ETHICAL CONSIDERATIONS IN LASER-ASSISTED REFRACTIVE SURGERY

P. Curcă, C. I. Tătaru, M. Burcea, C. Tătaru,

Abstract: Introduction. Clinical ethics based on principlism of Tom Beauchamp and James Childress have become an inherent part of medical practice. Laser-assisted refractive surgery corrects refractive errors by remodeling the anterior corneal curvature, and is perceived by the patient as a simple, low-risk intervention that provides excellent measured visual results and quality of life improvement.
Materials and methods. A wide-targeted search of Clarivate Web ok Knowledge and PUBMED databases was performed for papers within the last 15 years concerning patient selection for refractive surgery, efficacy and safety of the procedure, complications and legal recourse.
Results and discussion. Laser-assisted refractive surgery was found to have high perceived and effective beneficence for the patient, providing spectacle-independent vision with excellent safety profile. Non-maleficence requires completeness of preoperative screening for conditions such as corneal ectasia or managing systemic disease such as autoimmune disorders. It is critical for autonomy to fully inform the patient on a wide range of possible complications or unwanted results including quality of vision effects such as photic phenomena (glare and rainbow glare, haze, halos) or variance in the healing process that can lead to refractive regression, buildup of corneal haze or other healing complications. Justice was sought for negligence in treament or informed consent.
Conclusion. Refractive surgery satisfies the bioethical principles, being benefic both to the patient and to society. Completeness of information for the patient is of utmost importance. Minimizing risk and providing therapeutic management to complications while preserving the patient-physician relation is a mark of professionalism and averts harm and dissatisfaction to the patient.
Keywords: laser-assisted refractive surgery, cornea