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Ophthalmologist Failed to Diagnose Retinitis Pigmentosa; Post-LASIK Tunnel Vision


A man presented to an ophthalmologist to obtain a referral for LASIK (laser-assisted in situ keratomileusis) surgery, a type of refractive eye surgery that permanently changes the shape of the cornea to improve vision and reduce a person's need for glasses or contact lenses. The ophthalmologist conducted an examination to determine if the man was an appropriate candidate for the procedure. The ophthalmologist referred the man to a LASIK surgeon for the procedure.

 

After the man underwent LASIK surgery, his visual perceptions worsened. He developed tunnel vision, which is significant loss of the visual field, the area of space that is visible at a given instant without moving the eyes.

 

He was subsequently diagnosed with retinitis pigmentosa, a rare, genetic disorder that involves a breakdown and loss of cells in the retina. According to the National Eye Institute, in the early stages of retinitis pigmentosa, people experience night blindness and a progressive loss of the visual field. In the late stages of retinitis pigmentosa, people tend to lose more of the visual field, developing tunnel vision.

 

The man sued the ophthalmologist for medical negligence and lack of informed consent. The complaint alleged that the ophthalmologist was negligent in failing to diagnose the man with retinitis pigmentosa at the pre-LASIK surgery exam. The complaint argued that, if the ophthalmologist had properly diagnosed the man’s retinitis pigmentosa, the ophthalmologist would not have referred the man for LASIK surgery due to the potential risk of very poor vision after refractive surgery for people with retinitis pigmentosa.

 

The ophthalmologist filed a motion for summary judgment and made a prima facie showing of entitlement to summary judgment on the ground that nothing at the time of the man’s pre-LASIK surgery exam should have alerted the ophthalmologist to the man having retinitis pigmentosa. The ophthalmologist argued that he could not be liable on a claim for lack of informed consent because he was merely a referring physician.

 

In response to the ophthalmologist’s motion for summary judgment, the man presented the testimony of an expert who opined that the pre-LASIK surgery exam should have alerted the ophthalmologist to the man having retinitis pigmentosa. The expert’s opinion was based on the man’s complaints before surgery concerning problems with his vision. The expert’s opinion was also based on the relatively stable condition of the man’s retinitis pigmentosa after it was diagnosed, which indicated that the disease was not of sudden onset and had already expressed itself at the time of the pre-LASIK surgery exam.

 

The New York County Supreme Court denied the ophthalmologist’s motion for summary judgment.

 

The Appellate Division of the New York Supreme Court, First Department, affirmed. The court held that the man’s expert raised questions of fact as to the accuracy of the ophthalmologist’s assertion that nothing at the time of the man’s pre-LASIK surgery exam should have alerted the ophthalmologist to the man having retinitis pigmentosa and the ophthalmologist’s argument that he could not be liable on a claim for lack of informed consent because he was merely a referring physician was unpersuasive.

 

The man’s expert raised questions of fact as to the accuracy of the ophthalmologist’s assertion that nothing at the time of the man’s pre-LASIK surgery exam should have alerted the ophthalmologist to the man having retinitis pigmentosa. The court found that the man’s expert’s opinion was not speculative. The court also noted that the ophthalmologist was not entitled to summary judgment on proximate cause grounds. The court found that while LASIK surgery does not cause or accelerate retinitis pigmentosa, the man’s expert and his nonparty treating physician testified that LASIK surgery in individuals with retinitis pigmentosa can cause a patient’s visual perceptions to worsen, as if they were looking through a tunnel.

 

The ophthalmologist’s argument that he could not be liable on a claim for lack of informed consent because he was merely a referring physician was unpersuasive. The court based its conclusion on the evidence that the ophthalmologist co-managed the man’s care and that the LASIK surgeon specifically relied on the ophthalmologist’s examination to clear the man for surgery.

 

The Appellate Division of the New York Supreme Court, First Department, affirmed the trial court’s denial of the ophthalmologist’s motion for summary judgment.

 

See: Odoardi v. Abramson, 2016 WL 6684858 (N.Y.A.D. 1 Dept., November 15, 2016) (not designated for publication).

 

See also Medical Law Perspectives, July 2016 Report: Unlocking Genetic Secrets: Liability Risks for Genetic Testing and Information Providers

 

See also Medical Law Perspectives, July 2014: Injuries Resulting From Laser Procedures: Risks for Physicians, Technicians, and Manufacturers

 

See also Medical Law Perspectives, March 2013: When Cataract Treatment Creates More Harm Than Cure: Malpractice Liability Issues 

 

 

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