Ophthalmology Malpractice

Cataracts Surgery Errors

Damaged Cornea | Permanent Vision Loss

Unnecessary Cataract Surgery

A cataract is the clouding of the normally clear, natural crystalline lens of the eye. The normally clear lens can become cloudy, which blocks or scatters some light and prevents it from reaching the retina in sharp focus. This causes blurred vision and glare.

Recognized risk factors associated with developing cataracts include the following:

• Age
• • 60 years of age and older
• Medical Conditions
• • Diabetes and other systemic diseases, glaucoma, and metabolic abnormalities can cause cataracts.
• Physical Injury
• • Commonly called traumatic cataracts. A blow to the eye, great heat or cold, chemical injury, exposure to radiation (usually associated with radiation therapy for cancer patients), and other injuries can lead to cataract formation.
• Ultraviolet radiation (UVA or UVB)
• • Long-term exposure to sunlight is believed to speed the development of cataracts.
• Oral steroids and other medications
• • Oral steroids (such as prednisone), the gout medication allopurinol, the breast cancer drug tamoxifen, the heart medication amiodorone, and the long-term use of aspirin have also been associated with cataracts.
• Smoking
• • Smokers are twice as likely to develop cataracts than nonsmokers and that quitting can reduce the risk for developing cataracts.

Most cataracts generally progress slowly over a period of years. They can affect one eye or both eyes. As cataracts become more dense, they produce visual symptoms; these typically include blur, glare, halos around lights, and double vision. Colors can become dull, a brown-yellow tint is common, and driving can become dangerous.

An increasing problem is unnecessary cataract surgery. Because cataracts develop slowly, immediate surgery is often not required. Premature surgery performed to remove cataracts, which results in corneal injury or permanent vision loss, may be grounds for an ophthalmology malpractice claim.

Common Cataracts Surgery

Most cataract operations are performed in an outpatient setting, typically a doctor's office or surgery center. Often, the ophthalmologist has ownership in the surgery center, so the ophthalmologist is paid not only for performing the surgery, but for the fees paid to the surgery center for use of its operating room. In the past 20 years, however, small artificial lenses that can be implanted in the eye have been developed. These are called intraocular lenses (IOLs).

The most common cataract surgery technique is phacoemulsification, also known as "phaco."

The ophthalmologist makes a small incision at the edge of the cornea and then creates an opening in the membrane that surrounds the cataractous lens. Then a small probe is inserted through the opening in the cornea and capsule. The probe's vibrating tip breaks up or "emulsifies" the cloudy lens into tiny fragments that are suctioned out of the capsule by an attachment on the probe tip.

After the lens is completely removed, the probe is withdrawn leaving only the clear opening pocket, which will hold the intraocular lens (IOL).

After removal of the cataract-damaged lens, an artificial intraocular lens (IOL) is implanted.

Ophthalmology Malpractice and Cataract Surgery Errors

Failure to Administer Antibiotic Eyedrops

Failure to Diagnose and Treat Endophthalmitis

Antibiotic eyedrops are needed to decrease the risk of developing an infection inside the eye called endophthalmitis.

In the event the eye develops the endophthalmitis infection, antibiotics may be injected into the eye to control the spread of the infection. In rare instances, additional surgery, called a vitrectomy, is indicated. During this procedure, the vitreous (a jelly-like material inside the eye) is removed to control infection.

Failure to diagnose endophthalmitis following cataracts surgery, and aggressively treat it, which then results in permanent vision loss or blindness, may be grounds for an ophthalmology malpractice claim.

Failure to Diagnose Cystoid Macular Edema

The back part of the eye is lined by the retina, which is a layer of nerve cells that can sense light. The central portion of the retina is called the macula, which responds to light in the center of the visual field.

Following cataract surgery, inflammation may develop, which can cause the fine blood vessels in the retina to leak fluid that gathers in the macula, causing it to swell. The result is decreased vision in the central part of the visual field.

This swelling is called cystoid macular edema. To determine the extent of the swelling, a test called a fluorescein angiogram or ocular coherence tomography may be done. A patient who notices a decrease in vision as time goes by after cataract surgery should contact his or her ophthalmologist immediately.

If the ophthalmologist fails to diagnose this condition aggressively treat the condition, or refer the serious problem to a retinal specialist, and blindness or permanent vision loss occurs, then this may be grounds for a malpractice claim.

Macular edema is treated with anti-inflammatory eyedrops. Sometimes, injections of steroids behind the eye or vitrectomy surgery are done to resolve the problem.

Failure to Diagnose Retinal Detachment

In some patients, cataract surgery may increase the risk for retinal detachment, which occurs when vitreous fluid leaks through a tear in the retina. The leak may cause the retina to separate from the back of the eye.

Patients with retinal detachments may notice what appears to be a curtain moving across part or all of the field of vision. Early symptoms of retinal detachment include flashes of light (e.g. lightning streaks) and dark spots that appear to float in the visual field ("floaters"), but these symptoms occur frequently during the normal recovery from cataract surgery. Patients who notice flashes, floaters, or loss of part of their visual field should contact their ophthalmologist immediately.

If the ophthalmologist fails to diagnose this condition and refer the serious problem to a vitreo-retinal specialist (retinal specialist), and blindness or permanent vision loss occurs, then this may be grounds for a medical malpractice claim.

Dislocated Lens Material

On rare occasions, fragments of the cataractous lens fall into the vitreous cavity behind the thin membrane that normally surrounds the lens. The ophthalmologist may recommend a vitrectomy to remove the lens material and prevent inflammation.

Failure to timely detect this condition, treat it, or refer the patient to a retinal specialist to treat the condition, which results in permanent eye damage, including blindness, may be grounds for a medical malpractice claim.

Choroidal Hemorrhage

The retina receives its blood supply from a delicate web of fine blood vessels called the choroid. During cataract surgery, the choroid begins to bleed, a condition known as a choroidal hemorrhage. It is more likely to occur in elderly patients and those with glaucoma or high blood pressure.

This issue can be identified in pre-surgery screening, and may determine whether the patient is a suitable candidate for cataracts surgery.

If the hemorrhage is confined to a small area of the choroid, patients often recover without significant visual loss. However, in the most severe cases of choroidal hemorrhage, patients can have complete and permanent visual loss.

In modern cataract surgery, the use of small incisions has reduced the severity of choroidal hemorrhages.

Corneal Injury

During the cataracts surgery, the ophthalmologist may scratch or tear the cornea during the surgery. This is a very painful condition, and should be recognized immediately by the treating ophthalmologist.

In the event a corneal scratch or tear is caused by the surgery, then immediate referral to a corneal specialist is often warranted.

If left untreated, this condition can lead to permanent vision loss and blindness.

Improper Pre-Surgery Screening

Proper screening is necessary, and this is another common source of cataract surgery error leading to ophthalmology claims: poor pre-surgery cataracts screening and performing the surgery on non-surgical candidates, which leads to permanent vision loss or blindness, may be grounds for a medical malpractice claim.

Before a physician recommends cataract surgery, a complete eye examination must be performed. During this examination, it may become clear that a simple change in the eyeglass prescription will restore good vision. However, if a change in prescription fails to restore vision to an acceptable level, additional tests will be needed.

Unnecessary cataracts surgery is often revenue driven. In other words, when cataracts surgery is not needed but performed because the ophthalmologist is seeking to make a profit -- in which ophthalmologists perform cataract surgery on large volumes of patients to increase their revenue -- ultimately not only does the patient suffer, but so do taxpayers who are paying Medicare taxes for unnecessary treatments.

Medical Malpractice Attorney

If you have been the victim of malpractice because of errors in cataracts surgery , and suffered blindness or permanent vision loss, then contact our office for an immediate, confidential, consultation.