Penningtons Manches has recently succeeded in having judgment entered at the High Court for a client who suffered repeated negligence under the care of a specialist ophthalmic surgeon at an Optegra centre.
The client had worn glasses and later contact lenses for many years to correct short-sightedness (myopia), but was attracted to the possibility of surgery that would rid him of the need for these. However, he had a history of multiple problems with his eyes, including conjunctivitis, meibomianitis, blepharitis, dry eyes and acne rosacea. His corneas were particularly flat.
He sought advice at Optegra. Despite his history and the condition of his corneas, the treating surgeon failed in his duty to assess him fully and told him that he was a suitable candidate for laser eye surgery. He offered and performed refractive surgery known as LASIK (laser assisted in situ keratomileusis) in both his eyes. LASIK involves the surgeon using a blade or laser to cut a flap in the surface of the eye to access and re-shape the cornea and thus to try to correct the natural refractive error that causes myopia.
The surgery failed. The client was left with worse vision in both eyes than before the procedure. His vision was blurred and hazy and his dry eye symptoms deteriorated. The surgeon initially reassured him these problems would settle and in the meantime, advised glasses to correct his vision. The surgeon fitted punctal plugs to reduce drainage of tears from the eyes, along with lubricating drops to try to improve the dryness.
The client’s symptoms did not resolve and his vision did not improve. After six months, the surgeon suggested more laser surgery. This time, he advised the client to undergo LASEK surgery, in his right (better) eye only. LASEK (laser assisted sub-epithelial keratectomy) involves using a diluted alcohol solution to push away the outer surface of the eye (the epithelium), instead of cutting a flap, and then re-shaping the cornea. Again, the surgeon failed fundamentally to appreciate the risks to the client, in particular that he had an unstable refractive error, which was made worse still by LASEK. It is generally preferred in patients with a thin cornea, but was an unacceptable procedure in this case, given the client’s condition and history.
After LASEK, his right vision was worse and he struggled to focus. He went on to develop a cataract in his left eye that required lens replacement. His refractive error was by then even more unstable. Despite this, the same surgeon offered to treat the left cataract by replacing the lenses in both eyes, with multi-focal implants, rather than standard lenses. The clinical negligence team at Penningtons Manches argued that these were completely inappropriate given the higher level aberrations he suffered.
The client has been left unable to continue working and has profound visual problems. He has no useful vision except with gas permeable contact lenses, but these irritate his eyes and he is therefore limited in the time he is able to tolerate lenses each day. At best, he has around six hours’ vision; some days he cannot wear them at all. He relies on family and friends to help when he cannot wear his lenses.
The surgeon has admitted negligence in the care he gave. The parties are now determining the full effect of the negligence and quantification of the case is ongoing.
Andrew Clayton heads a team in Penningtons Manches’ clinical negligence department which specialises in ophthalmic claims. He comments: “Corrective surgery to improve vision is now increasingly commonplace and gives great benefit to many patients. The procedures are perceived to be straightforward and low risk. There are, however, some people for whom laser eye surgery is inappropriate, or who will continue to need to wear glasses or contact lenses even after surgery.
“A wide range of providers now offer laser eye surgery, from specialist hospitals to high street opticians. A brief look at some of the many websites promoting these procedures highlights the focus on the potential benefits and the range of funding options. Frequently, however, there is a concerning lack of information about the risk factors, contraindications and potential complications.
“In our client’s case, he opted for a well reputed centre and received unacceptable care. For many, these centres are prohibitively expensive, so patients are attracted to cheaper, high street alternatives. We are receiving increasing numbers of enquiries from people who have suffered poor visual outcomes following laser eye surgery. More needs to be done to raise awareness that this is not always an appropriate option and carries with it risks that can have a devastating, life-long impact.”