LASIK: Evaluate Pre-Op Patients Thoroughly with an Eye towards Potential Litigation

While working on the Medical Law Perspectives, January 2017 Report: Under Pressure: Liability Risks in Diagnosing and Treating Glaucoma, I noticed a trend among the medical malpractice cases related to glaucoma: the failure to diagnose glaucoma prior to performing LASIK (laser-assisted in situ keratomileusis) surgery. LASIK surgery is 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. According to the Glaucoma Research Foundation, individuals who are at risk of developing glaucoma or already have glaucoma require special considerations before, during, and after LASIK surgery.

Glaucoma is one of many red flags for people thinking of undergoing LASIK surgery. People with retinitis pigmentosa, a rare, genetic disorder that involves a breakdown and loss of cells in the retina, risk very poor vision after refractive surgery. For example, in Odoardi v. Abramson, 2016 WL 6684858 (N.Y.A.D. 1 Dept., November 15, 2016) (not designated for publication), a man sued his ophthalmologist for failing to diagnose his retinitis pigmentosa prior to referring him for LASIK surgery. 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. 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 Appellate Division of the New York Supreme Court, First Department, 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 were unpersuasive.


This anecdotal evidence was supported by statistics from a recent study of the potential risk of severe problems that can result from LASIK surgery. Some study participants developed problems after having LASIK surgery, which severely impacted the patient’s daily living, such as difficulty driving at night, debilitating vision symptoms (seeing starbursts, glare, ghosting, or halos), and severe dry eye. The study found that up to 46 percent of participants, who had no visual symptoms before surgery, reported at least one visual symptom at three months after surgery. Of the participants who developed new visual symptoms after surgery, most developed halos. Up to 40 percent of participants with no halos before LASIK surgery had halos three months following surgery. Up to 28 percent of participants with no dry eye symptoms before LASIK surgery reported dry eye symptoms at three months after their surgery.


Perhaps the most worrisome finding in the study was that participants were more than twice as likely to report their visual symptoms on a questionnaire as to tell them to their health care provider. The implication for litigation is that the health care provider will probably never see the lawsuit coming.


By Sarah Kelman, JD, and the experts and editors at Medical Law Perspectives.

See also Medical Law Perspectives, January 2017: Under Pressure: Liability Risks in Diagnosing and Treating Glaucoma


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


For more further discussion on Odoardi v. Abramson, 2016 WL 6684858 (N.Y.A.D. 1 Dept., November 15, 2016) (not designated for publication), see Scalpel Weekly News, November 28, 2016: Ophthalmologist Failed to Diagnose Retinitis Pigmentosa; Post-LASIK Tunnel Vision.


For more details about the FDA study of the potential risk of severe problems that can result from LASIK, see the Scalpel Weekly News, December 4, 2016: Post-LASIK Problems Severely Impact Patients’ Daily Living.


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