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You are in: Home Page | Personal Injury | Clinical Negligence | Clinical Negligence Articles | Eye Surgery and Opthalmic Negligence
May 2009
Our National Specialist Clinical Negligence Team are experienced in dealing with all types of ophthalmic negligence cases. If you believe you may have suffered damage due to negligent ophthalmic treatment or care, you may be able to make a claim for compensation. Typical claims that may arise can involve, glaucoma, cataract surgery, laser eye surgery, and retinal detachment.
Glaucoma usually occurs when fluid in the eye builds up, causing higher pressure than the eye can withstand. The canal responsible for draining this fluid becomes plugged, preventing proper drainage. In other cases, the eye may produce more fluid than normal and simply cannot be drained fast enough, producing higher intraocular pressure. Researchers do not know exactly what makes some people more prone to this problem. Other causes may include trauma, genetic disorders, low blood flow to the optic nerve, also having high intraocular pressure increases the risk of developing glaucoma. Those who are over forty years of age and who are African-American also have an increased risk. Anyone sixty years of age is more at risk, especially Mexican-Americans. Furthermore, those with a family history of glaucoma are at higher risk of developing glaucoma. Having systemic diseases such as diabetes, high blood pressure and heart problems also increases your risk. Other risk factors include nearsightedness and direct trauma to the eye.
Glaucoma refers to a group of diseases that cause damage to the optic nerve. Containing more than a million nerve fibres, the optic nerve connects the eye to the brain. This important nerve is responsible for carrying images to the brain. The optic nerve fibres make up a part of the retina that gives us sight. This nerve fibre layer can be damaged when the pressure of the eye (intraocular pressure) becomes too high. Over time, high pressure causes the nerve fibres to die, resulting in decreased vision. Vision loss and blindness will likely result if glaucoma is left untreated.
Despite the fact that glaucoma can arise as a result of disease processes, poor clinical supervision of opticians or ophthalmologists can lead to delays in diagnosis of this serious condition which can, in turn, result in deterioration of vision which may lead to disability and, for example loss of earning capacity entitling victims to potential compensation.
Cataracts are a very common cause of impairment of vision. Although often a degenerative disorder related to age, it does, however, have other causes including diabetes, direct injury to the eye, exposure to ultraviolet light from sunlight, long term steroid use, smoking, heavy drinking and poor diet. Competent cataract surgery can improve eyesight and involves the lens of the eye being broken down into tiny pieces which are removed through a small cut in the eye. The lens is then replaced with an artificial one. Problems can occur due to poor surgical technique and insertion of inappropriate lens types following on from incompetent pre-operative assessment.
Laser eye surgery has become very popular in the UK, with many thousands of treatments being undertaken each week. Treatment has evolved and refined over the years. Procedures include Radial Keratotomy (RK) in which a diamond blade is used to make a micro-incision in the cornea to treat mild levels of nearsightedness and astigmatism. Laser corrective surgery began with Photorefractive Keratectomy (PRK) which uses an excimer laser to treat mild to moderate levels of nearsightedness, farsightedness and astigmatism. More recently, Laser Assisted In Situ Keratomileusis or (LASIK) has been developed which is a quicker technique in which an automated precision surgical instrument with an oscillating blade is used to create a corneal flap and the laser is then used to ablate the cornea.
When the treatments are carried out by experienced and qualified surgeons the results can be highly beneficial but there are risks and complications can occur. The safety and effectiveness of LES is not fully determined and varies between patients. The propensity for adverse outcomes may by higher in some patients who have pre existing risk factors which doctors should screen for such as large pupils, thin corneas, dry eyes and blepharitis. Patients should be fully advised regarding the risks of any proposed surgery. Adverse outcomes may include minor pain and sensitivity and blurred vision but could be more serious and include double vision, corneal scarring, ectasia (pathological dilation of the cornea) and even on occasions complete loss of vision.
Negligence cases may invlove allegations of surgical error, incompetent screening and failure to identify risk factors, and failure to advise of risks. In 2003 the Medical Defence Union (MDU), the largest indemnifier of UK doctors, reported that the number of laser eye surgery negligence claims reported by members of the MDU had increased by 166% over the previous 6 years. It was reported that these claims now account for a third of all opthalmology claims on the MDU’s books. On average, the cost of litigation against laser eye surgeons is triple that of opthalmic surgeons who do not carry out laser eye work.
A detached retina is a serious condition that can lead to extreme impairment of vision and blindness if not diagnosed and treated very quickly. It affects about one in 10,000 people. The retina is the innermost layer at the back of the eye that contains millions of tiny light receptors that convert the visual image formed by the eye’s optical system into electrical impulses. These are then relayed along the optic nerve to the brain.
In certain circumstances it is possible that the retina can become detached from its underlying layer, the choroid, which contains the many blood vessels that provide the retina with its nourishment. When this happens, vision in the affected region is lost. The retina may also become torn at the point of detachment. The situation can be exacerbated if fluids such as blood or vitreous fluid from the space in front of the retina penetrate beneath.
Clinical negligence cases involving retinal detachment tend to revolve around early detection and referral to specialists ophthalmologists. Early signs of retinal detachment are often picked up by opticians during routine eye tests and patients are then referred to their GP and then on to an ophthalmologist. Early diagnosis and treatment are vital for the patient to have a chance of preserving their eyesight.
In his paper, “ A Decade of Clinical Negligence in Ophthalmology” (BMC Ophthalmology 2007:7.20), Nadeem Ali reviews clinical negligence in the field of ophthalmology and makes the following observations:-
“All the claims on the NHS Litigation Authority database for ophthalmology for the period 1995 to 2006 were analysed. There were 848 claims, 651 of which were closed. 46% of closed claims resulted in payment of damages. The total cost of damages over the period was £11 million. The mean level of damages was £37,100. Cataract made up the largest share of claims (31%), paediatric ophthalmology had the highest mean damages (£170,000), and claims related to glaucoma were most likely to result in payment of damages (64%).”
It is quite clear then that if you have a justified claim for ophthalmic negligence the relevant defendant authorities are willing to recognise such claims and do make awards of compensation in appropriate cases. Given the seriousness of such injuries it is important that you are represented by lawyers who are experienced at handling this type of litigation.