Texas Trial of the Century
Texas Trial of the Century
By Jan P. Bergmanson, O.D., Ph.D., and Leigh Anne Green, B.A.
This mock trial presents conflicting arguments
about the safety of refractive surgery. Find out the jury's verdict.
The varied opinions regarding laser refractive surgery were voiced in the "Texas
Trial of the Century," held in conjunction with the Cornea, Contact Lenses and
Contemporary Vision Care 15th Annual Symposium on December 5th, 1998, in Houston, Texas.
Practitioners, predominantly from Texas (85 percent), but also from other states (13
percent) and abroad (2 percent), attended a meeting organized by the University of Houston
College of Optometry's office of Continuing Optometric Education Department (Director,
Niki Bedell). The highlight of the meeting was a thought-provoking debate regarding the
detriment, or lack thereof, to the corneal tissue and vision after laser refractive
The trial was officiated by "Judge" Kent Buckingham, O.D., J.D., who is a
pre-eminent malpractice trial lawyer with several multimillion dollar settlements to his
credit, and both law and optometry degrees from the University of Houston. The
"jury," composed of 50 randomly selected optometrists who were in attendance at
the meeting, was presented with a series of questions prior to the trial in order to
survey their pretrial opinions. A heavily decorated optometry and ophthalmology coalition
consisting of Brien Holden, Ph.D., D.Sc. and Dwight Cavanagh, M.D., Ph.D. led the
prosecution. They came to the trial claiming that laser refractive surgery too frequently
poses significant harm to the pristine corneal tissues that over millions of years of
evolution, have evolved to their present, near-perfect form. However, the defense team,
also an optometry and ophthalmology coalition with the experience of thousands of
successful surgeries on their records, was led by local experts, John Goosey, M.D., and
Richard Baker, O.D. This excellent defense team made a strong case advocating the safety
and success of laser refractive surgery.
The prosecution and the defense were each allowed two witnesses to assist in making
their case. The prosecution's first witness provided the jury with her experience and
dissatisfaction with a photorefractive keratotomy (PRK) laser surgery, which had a
less-than-ideal outcome. The prosecution's second witness, an ophthalmologist and lawyer,
provided legal insight and challenged business ethics regarding laser refractive
The defense provided two fact witnesses who convincingly testified to the safety of the
laser procedures. The first witness was an ophthalmologist who routinely performs laser
refractive procedures and feels confident about the safety of such procedures. The second
witness, who also happened to be an ophthalmologist, was very pleased with the outcome.
After both sides presented their case and offered closing comments, and witnesses had been
introduced and questioned by both sides, the jury was asked to deliberate over a coffee
Pre- and post-trial questioning consisted of questions asking the jurors about
background data and probed them for their opinions regarding the case at hand. The
practitioner survey indicated that the majority of refractive surgery patients were taken
from the contact lens wearing population. However, it's unlikely that all of the
refractive surgery candidates would be recruited from only contact lens failures, as often
is being claimed. This belief clearly demonstrates that laser refractive surgery
proves to be a tough competitor for the contact lens market. To compete effectively, the
contact lens market needs to position itself as a compelling solution for patients who are
in need of a convenient, safe and precise vision correction modality.
According to a survey conducted at this mock trial, the typical patient considering
laser refractive surgery is 31-40 years of age and tends to have a sizeable disposable
income available for nonessential items. Among the jury members themselves, 11 percent
were patients of laser refractive surgery, whereas 31 percent were current contact lens
wearers. Presumably, an approximated 60 percent of the jurors were wearing spectacles or
no form of vision correction at all.
Pretrial questioning determined that 84 percent of the practitioners involved had
previously referred a patient for refractive surgery. After having heard the factual
arguments, this number decreased to 58 percent when practitioners were asked the same
question again after the trial, "Would you now recommend laser refractive surgery to
a patient?" Therefore, a significant 26 percent had second thoughts regarding laser
refractive surgery after the prosecution's facts and their witnesses presentations.
However, this meant that the majority of the jury (58 percent) still felt confident enough
to continue to refer patients for laser refractive surgery. When presented with the
question of whether they felt that complications occurred in too many cases for the
surgery to be regarded as safe, a majority opinion of 56 percent answered "no."
Even though the defense maintained the majority vote of the jury on these issues, the
prosecution swung the majority opinion from 84 percent to 58 percent when they asked
practitioners if they would refer patients for laser refractive surgery. It could
therefore be argued that the prosecution was the moral victor in this trial. The eminent
members of the prosecution certainly felt this to be their victory, but naturally, the
defense proclaimed a victory of their own since the majority was still favorable to laser
refractive surgery, both as being a safe procedure (56%) and as being one that a
practitioner would refer their patients for (58%). The results of the practitioners
questions are listed in the sidebar on the page 44 (sample size = 50).
This mock trial allowed for educated and informed opinions to be voiced, and created
convincing arguments for and against laser refractive surgery. This event was a rare
meeting of some of the most distinguished professionals in the field, making for an
exceptional educational experience. We thank all of the participants for making the event
such a memorable and educational one.
The extensive involvement of optometry in laser refractive surgery and care is evident,
and speaks for its wide acceptance in the Texas community.
Dr. Bergmanson is a professor of optometry and director of the Laser Laboratory and
the Anatomy and Pathology Laboratory at the University of Houston.
Leigh Anne Green is a fourth year optometry student at the University of Houston,
currently working with Dr. Bergmanson.
Questions Asked Prior to the Trial
1. Where do you practice?
a. Texas-metropolitan area 70%
b. Texas-rural area 15%
c. Other U.S. state-metropolitan area 9%
d. Other U.S. state-rural area 4%
e. Outside the United States 2%
2. Are you male or female?
a. Male 84%
b. Female 7%
c. Not given 9%
3. Have you referred patients for laser refractive surgery?
a. Yes 84%
b. No 16%
4. If yes, from what population do your refractive surgery patients come from?
a. Contact lens wearers 67%
b. Spectacle wearers 26%
c. Other 7%
5. In what age range do you find most of your refractive surgery candidates?
a. 21 - 30 16%
b. 31 - 40 73%
c. 41 - 50 11%
d. 51 - 60 0%
e. 61+ 0%
6. Have you had laser refractive surgery?
a. Yes 11%
b . No 89%
7. Do you wear contact lenses?
a. Yes 31%
b. No 69%
8. Would you now recommend laser refractive surgery to a patient?
a. Yes 58%
b. No 42%
9. Did the prosecution convincingly demonstrate laser refractive surgery to be
detrimental to corneal health in a significant number of cases?
a. Yes 44%
b. No 48%
10. Did the defense convincingly demonstrate laser refractive surgery to be beneficial?
a. Yes 52%
b. No 48%
11. Who won the debate?
a. The prosecution 53%
b. The defense 47%
Contact Lens Spectrum, Issue: January 2000