Borne MJ, Tasman W, Regillo C, Malecha M, Sarin L. Outcomes of vitrectomy for retained lens fragments. The time between the date of cataract surgery and the date of evaluation by a specialist to further manage the complications of retained lens fragments was a median of 7 days (range, same day to 15 months) in this study. Posterior-assisted levitation in cataract surgery. HHS Vulnerability Disclosure, Help AC IOL, anterior chamber intraocular lens; IOP, intraocular pressure; PC IOL, posterior chamber intraocular lens; VA, visual acuity. Risk management lessons from a review of 168 cataract surgery claims. This is without adjustment for potential differences in dollar amount due to inflationary changes. 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. With OMIC having 40% of the ophthalmology market share in 2010, OMIC policyholders compare favorably with current demographics of ophthalmologists.17 Because it is a single-specialty insurer with the ability to collect and analyze data on a large number of professional liability claims related to ophthalmology, gathering of information on malpractice claims related to a specific ophthalmic procedure is possible. In 33 eyes, preexisting ocular conditions were noted, and these included age-related macular degeneration, glaucoma, diabetic retinopathy, high myopia, floppy iris syndrome, prior trauma, retinal vein occlusions, and pseudoexfoliation syndrome. and transmitted securely. The complication of capsular tear and retained lens fragments was further aggravated by development of corneal wound dehiscence, corneal ulcer, and endophthalmitis. Management of dislocated lens fragments following phacoemulsification surgery. 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). A study on causes of cataract surgery malpractice claims in England showed that claims relating to biometry errors and wrong IOL power were the second most frequent cause of claims and resulted in payment of damages in 62% of cases.73 In 9% of claims related to retained lens fragments, the capsular tear apparently was due to a sudden or uncontrollable movement of the patient during surgery. Therefore, it would be interesting to continue to monitor closed claim incidence trends of this complication. Wilkinson CP, Green WR. In one case, the physicians honesty was questioned when the operative note was dictated 1 week after the incident and appeared to be dictated in a manner to cover up the damages. Ho LY, Doft BH, Wang L, Bunker CH. Kraushar MF, Robb JH. ADDITIONAL SURGICAL PROCEDURES PERFORMED TO MANAGE COMPLICATIONS FROM RETAINED LENS FRAGMENTS. 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. Also, settlement should not be considered admission of malpractice, since some physicians, patients, and insurance carriers may elect to settle in order to avoid prolonged litigation or stress or to minimize legal expenses. Average defense costs per claim were $30,692 and ranged from a low of $0 to a high of $190,961. When intraocular pressure or inflammation cannot be managed adequately or cystoid macular edema is detected, the patient should be definitely referred to a specialist. Socioeconomic Characteristics of Medical Practice 1990/1991. The distribution of the number of closed claims related to the complication of retained lens fragments per year from 1989 through December 2009 is shown in Figure 2. The In comparison, indemnity payment for all closed claims for OMIC is a mean of $150,000 and median of $75,000. The mean age was 69 years (range, 4090 years). 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. 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. There was another 29 months on average until the closure of a claim. 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. Hansson LJ, Larsson J. Vitrectomy for retained lens fragments in the vitreous after phacoemulsification. 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. The negligent act must be a proximate cause of the plaintiffs injuries, which means the act was necessary for the injury when and in the manner it occurred, and the injury must be a foreseeable consequence of the negligent act. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. Stilma JS, van der Sluijs FA, van Meurs JC, Mertens DA. WebIt was discovered that a 23-power lens was inserted in the left eye, instead of the intended 20-power lens. government site. During the 21 years from 1989 through 2009, OMIC had 937 closed claims related to cataract surgery, and, of these, 117 closed claims from 108 cataract surgeries were related to the cataract surgery complicated by retained or dropped lens fragments. For cataract surgery litigation, 119 cases (21 percent) led to settlements, totaling $22.9 million. In one additional case, observation was recommended without further surgery because the retina specialist felt that the retinal detachment was inoperable. An official website of the United States government. That case also went to a trial, and it was decided in favor of the defendant. The difference between the mean and median payment reflects the right-skewed payment distribution. 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. CLAIMS WITH INDEMNITY PAYMENT BY FINAL VISUAL ACUITY AND CHANGE IN VISUAL ACUITY AMONG CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. 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 Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments. Total cost of defense for all 108 claims was $3,312,688. Mean change in visual acuity between preoperative visual acuity and final visual acuity for all patients was a worsening of 2 lines. Cohen SM, Davis A, Cukrowski C. Cystoid macular edema after pars plana vitrectomy for retained lens fragments. 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. Cataract surgery with phacoemulsification is a procedure that has an initial steep learning curve, and the complication of retained lens fragment is more likely with phacoemulsification than with extracapsular cataract extraction. The verdict was 6 for plaintiff and 2 for defendant. Therefore, while retained lens fragment is an infrequent complication of cataract surgery, this complication has a potentially high likelihood of legal consequences. There was a trend toward significance for increasing time to referral, but this was not statistically significant (P=.053). Retained nuclei after cataract surgery. Light sensitivity after cataract surgery After cataract removal, a little bit of light sensitivity is expected due to dryness in the eye. Time between cataract surgery and referral to a subspecialist was a median of 7 days, ranging from the same day as the cataract surgery to 15 months after cataract surgery. This study was not designed to answer whether claims resulted from lack of adherence to practice guidelines or standard of care. Bricks study on cataract surgery claims also recommends earlier referral if there was a potential for retinal complications.10. The plaintiff alleges that on June 17, 2013 she underwent a second surgery on her left eye to install the proper implant and that afterward she continued to have difficulty seeing out of the eye. These included the number of ophthalmologists insured by OMIC from 1989 through 2009, the number of closed claims related to cataract surgery, OMIC policyholder demographics, and average indemnity payments for OMIC policyholders. The first case closed in 1992 for $125,000, and the second case closed in 2002 for $250,000. Medical malpractice experiences of vitreoretinal specialists: risk prevention strategies. The average cataract surgery settlement was for $192,865. Kim JE, Flynn HW, Jr, Smiddy WE, et al. The new PMC design is here! The items collected during the review of the claims are listed in Table 1. 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. 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). Florida and Louisiana each had 10 claims. Olsson RB, Ritland JS, Bjrnsson OM, Syrdalen P, Eide N, Overgrd R. A retrospective study of patients with retained nuclear fragments after cataract extraction. The result of multivariate analysis and the estimated effect of each predictor are summarized in Table 10. Lu H, Jiang YR, Grabow HB. If a surgeon and the hospital or the practice (entity) were named in the claim, only the surgeons data was analyzed to avoid duplicity. Hickson GB, Clayton EW, Entman SS, et al. The number peaked in 1997 with 11 cases and again in 2001, 2003, and 2004 with 13 cases each year. No indemnity payment was made in claims that went on to a trial but the verdict was in favor of the defendant or in claims that were dismissed or closed without compensation. However, the patient did not show up for appointments, despite being sent no show letters. Cataract surgery: What to expect before, during and after - Harvard Health Lens extraction is done using one of two procedures: phacoemulsification or extracapsular surgery. For statistical purposes, only the data from the primary surgeon was analyzed in the study. 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. The remaining 9 cases (10%) were left aphakic by the cataract surgeon. The retina successfully reattached with a final visual acuity of 20/25. 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. A new trial and correction of the amount of verdict and judgment were all denied by the trial judge. In 91 eyes, preoperative visual acuity was recorded for both eyes. However, the majority of the claims were dismissed and did not result in an indemnity payment. Management of dislocated nuclear fragments after phacoemulsification. Regan JJ, Regan WM. For patients who have relatively good preoperative visual acuity, additional care should be taken during preoperative discussion and informed consent process and proper documentation should be performed as to the necessity of the surgery. Two weeks later, visual acuity was hand motions. Cataract surgery involves removing a cloudy lens from the patient's eye and replacing it with a clear, artificial lens. One of the most devastating complications after any ophthalmic surgical procedure that can result in profound visual loss is endophthalmitis. Outcome of vitrectomy for retained lens fragments after phacoemulsification. In one case of alleged delayed referral, the defendant stated that he made a call immediately after the complication to a retina specialist regarding recommendation for the management, but the retina specialist stated that he did not recall the conversation. 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. An opening in the inferior portion of the posterior capsule was seen and retinal detachment was confirmed. A retinal surgeon who was called into the operating room was able to remove the nucleus using 3-port pars plana vitrectomy. Bovbjerg RR, Petronis KR. Management of nucleus loss into the vitreous: long term follow up in 63 patients. CF, counting fingers; HM, hand motion; NLP, no light perception. In the current study, closed claims from cataract surgeries complicated by retained lens fragments were evaluated to identify factors that are associated with indemnity payment or resulting in a trial. Accounting for these factors, there were 108 unique cataract surgeries that met the inclusion criteria and were the basis for the current analyses. 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. 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 Therefore, while retained lens fragment is an infrequent complication of cataract surgery, this complication has a potentially high likelihood of legal consequences. Since the number of OMIC-insured ophthalmologists continued to grow each year over this 21-year period, the frequency of closed claims related to retained lens fragments relative to the total number of physicians insured per year was actually the highest in 1997 (Figure 3). Murat Uyar O, Kapran Z, Akkan F, Cilsim S, Eltutar K. Vitreoretinal surgery for retained lens fragments after phacoemulsification. Although these findings may cause fear and increased practice of defensive medicine by physicians, better understanding of the incidence, associated factors, and outcomes of medical malpractice claims may result in increased knowledge to the physicians and more effective and improved care to the patients. Finally, retinal detachment is a frequent adverse event in these eyes and can occur after the complicated cataract surgery or after vitrectomy surgery to remove the lens material.21,28,31,36,38,6165 Therefore, both the cataract surgeon and the retinal surgeon need to closely follow these patients for retinal detachment. 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. 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. Can I sue a doctor for a botched cataract surgery? Each log unit of visual acuity loss resulted in more than a twofold increase in likelihood of a claim going to a trial or resulting in an indemnity payment. The number of policyholders doubled between years 2000 and 2009. Furthermore, certain eyes are known to have an increased risk for developing this complication, including eyes with prior trauma, pseudoexfoliation, dense cataract, and history of having had prior vitrectomy surgery.42,49 Therefore, additional care should be taken during the cataract surgery in these eyes. Aasuri MK, Kompella VB, Majji AB. 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. In another study with anesthesiologists, approximately 40% of the claims did not involve substandard care but 42% of these claims ended with an indemnity payment.81, Therefore, it is difficult to clearly predict which physicians will get sued or what the final outcome of the malpractice suit will be. 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. There appeared to be differences in legal outcomes depending on the state where the physician practiced, such that claims from Louisiana were most likely to be dismissed. Their analysis also found that vitrectomy on the same day and up to 2 days after the cataract surgery had poorer visual outcome. The possible outcomes are assumed to be ordered: Trial with a verdict > Settled > Dismissed and the accompanying P value indicates whether a change in the predictor is associated with a more severe outcome. 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. Chen CL, Wang TY, Cheng JH, Tai MC, Lu DW, Chen JT. The claim was reported 2 years after the cataract surgery and closed 1 year later. The claimant was a 74-year-old woman who had been a patient of the plaintiff for 2 years. Attempts for post-trial settlement were rejected by the plaintiff. The lower number of claims in the recent years may indicate increased awareness by the cataract surgeons in optimal management of this complication. However, how this complication was managed intraoperatively and postoperatively, what degree of injury resulted, as well as how the informed consent was presented preoperatively, will determine whether or not malpractice occurred due to substandard care that resulted in harm to the patient. After your cloudy lens is removed, it will be replaced with an implanted clear artificial lens called an intraocular lens (IOL). 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. The average insurance company payment - mostly settlements -- in these cases were $112,000. Later records indicate that the patient complained of blurry vision from the presence of a vitreous strand. Vilar NF, Flynn HW, Jr, Smiddy WE, Murray TG, Davis JL, Rubsamen PE. The data accumulation adhered to the Declaration of Helsinki and conformed with all federal and state laws and HIPAA guidelines. Start here to find personal injury lawyers near you. Schaal S, Barr CC. 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 the univariate analysis, final visual acuity, development of corneal edema, and the difference between preoperative visual acuity and final visual acuity were found to be statistically significant. If you've suffered an adverse outcome after cataract surgery, you might be wondering if you can or should sue your eye doctor for Among the 108 cases, two physicians had multiple claims relating to retained lens fragments, with 2 claims each. Copyright 2023 MH Sub I, LLC dba Nolo Self-help services may not be permitted in all states. The patient was referred 1 month after the initial cataract surgery to a retina specialist and underwent two pars plana vitrectomy surgeries, corneal wound closure, and intravitreal antibiotic injections. Among these, the patients sought a second opinion and referred themselves in 3 cases. 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. DESCRIPTIVE STATISTICS OF THE ANALYSIS VARIABLES BY CLAIMSOUTCOME ASSOCIATED WITH RETAINED LENS FRAGMENT. The hypothesis of the current study is that there may be differences among the groups of cases with different legal outcomes. National costs of the medical liability system. 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. Of the 108 physician defendants, 94 (87%) were men and 14 (13%) were women. Physicians with higher frequency of patient complaints may indicate less attention to interpersonal or technical aspects of patient care.2,8691 Interestingly, a physicians credentials, such as board certification, ranking of medical school attended, and foreign medical school graduate vs US graduate, did not have a significant impact on whether a physician was more likely to get sued or not.4 However, various studies indicate that the risk of being sued appears to be related to patients dissatisfaction, which may be related to their physicians ability to establish rapport, provide access, administer care consistent with expectations, and communicate effectively and in a timely fashion.4, 8791 Other physicians who subsequently manage the patient may also have a role in the patients decision to bring a claim.91. 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. Closed claims data from OMIC were chosen to be the basis of this study because OMIC provides coverage to a large number of ophthalmologists and can provide data specific to an ophthalmic procedure. The final visual acuity for claims resulting in indemnity payment vs no payment is shown in Figure 5. Both of these were defined as glaucoma, and there were a total of 31 cases.