Ophthalmology expert witness advises on man’s vision loss from laser eye surgery

An ophthalmology expert witness advises on a case involving laser eye surgery that resulted in a man’s vision loss. Prior to obtaining laser eye surgery, the plaintiff underwent testing. The test results were normal, however, the plaintiff had worn contact lenses that day and within the five previous days, which makes the testing inaccurate. A second round of tests showed abnormalities, including anterior float; keratometric; and thickness.

Two years after the surgery, the plaintiff developed corneal ectasia, a progressive thinning, warping and irregular bulging of the cornea, with attendant progressive severe visual problems. Symptoms included monocular diplopia, halo, glare and decreased vision.

The plaintiff sued the defendant doctor for medical malpractice.

Question(s) For Expert Witness

1. Is it generally accepted to perform laser eye surgery when corneal abnormalities are present?

2. Was it medical malpractice?

Expert Witness Response

The corneal topographies performed by the defendants showed that the plaintiff was suffering from corneal disease that is a generally accepted contra-indication to doing LASIK eye surgery, because of the risk, among others, of developing corneal ectasia. Nevertheless, the patient was cleared for, and underwent, bilateral LASIK that same day.

The plaintiff had a good result from the surgery with 20/20 vision. It takes 1 to 2 years before a patient begins to experience symptoms of ectasia.

The patient's symptoms became noticeable around two years after the LASIK, are fully consistent with corneal ectasia, as is the time-frame for these complaints. The testing showed a high degree of irregular corneal astigmatism, with progressively worsening corneal topographies, consistent with the complication of post-LASIK ectasia.

The defendants knew or should have known that the plaintiff was suffering from post-LASIK ectasia based on the combination of the abnormal visual symptoms he was reporting and complaining about; the high degree of irregular astigmatism; and the clearly worsening corneal topographies, but did not tell the patient.

In my opinion, medical malpractice was committed in this matter, in clearing the patient for LASIK, and in performing LASIK on this patient because of the well-known and generally accepted contra-indications to LASIK in his case.

The expert is a board-certified ophthalmologist specializing in anterior segment surgery of the eye including LASIK laser vision correction.