Addressing ethical concerns in eye tourism for ocular surgeries

Dear Editor, Globally, a significant rise in medical tourism for eye surgeries has been reported, depicting a high demand for eye care services across borders.[1] In fact, the findings of a retrospective study done in Turkey highlighted that a significantly higher proportion of visiting patients underwent corneal refractive procedures and had a much shorter postoperative follow-up period compared with local patients.[2] This growth in ophthalmology tourism is driven by a combination of lower costs, shorter waiting times at destination centers, active marketing, the influence of social media, attractive packages (such as health plus holiday), shortages or unequal access to donor tissue and transplant facilities, regulatory differences, and other factors.[1,2] The objectives of the article are to identify the potential ethical concerns in eye tourism and propose solutions to overcome the same. This unprecedented rise in ophthalmology tourism has presented a broad range of ethical challenges for various stakeholders.[2–5] Patients who travel for eye surgery often experience variable clinical standards (namely concise preoperative assessment, shorter stays, and postoperative follow-up), which together augment the risk of complications and jeopardize patient safety.[2] In fact, higher rates of surgical complications (due to limited follow-up), variable refractive outcomes, and postoperative infections (due to risk of travel) have been reported among patients.[2] Ethical concerns have been reported regarding the obtaining of valid informed consent, where patients are either not fully informed about the procedure or face language barriers.[3] There have been issues of exploitation of patients, wherein commercialization and aggressive marketing have been given priority instead of patient welfare, which often results in ignoring the potential risks.[4] In other words, this has led to a general tendency for hospitals to prioritize revenue from foreign patients than local patients. Moreover, the trade of cross-border corneal procurement has raised ethical concerns regarding equitable allocation and often unethical procurement practices.[5] In continuation, differences in regulations and a lack of international accountability have created legal and ethical gaps, which give a platform for malpractices.[4,5] Further, there are definite concerns regarding maintaining the privacy of medical records, especially in cases of transnational transfer.[3–5] Acknowledging the presence of multiple ethical concerns in ophthalmology tourism and the potential harmful consequences, there is an urgent need to involve different stakeholders [Table 1].[1,3,6–8] To begin with, patients need to be more diligent about the entire process and thoroughly understand the risks of eye surgeries across borders.[1] In this regard, healthcare providers play a significant role in ensuring transparent communication with patients and consistently adhering to ethical standards, regardless of commercial pressures from any sources.[1] However, for sustained results, the local governments must contribute to the entire process by creating appropriate regulatory provisions and implementing strict measures to prevent unethical procurement of donor corneas.[6]Table 1: Potential interventions to overcome ethical challengesThere is a definite need for the formulation of global standards, and based on these standards, accreditation of eye surgery centers should be carried out.[7] The prices for various ophthalmic procedures must be kept transparent and publicly displayed, allowing patients to make informed decisions. Moreover, the methods for obtaining informed consent should be strengthened, and this will ensure better accountability.[3] In addition, the sourcing and allocation of corneal tissues must be conducted ethically and in accordance with the norms established by the government and international agencies.[6] This calls for developing cross-border medicolegal agreements, as such steps can streamline all the problems.[6] Finally, eye surgery centers must develop telemedicine facilities to enable and ensure postoperative continuity of care, especially for patients who cannot stay back for necessary follow-up.[8] In conclusion, tourism for eye surgeries has a positive side, but it has also raised significant ethical concerns. The need of the hour is to adopt a patient-centered approach, built on the framework of clear ethical guidelines, international collaboration, and better patient education. Data availability statement Data will be made available on reasonable request to the corresponding authors. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.