Ophthalmology expert witness advises on failure to diagnose corneal disease from LASIK surgery

ByKristin Casler

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Updated onOctober 14, 2017

Ophthalmology expert witness advises on failure to diagnose corneal disease from LASIK surgery

An ophthalmology expert witness advises on a case involving failure to diagnose corneal disease that led to long-term damage from LASIK surgery. The plaintiff, located in New Hampshire, who was in his late 20s, was evaluated by the defendant ophthalmologists for possible LASIK laser eye surgery. Corneal topography studies were normal, but the plaintiff had worn his contact lenses the day of the study and during the five previous days. Repeat testing without the contact lenses several days later revealed corneal abnormalities. Despite the test results, the plaintiff was cleared for and received LASIK surgery that day.

Two years later, the plaintiff reported to the defendants that he had symptoms of monocular diplopia, halo, glare and decreased vision. The defendants did not tell the plaintiff that he was suffering from post-LASIK ectasia.

The plaintiff sued the ophthalmologists for medical malpractice.

Question(s) For Expert Witness

1. Should the LASIK surgery have been performed?

2. What should the defendants have told the plaintiff about his condition?

3. Was this medical malpractice?

Expert Witness Response

inline imageThe second pre-surgery testing showed corneal abnormalities bilaterally. Specifically, the right eye showed clear abnormalities in three of four studies and borderline abnormality in the fourth. Orbscans of the right eye showed asymmetrical elevation, abnormal topography with an irregular asymmetric corneal astigmatism centrally and paracentrally, and thinnest portion of the cornea was not in the center of the cornea as it normally should be. Corneal topography of the left eye demonstrated borderline abnormalities.

inline imageTaken together, the corneal topographies showed that the patient was suffering from corneal disease — form fruste keratoconus, a dormant, sub-clinical condition — which is a well-known, generally accepted contra-indication to doing LASIK, because of the risk, among others, of developing corneal ectasia, a progressive thinning, warping and irregular bulging of the cornea, with attendant progressive severe visual problems. It usually takes one to two years before the patient begins to experience symptoms because the ectasia is progressive.

inline imageOrbscan studies two years later in the defendants’ office showed a high degree of irregular corneal astigmatism, with progressively worsening corneal topographies, consistent with the complication of post-LASIK ectasia. At this point, the defendants knew, or should have known, before the expiration of the 2½ year statute of limitations, that the patient was suffering from post-LASIK ectasia but did not tell the patient. Medical records prepared by the defendants contain no progress notes for the patient's subsequent orbscan studies, as would be good practice. This may suggest reluctance on the part of the defendants to put in writing what they already knew or suspected, as was the sudden, unexplained cancellation by one defendant of previously scheduled enhancement surgery. It is also noteworthy that the defendants did not provide the patient's subsequent treating ophthalmologist with copies of the incriminating report of the orbscan studies of the right eye from the pre-LASIK visit.

inline imageIn my opinion, the patient's LASIK-induced keratoconus or post-LASIK ectasia was a direct and proximate cause of his LASIK surgery. Medical malpractice was committed in this matter, in clearing the patient for LASIK, and in performing LASIK on this patient.

inline imageThe expert is a board-certified Ophthalmologist specializing in anterior segment surgery of the eye including LASIK laser vision correction.

About the author

Kristin Casler

Kristin Casler

Kristin Casler is a seasoned legal writer and journalist with an extensive background in litigation news coverage. For 17 years, she served as the editor for LexisNexis Mealey’s litigation news monitor, a role that positioned her at the forefront of reporting on pivotal legal developments. Her expertise includes covering cases related to the Supreme Court's expert admissibility ruling in Daubert v. Merrell Dow Pharmaceuticals Inc., a critical area in both civil and criminal litigation concerning the challenges of 'junk science' testimony.

Kristin's work primarily involves reporting on a diverse range of legal subjects, with particular emphasis on cases in asbestos litigation, insurance, personal injury, antitrust, mortgage lending, and testimony issues in conviction cases. Her contributions as a journalist have been instrumental in providing in-depth, informed analysis on the evolving landscape of these complex legal areas. Her ability to dissect and communicate intricate legal proceedings and rulings makes her a valuable resource in the legal journalism field.

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