2023-11-20 10:00:00
One of the largest groups of ophthalmology clinics in Quebec carries out procedures deemed “superfluous and useless”, according to specialists in the field consulted by The Presswhich inflate the bill by several thousand dollars given to patients undergoing refractive cataract surgery.
Louise Moreau went to the Bellevue clinic in Longueuil in February 2021 for cataract surgery. There she met the Dr Paul Harasymowycz, medical director of the Bellevue clinics and professor at the University of Montreal.
During the meeting, the Dr Harasymowycz recommended that Louise Moreau have specialized lenses called “Symfony Toric” that correct both her cataract and her astigmatism, known as refractive cataract surgery. “It was attractive, for me, the fact of no longer wearing glasses,” confides Mme Moreau.
The Bellevue clinics, which bring together six establishments in Quebec and around sixty ophthalmologists, are private establishments whose doctors are members of the Régie de l’assurance santé du Québec (RAMQ). Some of their services, such as cataract extraction, are covered by the public plan. Others, linked to the correction of astigmatism, are not. Louise Moreau therefore agrees to go ahead with the twenty-minute procedure, the bill for which amounts to $6,400, or $3,200 per eye.
A significant portion of his bill, $2,400, is attributed to “relaxing incisions,” a procedure also aimed at correcting his astigmatism.
However, ophthalmologists normally choose lens implantation or even incisions to correct this visual disorder, but not both procedures simultaneously, according to Dr.r Paul Thompson, ophthalmologist at the University of Montreal Hospital Center (CHUM).
If a specialist opts for the implantation of a toric lens, “it becomes superfluous and unnecessary to make relaxing incisions at the same time,” says the D.re Marie-Claude Blouin, ophthalmologist at Hôtel-Dieu in Sorel and expert doctor for the College of Physicians and for the Canadian Medical Protective Association in previous appeals.
A “weird” way of doing things
The Press consulted two other invoices from patients who were operated on by Dr Paul Harasymowycz in the last three years which confirm that Louise Moreau’s situation is not unique. In both cases, patients underwent relaxing incisions in addition to lens implantation.
I cannot imagine a clinical situation in which it would be useful to perform both relaxing incisions and cataract surgery with a toric lens at the same time, in the same procedure.
The Dr Éric Fortin, clinical coordinator of the University Ophthalmology Center of the University of Montreal
The combination of the two procedures could also cause certain harmful effects, indicates the Dr Davin Johnson, specialist in cataract, refractive and corneal surgery and professor in the department of ophthalmology at Queen’s University in Kingston, Ontario. “Relaxing incisions sever the nerves that provide sensation to the cornea. Although these nerves regenerate, the combination of procedures potentially increases the risk of dry eye after surgery,” he explains.
The president of the Association of Ophthalmological Doctors of Quebec (AMOQ), Dr.r Salim Lahoud, for his part, considers this way of doing things “bizarre”, although he prefers not to pass judgment without having examined the file in detail. “I find it an unusual procedure to say the least,” he said.
As for the Canadian Ophthalmological Society, it did not want to provide a comment. We therefore turned to the French Society of Ophthalmology, where the Dre Barbara Ameline-Chalumeau, a specialist in refractive and cataract surgery, said by email that she sees “no reason to do [les deux procédures] systematically.”
Optimize vision
The Press agreed to a telephone interview with the director of medical and surgical operations at the Bellevue clinics, Mylaine Beaudry, the Dr Paul Harasymowycz not available.
Mylaine Beaudry simply responded that the clinic specialists “operate in compliance with regulations” and have “never had any problems with the health insurance plan or the College of Physicians”. She declined other questions asked by telephone, preferring to respond in writing.
In response to the request for The Press As to whether all Bellevue Clinics patients who choose toric lens implantation also receive relaxing incisions during the same procedure, she said via email that “toric lenses do not correct astigmatism completely, because they come in standard diopters” and that “the relaxing incisions correct the residual astigmatism of each patient in a personalized way”.
Patients’ astigmatism is measured in diopters (D), but Symfony toric lenses are only available in 0.50 D increments, or half diopters, D explains.rs Marie-Claude Blouin and Paul Thompson.
Mylaine Beaudry maintains that clinics complete the correction by means of relaxing incisions, in order to optimize “vision after the operation” and “reduce secondary dysphotoopia”, commonly called light halos.
Best practices
The experts consulted by The Press refute the Bellevue clinics’ explanation. According to the Dre Marie-Claude Blouin, it is simply not necessary to correct astigmatism lower than 0.50 D. “Moreover, a residual amount of astigmatism of less than 0.50 D is far from being problematic and is even desirable, because it is proven that very slight astigmatism can improve depth of field,” she explains.
The Dr Paul Thompson, from CHUM, second.
A little astigmatism isn’t bad. Sometimes it can even help with reading. So, half a diopter, no one is going to have fun correcting that.
The Dr Paul Thompson, ophthalmologist at CHUM
He says relaxing incisions may be an option in cases where significant astigmatism persists in the months following lens implantation. However, he is perplexed by the need to perform both procedures simultaneously. “There, I can’t explain this approach,” he said.
The Dre Blouin is of the same opinion. “If the goal was truly to obtain the greatest degree of precision possible [après l’opération]”The best way would be to first install the toric lens, let the eye heal, and then check the final refractive result,” she says. If astigmatism with a real impact on the patient’s vision persists, “at this point, a second laser intervention or relaxing incisions could be offered to the patient.”
When we asked Bellevue clinics why their professionals do not wait until after the healing period to perform relaxing incisions in patients who require them, medical director Mylaine Beaudry referred us to the previously mentioned rationale.
Anger and sadness
Despite the implantation of lenses and relaxing incisions, Louise Moreau still has to wear glasses at all times, since her vision has not improved sufficiently following the procedure. His dry eyes have also worsened and now require daily care and medication.
“I experienced a lot of anger and sadness,” confides Louise Moreau, swallowing back sobs. “As we age, we become more vulnerable. But I took my courage in both hands and decided to pursue small claims. » In the consent form that she had signed before the operation, it was indicated that “the refractive intervention is not reimbursed in the event of a complication”, but that an amount “may be reimbursed according to the opinion [du] specialist”.
Louise Moreau therefore tried to have the costs of the operation reimbursed. Faced with the lack of responses from the clinic, she chose to file a lawsuit in October 2021. “The clinic contested my request and refused mediation. Noting the slowness of legal proceedings, currently three to four years in small claims, and experiencing the stress of waiting, I made the decision to withdraw my lawsuit in September. My health and inner peace are more important than money,” says Mme Moreau.
For its part, the Clinic did not want to comment on this case out of concern for confidentiality. As for Louise Moreau, she retains a bitter taste from her experience with the Bellevue clinic, affirming that her quality of life has deteriorated since her operation. “How can I not be disappointed to learn that I may have been overcharged? I hope this experience can help others to be very vigilant and not hesitate to question the fees and ask for a second opinion. »
Learn more
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- 110 000
- Number of cataract operations performed each year on average in Quebec between 2018 and 2022
Source: RAMQ
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