wilson found that Karas failed to mention potential long-term complications and overstated the chances Jesperson could “throw away” his glasses, meaning he did not obtain the required informed consent before operating.
The judge also concluded the ophthalmologist didn’t meet the standard of care at the time, using a pattern of incisions that left too small a clear area and that cut into the eye’s limbus, known to reduce the effectiveness of the operation.
Most of the damages were to compensate for money Jesperson could not earn. By the time he quit dentistry in 2009, he was making $ 400,000 a year in salary and profit from the practice he co-owned with another dentist.
Wilson awarded about $ 2.5 million in damages each for income lost in the past and potential income in the future, as well as other forms of compensation.