Some studies found that there was a decreased incidence of retinal detachment, glaucoma, or cystoid macular edema in early vitrectomy group compared to delay of more than 1 week to 1 month.34,3740 Others found only a trend toward better visual acuity outcome with earlier vitrectomy.32,33,36 Yet others found that there was no difference in terms of the incidence of retinal detachment or glaucoma or visual acuity outcome with the timing of vitrectomy.2031,35, Furthermore, there is no clear evidence that all patients with retained lens fragments need to be referred or need surgical management. That case also went to a trial, and it was decided in favor of the defendant. WebMedical board investigations are now often triggered by mandatory reports from surgery centers and hospitals. Stilma JS, van der Sluijs FA, van Meurs JC, Mertens DA. In addition to the original cataract surgery, patients underwent a mean of 1.3 additional surgeries (range, 04) where one or more combined procedures were performed. The attorney listings on this site are paid attorney advertising. However, when there was a claim related to retained lens fragments, this study found that the age and gender of the physician did not affect the legal outcomes. Ross WH. Even when an IOL was initially placed at the time of complicated cataract surgery, subsequent dislocation of IOL occurred in 6 cases. Miller KP. However, there is no prospective randomized clinical trial to guide which cases should be referred for surgical management. 8600 Rockville Pike Hickson GB, Clayton EW, Githens PB, Sloan FA. This grouping was done to compare the findings of this study to other published data. Factors associated with these claims and claims outcomes were analyzed. As noted already, the majority of claims are dropped, dismissed, or closed without payment. The retina specialist confirmed that the IOL was well positioned without vitreous in the anterior segment. However, as consultants, vitreoretinal surgeons should remember that they are still at a risk for being included in lawsuits directed toward other physicians and may be named as primary defendants due to significant potential for severe visual impairment among the conditions they manage.16. However, they could not eliminate the possibility of the second week of surgery being just as adequate, since this time point could not be analyzed based on the published studies. Design/methodology/approach In this mixed-methods study, the SEIPS framework was used to analyse a series of (near) misses of IOL The doctor-patient relationship and malpractice: lessons from plaintiff depositions. Medical liability claim frequency: a 20072008 snapshot of physicians. Hansson LJ, Larsson J. Vitrectomy for retained lens fragments in the vitreous after phacoemulsification. One analysis was performed with the litigation outcomes divided into (1) trial, (2) settlement, and (3) dismissed. However, the cataract surgeon did not document having made this call and the case was settled. In 91 eyes, preoperative visual acuity was recorded for both eyes. In the last 2 years the femtosecond laser has been developed to assist in cataract surg Read More. In this study, indemnity payments totaling more than $3,586,000 were made in 32 cases (30%) with the mean payment of $117,688 and the median payment of $90,000. Kachalia A, Kaufman SR, Boothman R, et al. In comparison, indemnity payment for all closed claims for OMIC is a mean of $150,000 and median of $75,000. Among the 108 cases, two physicians had multiple claims relating to retained lens fragments, with 2 claims each. Holak sued Tyson and Eye Associates. If you've suffered an adverse outcome after cataract surgery, you might be wondering if you can or should sue your eye doctor for medical malpractice. This article discusses the most common risks of cataract surgeries, how to prove medical malpractice, and the challenges you will face in a cataract surgery medical malpractice lawsuit. Another claim alleged that there was a delay in time to pars plana vitrectomy by the retinal surgeon to manage the elevated intraocular pressure. Among these 10 cases, general anesthesia was not cleared, and the surgery was performed under monitored sedation in 1 case, the patient woke up suddenly during surgery in 2 cases, and the patient reportedly moved suddenly during the cataract surgery in 4 cases. Vincent C, Young M, Phillips A. Transactions of the American Ophthalmological Society, http://www.amaassn.org/ama1/pub/upload/mm/363/prp-201001-claim-freq.pdf, http://www.omic.com/about/financial_info/members_rpt.cfm, MVR blade to impale the fragment that landed on optic nerve, Duration of claim opening to closing (months), Duration between surgery and claim occurring (months), Duration of claim opening to closing (Months). Claims with referral within 1 week of the complicated cataract surgery had a lower amount of indemnity payment and were more likely to be dismissed. Over 3 million cataract surgeries are performed annually in the United States.18 Given the frequency of this procedure, perhaps it is not surprising that cataract surgery is the single most frequently named procedure in malpractice actions against ophthalmologists.1315 An uncommon but potentially devastating complication of cataract surgery that can affect both the anterior segment and the posterior segment surgeons is posterior dislocation or retention of lens fragments during cataract surgery. These items can be broadly separated into those pertaining to (1) the physician, (2) the patient, (3) preoperative, intraoperative, and postoperative clinical data, and (4) the litigation. Although the final visual acuity was important, the most important factor associated with going to a trial or resulting in an indemnity payment was found to be the amount of visual acuity loss following cataract surgery complicated by retained lens fragments, such that the greater the difference between the baseline visual acuity and the final visual acuity, the greater the likelihood of a claim resulting in a trial or indemnity payment. If a physician had multiple claims from separate cataract surgeries, each was counted separately. The The remaining 76 claims (70%) closed without any payments. Available at: Slora EJ, Gonzales ML. Florida and Louisiana each had 10 claims. The .gov means its official. However, the majority of the claims were dismissed and did not result in an indemnity payment. Poorly documented cases were deemed more difficult to defend, whereas claims with aggressive intraocular manipulation by the cataract surgeon resulting in retinal detachment were more likely to result in poor final visual acuity and were more likely to go to a trial or settle. AC IOL, anterior intraocular lens; OD, right eye; OMIC, Ophthalmic Mutual Insurance Company; OS, left eye; PC IOL, posterior intraocular lens; VA, visual acuity. Therefore, cases that start out with poor visual acuity and end up with poor final visual acuity are less likely to result in a trial, settlement, or indemnity payment than cases with relatively good preoperative visual acuity that end up with poor final visual acuity. Ways to reduce significant vision loss, including improved management of corneal edema and IOP, and timely referral to a subspecialist should be considered. Early vitrectomy was considered to be between days 3 and 7 after the cataract surgery in their study. Another analysis was performed with the litigation outcomes grouped as (1) indemnity payment and (2) no indemnity payment. The documentation includes informed consent, office examination notes, operative notes, any conversation with the patient before or after the cataract surgery, as well as any discussions with a specialist. After your cloudy lens is removed, it will be replaced with an implanted clear artificial lens called an intraocular lens (IOL). The number of cases in each visual acuity grouping for claims with payment and no payment is also shown. Levinson W, Roter DL, Mullooly JP, et al. In one case, the surgical technician failed to securely attach the cystotome to the needle, and the cystotome shot off during injection of the viscoelastic material. Simon and colleagues12 found that the most common surgical confusion in ophthalmology was use of the wrong IOL implants. Furthermore, a review of closed claims by Studdert and colleagues80 showed that no injury had occurred in 3% of malpractice claims, and there had been no error in another 37% of claims. This study was carried out for a number of reasons: (1) the absence of published studies addressing the legal outcomes for this complication despite the number of cataract surgeries being performed in the United States; (2) tremendous interest in the management and outcomes of this potentially visually devastating complication based on the large number of published studies on this topic; (3) the relevance of study findings to both the anterior and posterior segment specialists; and (4) a potential to improve patient outcomes. Management of dislocated lens material. Additional categorization and analyses were performed in this study to include claims outcomes of trial vs settlement vs dismissal in hopes of gaining additional information, such as legal expenses that may differ for these groupings, as well as to highlight factors associated with claims that result in a verdict for the plaintiff vs that for the defendant when there was a trial. Among the 108 claims, 107 claims had a record of which eye was operated on; 42 cases (39%) involved the right eye and 65 (61%) involved the left eye. Baldwin LM, Larson EH, Hart LG, et al. However, all claims with a record of aggressive intraoperative manipulation by the cataract surgeon resulted in retinal detachment. On 5/20/14, the patient was admitted to Cataract & Laser Center West, in W. Springfield, Massachusetts, for right eye phacoemulsification with implantation of posterior chamber intraocular lens. Retained lens fragments can be successfully managed by the retina specialists in most cases. Intraocular lens was implanted in 85 (90%) of 94 cases where this was recorded, with 63 (67%) being posterior chamber IOL and 22 (23%) being anterior chamber IOL. Tackling the dropped nucleus. The majority of eyes developed one or more ocular complications following surgery, many of which contributed to poor visual outcome. A new trial and correction of the amount of verdict and judgment were all denied by the trial judge. Professional liability insurance: II The legal environment. These transformed variables were used in further analyses. Claims data of all the identified claims based on coding were reviewed and further narrowed to include only those claims where there was a mention of a retained, dropped, or dislocated crystalline lens fragment with or without other comorbidities. The doctor used a technical lens for my right eye and a standard lens for the left one. In contrast, 29 (45%) of 65 cases with no indemnity payment had final visual acuity of 20/200 or worse. Furthermore, they estimated that an additional $45.59 billion was spent on defensive medicine, most of which went to pay for tests, procedures, and treatments associated with defensive medicine. Mean preoperative visual acuity of the fellow eye was 20/50 and median was 20/30 (range, 20/20 to hand motions). He also damaged the film over the WebFor us at UCLA, its a nonissue, he said, noting that in the departments 40 years, theres never been a wrong-site cataract surgery. The site is secure. If you've suffered an adverse outcome after cataract surgery, you might be wondering if you can or should sue your eye doctor for medical malpractice. The retina successfully reattached with a final visual acuity of 20/25. The current study is not inclusive of all claims related to retained lens fragments in the United States that occurred during the study period. When there was a trial, the verdict was likely to be in favor of the defendant, similar to most malpractice claims. Smiddy WE, Guererro JL, Pinto R, Feuer W. Retinal detachment rate after vitrectomy for retained lens material after phacoemulsification. Copyright 2023 MH Sub I, LLC dba Nolo Self-help services may not be permitted in all states. Of the 108 defendants, 105 (97%) were cataract surgeons and only 3 (3%) were retinal surgeons. Management of dislocated nuclear fragments after phacoemulsification. Borne MJ, Tasman W, Regillo C, Malecha M, Sarin L. Outcomes of vitrectomy for retained lens fragments. The overwhelming majority of the referrals were to a retina specialist, but referrals also included cornea and glaucoma specialists. One month after the cataract surgery, the patient called and reported that the vision in the right side of the left eye was gone. He was seen on the same day and found to have visual acuity of 20/400 with a superotemporal retinal detachment. They found that the claims frequency for ophthalmology was slightly lower than the average for all specialties and was in between nephrology and diagnostic radiology. A retrospective review was performed of all closed claims during the 21 years from 1989 through 2009 of those insured by OMIC to identify cases associated with cataract surgeries complicated by retained lens fragments (see Inclusion and Exclusion Criteria section that follows). Studdert DM, Mello MM, Gawande AA, et al. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments after phacoemulsification. bill1952 Has anyone who experienced a negative result from the Symfony lens brought a product liability lawsuit against Johnson and Johnson or a malpractice lawsuit against their eye surgeon? Displacement of nuclear fragments into the vitreous complicating phacoemulsification surgery in the UK: clinical features, outcomes and management. Furthermore, these malpractice claims data can be used to identify ways to improve patient safety, develop risk management programs, and provide an excellent opportunity to enhance patient care related to an ophthalmic subspecialty or an ophthalmic procedure. Acuity improved to 20/200, but eventually the eye became phthisical with light perception vision at 19 months after the initial cataract surgery. Please reference the Terms of Use and the Supplemental Terms for specific information related to your state. Accessibility The number of closed claims related to cataract surgery complicated by retained lens fragments each year from 1989 through 2009. Learn more Most people may get benefited from an IOL transplant during surgery. Managing a dropped nucleus during the phacoemulsification learning curve. This gender spread was compared with OMIC data on demographics. In one study that did attempt comparison of observation vs vitrectomy, randomization was not possible because of bias toward vitrectomy for larger lens fragments and more severe inflammation.40. In contrast, among the 47 cases where referral to a specialist was earlier than 1 week, only 28% went on to a trial or settlement. Although there were no cases involving residents, there was one claim against a policyholder ophthalmologist who was overseeing a colleagues attempt at learning cataract surgery. The information provided on this site is not legal advice, does not constitute a lawyer referral service, and no attorney-client or confidential relationship is or will be formed by use of the site. In the multivariate analysis, two factors were found to be associated with indemnity payment: (1) the difference between preoperative visual acuity and final visual acuity and (2) the development of corneal edema or corneal decompensation. My vision actually was worse after the lens placement. Trial with a verdict was assumed to be a more severe outcome than settled, since historically longer duration between opening and closing of a claim and higher costs are associated with trials compared to settled claims. Therefore, appropriate management of elevated intraocular pressure is necessary to reduce poor patient outcome. Glaucoma was defined as elevated intraocular pressure requiring pressure-lowering medication or documented visual field defect. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. Continuous irrigation was performed, but the nuclear fragment could not be elevated. Interestingly, this physician had another case brought against him 6 years later. American College of Obstetricians and Gynecologists. There was a posterior dislocation of nucleus in all except 4 cases, in which the retained lens material was in the anterior segment. DESCRIPTIVE STATISTICS OF THE ANALYSIS VARIABLES GROUPED BY WHETHER INDEMNITY WAS PAID. Sufficient and legible documentations, including visual acuity, intraocular pressure, status of the cornea, IOL position, and dilated fundus examination, are essential for risk management purposes. Financial Disclosures: Mr Weber is an employee of Ophthalmic Mutual Insurance Company. Additionally, there can be surprises in post-penetrating keratoplasty patients and in cases where the anterior segment of the eye is disproportionately sized compared to the overall length of the eye. Author Contributions: Design and conduct of the study (J.K.); Collection, management, analysis, and interpretation of the data (J.K., P.W., A.S.); Preparation, review, and approval of the manuscript (J.K., P.W., A.S.). Vanner EA, Stewart MW. WebAllegation Wrong power IOL insertion led to complicated lens exchange surgery. Retinal detachment in eyes undergoing pars plana vitrectomy for removal of retained lens fragments. However, when this complication is associated with retinal detachment, the visual outcome is often poor even after successful reattachment.21,6163 Development of retinal detachment was not found to be one of the factors associated with the claims outcome in this study, possibly because of small sample size or satisfactory management by the retina specialists even when retinal detachment occurred. Claims were excluded when found not to pertain to retained lens fragments but were due to dislocated intraocular lens (IOL), wrong intraocular lens, endophthalmitis, or retinal detachment following cataract surgery. A claim may include institution of a lawsuit or arbitration proceedings against the insured. PMC legacy view The mean defense costs were significantly lower in cases that were dismissed but were considerably higher in cases that went on to a trial, even when there was no indemnity paid. Romero-Aroca P, Fernndez-Ballart J, Mndez-Marn I, Salvat-Serra M, Baget-Bernaldiz M, Buil-Calvo JA. Physicians with higher clinical activity also may have greater exposure or deal with more complex medical situations. Of the 108 defendants, 105 (97%) were cataract surgeons and only 3 (3%) were retinal surgeons. Although there were no cases involving residents, there was one claim against a policyholder ophthalmologist who was overseeing a colleagues attempt at learning cataract surgery. All variables significant in the univariate analyses were included in a multivariate logistic regression model. In 3 cases, malfunctioning or unavailability of necessary equipment resulting in prolonged cataract surgery time was thought to have contributed to the patient movement and complication of capsular tear. Postoperatively, dilated fundus examination should be performed to detect possible retinal detachment, and patients should be promptly referred to a retina specialist when it occurs or if the fundus cannot be visualized well by indirect ophthalmoscopy.15,28,34,61 In this study, there were 3 claims that named the retinal surgeon as the defendant. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. Indemnity payment occurred in those claims that went on to a trial and a verdict in favor of the plaintiff was made or in claims that settled. They disclosed that they felt it was appropriate to have attempted to remove the lens, but, once he got to the back of the eye and saw what he was dealing with, he should have quit and called the retina surgeon rather than attempting retrieval further. They believed that he was not experienced enough to proceed as he had. Posterior-assisted levitation in cataract surgery. This trend may reflect increased popularity and adaptation of phacoemulsification by cataract surgeons in the mid-1990s and increased complication rates during transition period from extracapsular cataract surgery. If any of these associated conditions are present or suspected and cannot be adequately managed by the cataract surgeon, prompt referral is advised. There were differences between claims associated with retained lens fragments that went on to a trial vs settled vs dismissed and whether indemnity payment occurred or not. But if your eyes reflexively squint or close with light exposure, it could be a signal of inflammation in the eye, or iritis. According to the Physician Insurers Association of America (PIAA), a large multispecialty liability insurance carrier, the following occurred in 2008: 65% of claims were dropped, dismissed, or withdrawn; 25.7% were settled; 4.5% were decided by alternative dispute mechanism; and 5% were resolved by trial, with the defendant prevailing in 90% of those tried cases.79, It is important to point out that the claim frequency should not be used as an estimate of the error rate or malpractice rate in medicine. Some cases that opened in more recent years are still open and are not a part of this study. This division allowed additional information regarding the duration between opening and closing of the claim and legal expenses for each group. The vitrectomy probe was inserted in an attempt to aspirate the lens, but the lens could not be aspirated to be removed. The first categorization was needed to evaluate legal costs incurred for each category of legal outcomes. All variables significant at a 10% level in the univariate analyses were included in a multivariate proportional odds regression model. Of the 108 physician defendants, 94 (87%) were men and 14 (13%) were women. Univariate descriptions of the analysis variables grouped by the presence of indemnity payment are shown in Table 6. In addition to the review of the closed claim cases related to the complication of retained lens fragments, other data that were thought to be relevant to the study were obtained from OMIC and analyzed for comparison with the findings from this study. Cohen SM, Davis A, Cukrowski C. Cystoid macular edema after pars plana vitrectomy for retained lens fragments. The third claim alleged decreased vision following negligent vitrectomy surgery to manage retained lens fragment. WebThere has been a large interest over the years in clinical outcomes and management of retained lens fragments as evidenced by the substantial number of articles continuing to The patient was referred the same day as the complicated cataract surgery to the retina specialist, who performed pars plana vitrectomy on the following day without any complications. Cases to be included in the study were identified based on OMIC coding for claims resulting from complications related to cataract surgery. Every year, millions of people have routine surgery to replace a cataract that is, a lens in the eye that has become clouded. Cataract surgery involves removing a cloudy lens from the patient's eye and replacing it with a clear, artificial lens. Margherio RR, Margherio AR, Pendergast SD, et al. The purpose of this paper is to explore the use of the Systems Engineering Initiative for Patient Safety (SEIPS) framework to sustainably reduce wrong intraocular lens (IOL) implants in cataract surgery. i'm sorry to read of your troubles and I know enough as a practicing physician for 20 years that your course has deviated from the typical cataract What helps? 23-gauge transconjunctival sutureless vitrectomy for retained lens fragments after complicated cataract surgery. WebSurgery for cataracts involves removing the cataract-ridden lens of the eye and either replacing it with an artificial lens called an IOL implant or compensating for its absence with eyeglasses or contact lenses. Medical malpractice cases present a complex interaction between medical and legal issues, and it typically takes an experienced medical malpractice attorney working alongside a well-qualified expert witness to present the best case. Of the 30 claims that were settled, there were 6 claims from Illinois; 5 from Florida; 3 from California; 2 claims each from Colorado, Michigan, and New York; and one claim each from Georgia, Louisiana, Missouri, Nevada, Tennessee, Texas, Virginia, Washington, West Virginia, and Wyoming. Therefore, claims related to cataract surgery accounted for 33% of all closed claims during this period, and cataract surgeries complicated by retained lens fragments accounted for 4% of all closed claims and 12.5% of cataract-related claims. A study based on a survey of retina specialists recommended that vitreoretinal surgeons should place an increased importance on the informed consent process and the patient/doctor relationship in order to improve risk management.16 Informed consent is a process rather than a form. Closed claims data related to cataract surgeries complicated by retained lens fragments (1989 through 2009) from an ophthalmic insurance carrier were reviewed. To be insured by OMIC, an ophthalmologist must be a member of the American Academy of Ophthalmology. In the second case, a male patient with advanced posterior subcapsular cataract in the left eye underwent cataract surgery with phacoemulsification in 1996, reportedly without complications. After the trial, the jurors were polled. Once an insured becomes aware that a wrong site surgery or incorrect power iOL insertion has occurred, the incident should be reported to OMICs Claims Department or confidential Risk Management hotline at (800) 562-6642, option 2 Gonzalez ML. sharing sensitive information, make sure youre on a federal The https:// ensures that you are connecting to the The issue of malpractice has wide-ranging stakeholders, including our society. There were 11 cases (10%) from the Northeastern states, 32 (30%) from the Midwest, 25 (23%) from the Western states, 12 (11%) from the Southern states, and 28 (26%) from the Southeastern states. Kraushar MF, Robb JH. Physician surveys and actuarial data show that one risk factor for lawsuit is the area of specialty, where surgeons, obstetricians, and gynecologists are sued more often than physicians from nonsurgical specialties.25,82 Other studies have shown that the claim frequencies increase with increasing age of the physician, physicians with higher clinical activity, male gender, a previous claims history, and higher frequency of patient complaints. National Library of Medicine Vitrectomy with endoscopy for management of retained lens fragments and/or posteriorly dislocated intraocular lens. Physician age ranged from 31 to 72 years (mean, 49 years). Schutz JS, Mavrakanas NA. The overwhelming majority of allegations consisted of negligent cataract surgery with or without subsequent complications, followed by delayed diagnosis or referral, and issues related to preoperative discussions such as informed consent. In most states, some form of special procedural rules exist for medical malpractice cases, and these rules are specifically designed to make suing a health care provider more difficult, when compared with "ordinary" civil cases for personal injury. Another study found that 7.4% of all physicians had a malpractice claim each year, with 1.6% having a claim leading to a payment.5 The proportion of physicians facing a claim each year ranged from 2.6% in psychiatry to 19.1% in neurosurgery. The patient was released to a general ophthalmologist. Many are related to retained lens fragments with 108 unique cataract surgeries, 97% against cataract surgeon and The defense experts stated that these cases were more difficult to defend. Retained intravitreal lens fragments after cataract surgery. If a surgeon who had some retinal training was deemed not specialized enough to manage such a case, it may be best for most cataract surgeons to seek expertise of a retina specialist and avoid aggressive retrieval. Medical malpractice claims stemming from cataract surgeryrelated ophthalmic care present a unique opportunity to examine the risks associated with this frequently performed intraocular surgery and to improve the safety of patients. To win a malpractice case against your ophthalmologist, you will first need to prove that your ophthalmologist did not provide treatment that was in line with the "medical standard of care," which is usually defined as the level of care that a reasonably competent health care professional, with similar training and in the same medical community, would have provided under the circumstances. I am currently evaluating a similar case in involving a surgeon placing a wrong lens into a patient, however the error was recognized during the su
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