The data collected were chosen based on the review of the literature to have a potential relevance to the outcome of litigations in ophthalmology916 or to the clinical outcomes2065 and were obtainable from the available documents from OMIC. Thirty-four cases had other complications, including endophthalmitis, vitreous hemorrhage, choroidal detachment, macular hole formation, central retinal artery occlusion, uveitis, anterior ischemic optic neuropathy, floaters, and epiretinal membrane. What helps? Retained nuclear fragments in the anterior chamber after phacoemulsification with an intact posterior capsule. Retained lens fragments after phacoemulsification. 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. One unit change between preoperative and final visual acuity ( logMAR visual acuity) resulted in a 2.30-fold increase in likelihood of indemnity payment (P=.001). For statistical purposes, only the data from the primary surgeon was analyzed in the study. Twelve (11%) of 108 claims were resolved by a trial, 30 (28%) were settled, and 66 (61%) were dismissed. 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. From the Department of Ophthalmology (Dr Kim) and the Division of Biostatistics (Dr Szabo), Medical College of Wisconsin, Milwaukee,Wisconsin, and Ophthalmic Mutual Insurance Company, San Francisco, California (Mr Weber). Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the cases. Their analysis also found that vitrectomy on the same day and up to 2 days after the cataract surgery had poorer visual outcome. Of the 12 claims that went on to a trial, there were 5 claims from Illinois, 2 claims from Arizona, and 1 claim each from Colorado, Florida, Kentucky, Rhode Island, and Texas. CI, confidence interval; OR, odds ratio; SE, standard error. Among the 108 cases in this study, the final dispositions of the claims were as follows: 12 cases (11%) were resolved by a trial, of which 2 cases (17%) resulted in a verdict in favor of the patient plaintiff and 10 cases (83%) cases with a verdict in favor of the physician defendant; 30 cases (28%) were settled; and 66 cases (61%) were dismissed. Olsson RB, Ritland JS, Bjrnsson OM, Syrdalen P, Eide N, Overgrd R. A retrospective study of patients with retained nuclear fragments after cataract extraction. 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. However, he could not complete the surgery and his retinal colleague needed to intervene intraoperatively. CF, counting fingers; HM, hand motions; LP, light perception; MVR, microvitreoretinal; NLP, no light perception; PPL, pars plana lensectomy; PPV, pars plana vitrectomy; RD, retinal detachment; VA, visual acuity. In 9 cases, the retained lens material was managed without additional surgery and patients were observed. The doctor used a technical lens for my right eye and a standard lens for the left one. 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. In addition to corneal edema, inflammation from the lens material can result in elevated intraocular pressure that is significant enough to require pressure-lowering medication or development of glaucoma and potential visual field loss that require additional surgical intervention. The most common additional surgical procedure was pars plana vitrectomy to remove retained lens material or to manage retinal detachment, but procedures to manage IOL, glaucoma, corneal decompensation, and strabismus were also performed (Table 3). 4,11,79,8385 Medical liability claims are more common among older physicians than among young, yet inexperienced, physicians, because the older physicians have been in practice for a longer period of time and have had greater exposure to the possibility of claims. Another claim alleged that there was a delay in time to pars plana vitrectomy by the retinal surgeon to manage the elevated intraocular pressure. Dr. Poole performed cataract surgery on DeFrankos eyes over the course of one month. Kraushar MF, Turner M. Medical malpractice litigation in ophthalmology: the New Jersey experience. 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. WebUltrasound: The predominant technology for cataract removal is ultrasound. 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. Bhan A, Dave D, Vernon SA, Bhan K, Bhargava J, Goodwin H, Medical Defense Union; Medical Protection Society; Medical and Dental Defense Union of Scotland Risk management strategies following analysis of cataract negligence claims. Physicians Insurers Association of America . If a surgeon and the hospital or the practice (entity) were named in the claim, only the surgeons data was analyzed to avoid duplicity. Even when a trial ended in favor of a defendant and no payment was made to the plaintiff, the legal expenses were nearly twice that of claims that settled. A steroid drop prescribed by your ophthalmologist can help. It also does not answer whether true negligence and damage were present in these malpractice claims. Greven CM, Piccione K. Delayed visual loss after pars plana vitrectomy for retained lens fragments. The hypothesis of the current study is that there may be differences among the groups of cases with different legal outcomes. Depending on the medical malpractice laws in your state, the unique procedures and limitations might include: (To find the law in your state, choose from this chart.). When the complication resulted in a claim, there was an average of 15.5 months between the cataract surgery and opening of the case by the insurance company, which was soon after the insureds notification of being served with the litigation paper. AC IOL, anterior intraocular lens; OD, right eye; OMIC, Ophthalmic Mutual Insurance Company; OS, left eye; PC IOL, posterior intraocular lens; VA, visual acuity. Of the 12 claims resulting in a trial, 30 claims resulting in a settlement, and 66 claims resulting in a dismissal, the male-to-female physician defendant ratios were 12:0, 25:5, and 57:9, respectively. The current study is not inclusive of all claims related to retained lens fragments in the United States that occurred during the study period. An opening in the inferior portion of the posterior capsule was seen and retinal detachment was confirmed. Retained lens fragments in resident-performed cataract extractions. May M, Stengel B. Management of dislocated lens fragments following phacoemulsification surgery. about navigating our updated article layout. 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. 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. 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. Can I sue a doctor for a botched cataract surgery? The trial was in favor of the plaintiff with a payment of $231,754. In the univariate analysis the P values for continuous variables were calculated based on nonparametric tests: Wilcoxon rank sum test for two groups (indemnity payment vs no indemnity payment) and Jonckheere-Terpstra trend test for multiple groups (trial vs settlement vs dismissed). In comparison, indemnity payment for all closed claims for OMIC is a mean of $150,000 and median of $75,000. The technical lens was suppose to give me even better vision in the right eye. In all cases, retinal detachment occurred, 5 after the cataract surgery and 2 after pars plana vitrectomy and lensectomy by retinal specialists. 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. 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 defendant prevailed in 83% of trials. Referral to a subspecialist more than 1 week after the cataract surgery and development of inflammation severe enough to affect the cornea and intraocular pressure were additional factors associated with a claim resulting in an indemnity payment. The most common risks are: Although you may have experienced an unexpected outcome, even a severe injury, that does not mean medical malpractice is necessarily the cause. Therefore, it appears that same-day vitrectomy is not necessary, and it may be better to allow the eye to recover from the complicated cataract surgery prior to vitrectomy. Teo L, Chee SP. Some cases that opened in more recent years are still open and are not a part of this study, since both the legal outcome and expenses were required for the analyses. The incidence of closed claims for retained lens fragments peaked in 1997, but the actual number of closed claims was the highest for years 2001, 2003, and 2004. Vitrectomy for removal of retained lens material. Your use of this website constitutes acceptance of the Terms of Use, Supplemental Terms, Privacy Policy and Cookie Policy. In all cases, final visual acuity was 20/200 or worse, including 2 cases of no light perception. 5.3k views Reviewed >2 years ago. Displacement of nuclear fragments into the vitreous complicating phacoemulsification surgery in the UK: clinical features, outcomes and management. In this study, the cataract surgery that was complicated by retained lens fragments had been performed before 1996 in approximately 25% of claims, after 2002 in another 25%, and between 1996 and 2002 in the remaining 50%. Also, claims with worse final visual acuity tended to have higher indemnity payments (Figure 6). Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments. Kageyama T, Ayaki M, Ogasawara M, Asahiro C, Yaguchi S. Results of vitrectomy performed at the time of phacoemulsification complicated by intravitreal lens fragments. Blodi BA, Flynn HW, Jr, Blodi CF, Folk JC, Daily MJ. 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. Kim JE, Flynn HW, Jr, Smiddy WE, et al. 19851989. Because visual acuity outcomes are often poor in eyes with associated retinal detachment, and the degree of loss of visual acuity is found to be a significant risk factor for a claim resulting in a trial or a payment, it is important to minimize retinal detachment by avoiding aggressive measures to handle dislocated lens material by the cataract surgeon. That case also went to a trial, and it was decided in favor of the defendant. 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. The time between the date of cataract surgery and the date of reporting by the insured to OMIC regarding litigation was a mean of 15.5 8.7 months. The amount of indemnity payment for each grouping of final visual acuity among cataract surgeries complicated by retained lens fragments. In another study, the number of claims resulting in indemnity payment for ophthalmology was similar to the number for dermatology, internal medicine, and gastroenterology, and the mean and median payments for ophthalmology claims were slightly less than the mean indemnity payment of $274,887 and the median of $111,749 across 25 specialties.5 Therefore, the claims related to retained lens fragments appear to have lower indemnity payment on average when compared to malpractice claims across all specialties. Claims, errors, and compensation payments in medical malpractice litigation. As noted already, the majority of claims are dropped, dismissed, or closed without payment. Whereas good final visual acuity did not prevent indemnity payment, 23 of 32 claims (72%) with indemnity payment had final visual acuity of 20/200 or worse. Borne MJ, Tasman W, Regillo C, Malecha M, Sarin L. Outcomes of vitrectomy for retained lens fragments. The costs including indemnity payments and defense costs are summarized in Table 5. All variables significant at a 10% level in the univariate analyses were included in a multivariate proportional odds regression model. sharing sensitive information, make sure youre on a federal Overall, IOL had to be removed, sutured, inserted, or exchanged during pars plana vitrectomy by a retinal specialist in 17 (16%) of 108 cases. Management of nucleus loss into the vitreous: long term follow up in 63 patients. 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. 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). Many are related to retained lens fragments with 108 unique cataract surgeries, 97% against cataract surgeon and Management of dislocated nuclear fragments after phacoemulsification. Cataract surgery: What to expect before, during and after - Harvard Health Lens extraction is done using one of two procedures: phacoemulsification or extracapsular surgery. Medical professional liability claims and premiums. WebCataract Surgery Error: $1.15M Settlement Lawsuit claims anesthesiologist not properly trained or vetted by ophthalmologist results in right eye vision loss following cataract Ho and colleagues37 recommended that cataract surgeons refer patients with retained lens fragments to a retina specialist within 7 days for consideration of a pars plana vitrectomy to decrease the risk of developing secondary glaucoma. Vitrectomy timing for retained lens fragments after surgery for age-related cataracts: a systemic review and meta-analysis. Final visual acuity was the last recorded visual acuity. Victims of cataract surgery negligence may experience loss of vision, blindness, or other serious complications. WebIt was discovered that a 23-power lens was inserted in the left eye, instead of the intended 20-power lens. Given this time lag between the cataract surgery and beginning of litigation and the long duration to resolve a claim, the documentation is the most important supporting material to any case. You should consult with an attorney in your state as soon as possible. Time limitations apply so be aware of them. Check Avvo for a listing of atto To review malpractice claims associated with retained lens fragments during cataract surgery to identify ways to improve patient outcomes. In: Gonzalez ML, Zhang P, editors. and transmitted securely. Glaucoma was defined as elevated intraocular pressure requiring pressure-lowering medication or documented visual field defect. In these early referral cases, the claim was more likely to be dismissed. Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the claims (median payment, $90,000). AC IOL, anterior chamber intraocular lens; IOP, intraocular pressure; PC IOL, posterior chamber intraocular lens; VA, visual acuity. The most common complications were elevated intraocular pressure requiring initiation of pressure-lowering medications and development of visual field damage due to elevated intraocular pressure. Who sues their doctors? Management of retained lens fragments in complicated cataract surgery. A number of studies have found that there is substantial variation in the likelihood of malpractice suits across specialties and the cumulative risk of facing a malpractice claim is high in all specialties.26 The Physician Practice Information Survey by the American Medical Association of 5,825 physicians across 42 medical specialties, fielded in 2007 and 2008, found that an average of 95 claims were filed for every 100 physicians, almost 1 per physician, as a group.2 However, the chance of being sued each year for a physician was about 5%. 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. Kachalia A, Kaufman SR, Boothman R, et al. A retinal surgeon who was called into the operating room was able to remove the nucleus using 3-port pars plana vitrectomy. The patient was informed of the complication. The lower number of claims in the recent years may indicate increased awareness by the cataract surgeons in optimal management of this complication. Kane CK. Kraushar MF. Funding/Support: Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc, New York, New York (J.K.) and by grant 1UL1RR031973 from the Clinical and Translational Science Award program of the National Center for Research Resources, National Institutes of Health (A.S.). There are reports of using a technique called posterior-assisted levitation by cataract surgeons to attempt removal of posteriorly dislocated lens fragments.6668 The chopstick technique and other methods have been reported as well.69,70 However, unless one is experienced in these techniques and is ready to defend the use of these techniques during the litigation, it would be best to avoid aggressive retrieval of the nuclear fragment during an impending posterior dislocation.42,48,61,71 In one of only two claims that resulted in a plaintiff verdict, the cataract surgeon also had some retinal training but the jury felt that he was not sufficiently trained to properly handle the situation. It is important to remember that the eye with retained lens fragments may have significant inflammation not only from the lens material but also from concomitant infectious endophthalmitis.60 Therefore, vigilant follow-up and prompt referral of patients with suspected endophthalmitis is recommended. The number peaked in 1997 with 11 cases and again in 2001, 2003, and 2004 with 13 cases each year. Therefore, it appears that earlier referral is one of the ways a cataract surgeon can improve risk management. Acknowledgments: J.K. would like to thank Dr Harry Flynn Jr for critical reading of the manuscript, his mentorship, and getting her interested in the topic of retained lens fragments. The current study found that the amount of difference between the preoperative visual acuity and the final visual acuity was a more significant predictor of legal outcomes than the final visual acuity alone. Conservative management could be considered for eyes with good baseline visual acuity. WebCataract Symfony Lawsuits? The last variable was not included in the predictive model because it is not a preclaim covariate, but rather a type of outcome. WebAllegation Wrong power IOL insertion led to complicated lens exchange surgery. In 91 eyes, preoperative visual acuity was recorded for both eyes. Although documentation of informed consent does not prevent a malpractice claim, a better informed decision process may set realistic expectations by a patient, and presence of an appropriate informed consent is crucial when there is a malpractice claim. The needle impaled the lens and tore the lens capsule. Yang CS, Lee FL, Hsu WM, Liu JH. Bettman JW. 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? 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. All variables significant in the univariate analyses were included in a multivariate logistic regression model. Through highlighting circumstances of pertinent claims and identifying factors associated with malpractice claims resulting in an indemnity payment or going to a trial, this current study sought to ascertain steps that can be taken by ophthalmologists to improve patient care and safety as well as assist in risk management when cataract surgery is complicated by retained lens fragments. Jena AB, Seabury S, Lakdawalla D, Chandra A. Although indemnity payment is one measure of cost of malpractice claims, an additional $3,312,688 was spent on legal expenses. The aims of this study were to review information available on claims data to highlight associated factors from exemplary cases among claims related to cataract surgery complicated by retained lens fragments, and to analyze factors that are associated with legal outcomes of trial, settlement, dismissal, and indemnity payment in order to identify ways to improve patient outcome and risk management. Attempts for post-trial settlement were rejected by the plaintiff. The defense expert stated that (1) it is unclear as to when the vitreous prolapsed, since it was not noted at the time of postoperative examinations by the cataract surgeon or even by the retina specialist at the initial consultation, (2) the standard of care does not require that every rupture of the posterior capsule be recognized, and (3) following treatment for the retinal detachment, the patient attained a visual acuity of 20/25, which indicated a successful management of this complication. The number of Ophthalmic Mutual Insurance Company policyholders from years 1989 through -2009. Of the 108 physician defendants, 94 (87%) were men and 14 (13%) were women. The estimated effects of each predictor are shown in Table 8. Finally, the patient must have suffered actual damage or injury as a result of negligence. 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 This may reflect bias in reporting surgical cases in the literature related to this complication or tendency toward legal actions when the patient feels not enough was done with observation alone. Legal outcomes were categorized as those claims resulting in a trial, settlement, or dismissal, and indemnity payment was evaluated for those claims ending in a settlement or in favor of the plaintiff after a trial. This current study did not ask which physicians are more likely to get sued when the cataract surgery is complicated by the retained lens fragment, since all cases in this study were closed claims and do not have a comparison group that encountered the complication but were not sued. One of the most devastating complications after any ophthalmic surgical procedure that can result in profound visual loss is endophthalmitis. Plaintiff files a medical negligence lawsuit in Worcester County, alleging that the Defendants violated the standard of care by failing to calculate properly the During the immediate postoperative period, the visual acuity was 20/40 and the posterior chamber IOL was documented to be in good position. Managing a dropped nucleus during the phacoemulsification learning curve. Regan JJ, Regan WM. Gedde SJ, Karp CL, Budenz DL. Postoperative complications with significant inflammation causing corneal edema or corneal decompensation were found to be a potential risk factor for increasing the odds of an indemnity payment by more than threefold (P=.037). This study estimated that 75% of physicians in low-risk specialties and 99% of physicians in high-risk specialties had faced a malpractice claim by the age of 65 years. In 7 cases, the cataract surgeon documented an intraoperative attempt at retrieval of the lens fragment (Table 2). The number of policyholders doubled between years 2000 and 2009. Therefore, appropriate management of elevated intraocular pressure is necessary to reduce poor patient outcome. 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. Yazici AT, Kaya V, Bozkurt E, Imamoglu S, Yilmaz OF. CLAIMS WITH INDEMNITY PAYMENT BY FINAL VISUAL ACUITY AND CHANGE IN VISUAL ACUITY AMONG CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. Later records indicate that the patient complained of blurry vision from the presence of a vitreous strand. For this study, a P value <.05 was considered significant. Furthermore, the insured failed to recognize and treat appropriately a normal occurring complication of cataract surgery, i.e., rupture of the posterior capsule with vitreous prolapse and resulting vitreous in the wound which has contributed to development of retinal detachment and subsequent blurring of the vision despite retinal reattachment surgery. Copyright 2023 MH Sub I, LLC dba Nolo Self-help services may not be permitted in all states. For the current study, the claims were categorized into those that went on to a trial, settlement, or dismissal, and those with or without indemnity payment. This grouping was done to compare the findings of this study to other published data. Most cases of elevated intraocular pressure can be managed with medication or be resolved with pars plana vitrectomy.2024,2834,50,51 However, there were claimants in this study who required glaucoma surgeries to lower intraocular pressure and others who had suffered permanent visual field loss despite improved visual acuity. In 94 cases, a referral was made to a subspecialist. For the use in multivariate modeling, an optimal transformation from the Box-Cox family was calculated for each nonnegative continuous variable. There were also cases where the defense experts felt that the case was less defensible due to poor office visit documentations that did not include or had illegible notations regarding visual acuity, intraocular pressure, or dilated fundus examination in the setting of declined visual acuity. Risk factors for and management of dropped nucleus during phacoemulsification. Lifshitz T, Levy J. Posterior assisted levitation: long-term follow-up data. DESCRIPTIVE STATISTICS OF THE ANALYSIS VARIABLES BY CLAIMSOUTCOME ASSOCIATED WITH RETAINED LENS FRAGMENT. Spicer J. My vision actually was worse after the lens placement. The estimated incidence of the complication of retained or dropped lens fragment in the literature is 0.1% to 1.6% of cataract surgeries, but in the current study 12.5% of closed claims related to cataract surgery were associated with retained lens fragments. CI, confidence interval; IOP, intraocular pressure; OR, odds ratio; SE, standard error. The value of a cataract surgery lawsuit can vary depending on the severity of the injury, how it was caused, and the amount of medical care and treatment required. Cataracts cause foggy or blurred vision that makes it hard to do everything from reading to Covariate, but rather a type of outcome present in these malpractice claims an! As a result of negligence payments ( Figure 6 ) the ways a cataract surgeon can improve management. 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