The clinical negligence team at Penningtons Manches LLP acts in a range of cases involving clients who have experienced a poor outcome following ophthalmic surgery, and in particular laser eye surgery.
In one such case, the team has received admissions from a consultant ophthalmic surgeon that multiple procedures he performed on a patient’s eyes were in breach of duty and should never have been carried out.
The team’s client has a long-standing history of short-sightedness which began in childhood. This was corrected with spectacles and later with contact lenses, but he continued to experience various eyesight conditions over the years, including dry eye symptoms, episodes of conjunctivitis, and ocular surface disease. He also suffered from meibomianitis, in which the glands that secrete oil to protect the corneal surface of the eye become inflamed, and blepharitis, where the edges of the eyelids become inflamed. He also suffered from a skin condition known as acne rosacea, which aggravated his eye problems.
In his late 40s, the client was attracted by an advert on the high street promoting laser eye surgery and the promise of avoiding the need for glasses and contact lenses. Rather than attending an unregulated high street laser eye clinic, he sought advice from a consultant ophthalmic surgeon at a reputable private health clinic, Optegra.
At Optegra, a nurse and then the surgeon asked the client a series of standard questions before advising him that he was a suitable candidate for laser eye surgery in both eyes. He was offered LASIK, a procedure in which a laser or fine blade is used to create a flap in the top layer of the cornea. The flap is then lifted back and the cornea reshaped in order to change the angle of refraction of light into the eye. The objective is to improve the focus of light through the cornea onto the retinal cells at the back of the eye to enable clearer vision.
Although the client was given a long consent form to sign, it was not properly explained to him. In particular, the surgeon admits that he did not discuss the fact that the procedure would make the client’s already flat corneas even flatter. This carried the significant risk of causing greater problems with refraction and deterioration in vision. After the operation, the client’s vision was worse. His visual acuity hadreduced and his dry eye was aggravated.
Despite this decline in his condition, the same surgeon advised the client that further laser surgery in his right eye was likely to improve things. He was offered LASEK, where a laser is used to reshape the surface of the cornea, in another attempt to improve refraction and focus light more accurately on the retina. This was, however, inappropriate for the client given his cornea was already very flat. The LASEK made the client’s vision even worse in his right eye.
The surgeon went on to compound the problems caused by the two previous laser surgeries by offering and performing lens replacement surgery in both the client’s eyes. He had developed a cataract in his left eye, which he agreed would ultimately have needed removing and an artificial lens implanting at some point. The surgeon, however, offered multi-focal lens implants despite the highly variable refraction caused by the damage to the client’s corneas from the surgeries already performed. The surgeon has now admitted that the lens replacements were also negligent and that he caused irreversible damage to the client’s eyesight as a result.
Following these surgeries, the client was initially left with very little vision. He could no longer see at all without contact lenses and was unable to wear spectacles to correct his vision because of the irregular surface of his eyes. He has had very severe dry eye symptoms, which limit his tolerance to contact lenses and as a result of the damage he suffered, he has had to stop work as a successful businessman, co-running a small company. Over time and with very careful management by a consultant ophthalmologist and highly specialised optician, some of his symptoms have improved and he has reached a point where he is able to wear special gas permeable contact lenses for an average of four or five hours a day. When he cannot wear these though, he has no useful vision.
Andrew Clayton of Penningtons Manches’ clinical negligence team, who specialises in ophthalmic claims, comments: “While we welcome the surgeon’s admissions that he was negligent in proceeding with each of the operations he performed on our client, the case is a salient reminder that laser eye surgery is not without risk and the impact when it goes wrong can be devastating.
“A large majority of patients benefit from good results, but the outcome depends on proper pre-operative investigation to assess each individual’s suitability. It is incumbent on all those providing laser eye surgery to explore fully each patient’s objectives and their personal risks before advising them to go ahead with the procedure. From the cases in which we are involved, it is clear that there is also a need for greater public awareness of the risks associated with laser eye surgery.”