In the first case, the cataract surgery was performed in 1989. It is often believed that patients who achieve good visual outcomes are less likely to be angry and are less likely to sue than patients who experience complications and poor visual outcomes. The management of dislocated lens material after phacoemulsification. Most people may get benefited from an IOL transplant during surgery. The patient complained of a black spot with decreased vision 7 months after the cataract and vitrectomy surgery. DESCRIPTIVE STATISTICS OF THE ANALYSIS VARIABLES BY CLAIMSOUTCOME ASSOCIATED WITH RETAINED LENS FRAGMENT. Medical malpractice and respondeat superior. Another claim alleged that there was a delay in time to pars plana vitrectomy by the retinal surgeon to manage the elevated intraocular pressure. Lu H, Jiang YR, Grabow HB. For the use in multivariate modeling, an optimal transformation from the Box-Cox family was calculated for each nonnegative continuous variable. 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. For this study, a P value <.05 was considered significant. Among the 12 claims that resulted in a jury trial, 2 cases resulted in indemnity payment. The trial verdict was for the plaintiff in the amount of $125,000, although the initial demand was for $450,000. Some studies found that there was a decreased incidence of retinal detachment, glaucoma, or cystoid macular edema in early vitrectomy group compared to delay of more than 1 week to 1 month.34,3740 Others found only a trend toward better visual acuity outcome with earlier vitrectomy.32,33,36 Yet others found that there was no difference in terms of the incidence of retinal detachment or glaucoma or visual acuity outcome with the timing of vitrectomy.2031,35, Furthermore, there is no clear evidence that all patients with retained lens fragments need to be referred or need surgical management. 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. This is understandable, since the impact of poor final visual acuity would be greater for the patients who began with a reasonably good baseline visual acuity, and the degree of dissatisfaction would be greater as well. Although indemnity payment is one measure of cost of malpractice claims, an additional $3,312,688 was spent on legal expenses. OMIC underwriting applications and claims records were reviewed. A recent study recommended that the cataract surgeon perform an anterior vitrectomy and place a posterior chamber IOL if possible, prior to referral to a subspecialist in order to achieve better visual outcome.37 Based on the current study findings, it is recommended that the cataract surgeons avoid aggressive intraoperative manipulations to remove retained lens fragment in order to minimize the risk of retinal detachment. Twelve (11%) of 108 claims were resolved by a trial, 30 (28%) were settled, and 66 (61%) were dismissed. In 6 cases, there was documentation that the defendant had operated on the fellow eye of the claimant previously. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. 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. 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. In some categories of data, not all data points were available, and those are indicated in the appropriate tables. 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. These are a miniscule fraction of the tens of millions of cataract surgeries performed over the same period. Leaming DV. Aasuri MK, Kompella VB, Majji AB. 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. The distribution of claims resulting in a trial, settlement, dismissal, and indemnity payment seen in this study compares favorably to the current medical liability market for all medical specialties. The costs including indemnity payments and defense costs are summarized in Table 5. 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). Mean change in visual acuity between preoperative visual acuity and final visual acuity for all patients was a worsening of 2 lines. Regan JJ, Regan WM. When intraocular pressure or inflammation cannot be managed adequately or cystoid macular edema is detected, the patient should be definitely referred to a specialist. Vitrectomy timing for retained lens fragments after surgery for age-related cataracts: a systemic review and meta-analysis. Pars plana vitrectomy for the management of retained lens material after cataract surgery. An official website of the United States government. Each claim was counted separately as a unique case. 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. While some advocate vitrectomy to be performed on the same day as the day of complicated cataract surgery, many retinal surgeons prefer waiting the first few days after cataract surgery to permit the corneal edema to clear to allow unimpeded visualization of the retina.25,28,53 Vanner and Stewart78 performed a systematic review of 43 studies, including meta-analysis of 27 studies, for timing of vitrectomy for retained lens fragments after cataract surgery. The National Library of Medicine After performing an anterior vitrectomy, the cataract surgeon may consider putting in an IOL at the time of complicated cataract surgery but should have the correct type and power of IOL available in order to avoid poor visual outcome and subsequent allegations. Occurrence of retained lens fragments after phacoemulsification in The Netherlands. Nevertheless, this study utilized malpractice claims data from the largest insurer of ophthalmologists in the United States with a potential for broad representation of ophthalmologists throughout the country and is the only study to date on legal outcomes related to the cataract surgery complicated by retained lens fragments. The last variable was not included in the predictive model because it is not a preclaim covariate, but rather a type of outcome. Created for people with ongoing healthcare needs but benefits everyone. Colyer MH, Berinstein DM, Khan NJ, et al. 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. Posterior-assisted levitation: outcomes in the retrieval of nuclear fragments and subluxated intraocular lenses. Brazitikos PD, Androudi S, Alexandridis A, Ekonomidis P, Papadopoulos NT. 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. Who sues their doctors? Kim JE, Flynn HW, Jr, Smiddy WE, et al. 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 If you've suffered an adverse outcome after cataract surgery, you might be wondering if you can or should sue your eye doctor for Management of nucleus loss into the vitreous: long term follow up in 63 patients. According to the Physician Insurers Association of America (PIAA), a large multispecialty liability insurance carrier, the following occurred in 2008: 65% of claims were dropped, dismissed, or withdrawn; 25.7% were settled; 4.5% were decided by alternative dispute mechanism; and 5% were resolved by trial, with the defendant prevailing in 90% of those tried cases.79, It is important to point out that the claim frequency should not be used as an estimate of the error rate or malpractice rate in medicine. A claim may include institution of a lawsuit or arbitration proceedings against the insured. WebCataract Symfony Lawsuits? The amount of indemnity payment for each grouping of final visual acuity among cataract surgeries complicated by retained lens fragments. The patient was released to a general ophthalmologist. Hui JI, Fishler J, Karp CL, Shuler MF, Gedde SJ. Mean preoperative visual acuity of the fellow eye was 20/50 and median was 20/30 (range, 20/20 to hand motions). Two cases went on to trial and ended with a verdict in favor of the plaintiff. Bovbjerg RR, Petronis KR. In comparison, indemnity payment for all closed claims for OMIC is a mean of $150,000 and median of $75,000. Sponsored by the American Academy of Ophthalmology, OMIC is the largest professional liability insurer for ophthalmologists in the United States, currently insuring over 4,300 ophthalmologists throughout the 49 states (all states except Wisconsin). Univariate descriptions of the analysis variables and the result of statistical analysis are shown in Table 7. In the second case, a male patient with advanced posterior subcapsular cataract in the left eye underwent cataract surgery with phacoemulsification in 1996, reportedly without complications. 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. 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.). 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. However, optimal timing of vitrectomy is unknown, and the effect of vitrectomy timing on clinical outcomes has been highly controversial.2041,74,78 Therefore, there is currently no clarity in best time to refer to a specialist in cases of cataract surgeries complicated by retained lens fragment or the time between referral to vitrectomy. Associated factors were analyzed for (1) going on to a trial or settlement rather than being dismissed, and for (2) indemnity payment vs no payment. Four patients declined any further surgery. Why do people sue doctors? Oruc S, Kaplan HJ. Stenkula S, Byhr E, Crafoord S, et al. For cataract surgery litigation, 119 cases (21 percent) led to settlements, totaling $22.9 million. 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 Management of dislocated lens fragments after phacoemulsification surgery. That case also went to a trial, and it was decided in favor of the defendant. 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. Yazici AT, Kaya V, Bozkurt E, Imamoglu S, Yilmaz OF. 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