Time to additional surgical procedures such as vitrectomy was at the discretion of the subspecialist. The first case closed in 1992 for $125,000, and the second case closed in 2002 for $250,000. CF, counting fingers; HM, hand motions; NLP, no light perception. Start here to find personal injury lawyers near you. They disclosed that they felt it was appropriate to have attempted to remove the lens, but, once he got to the back of the eye and saw what he was dealing with, he should have quit and called the retina surgeon rather than attempting retrieval further. They believed that he was not experienced enough to proceed as he had. In another case, the operative note was the usual macro for standard cataract surgery and did not seem to take into account the problems encountered during the surgery. He also damaged the film over the Practice styles and preferences of ASCRS members1994 survey. The third claim alleged decreased vision following negligent vitrectomy surgery to manage retained lens fragment. Twelve (11%) of 108 claims were resolved by a trial, 30 (28%) were settled, and 66 (61%) were dismissed. Liability claims and costs before and after implementation of a medical error disclosure program. However, there is no prospective randomized clinical trial to guide which cases should be referred for surgical management. The relationship between physicians malpractice claims history and later claims: does the past predict the future? Spicer J. 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). The plaintiffs expert stated that it is below the standard of care to not notice the posterior tear during cataract surgery and the retained cortex was not removed at the time of surgery. The issue of malpractice has wide-ranging stakeholders, including our society. As noted already, the majority of claims are dropped, dismissed, or closed without payment. Also, claims with worse final visual acuity tended to have higher indemnity payments (Figure 6). Both of these were defined as glaucoma, and there were a total of 31 cases. 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. Rossetti A, Doro D. Retained intravitreal lens fragments after phacoemulsification: complications and visual outcome in vitrectomized and nonvitrectomized eyes. FINAL DISPOSITION OF CLOSED CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. Final visual acuity was the last recorded visual acuity. But if your eyes reflexively squint or close with light exposure, it could be a signal of inflammation in the eye, or iritis. The claimant was a 74-year-old woman who had been a patient of the plaintiff for 2 years. 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. National Library of Medicine These are a miniscule fraction of the tens of millions of cataract surgeries performed over the same period. However, the patient did not show up for appointments, despite being sent no show letters. If more than one physician was named in the claim, only the data on the primary surgeon was analyzed. Brick DC. In 10 cases, the tear of posterior capsule was not recognized by the cataract surgeon or was not indicated in the operative note and only became apparent during the investigation of the case. WebMedical board investigations are now often triggered by mandatory reports from surgery centers and hospitals. Hickson GB, Clayton EW, Githens PB, Sloan FA. Kim JE, Flynn HW, Jr, Smiddy WE, et al. 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. A retrospective review was performed of all closed claims during the 21 years from 1989 through 2009 of those insured by OMIC to identify cases associated with cataract surgeries complicated by retained lens fragments (see Inclusion and Exclusion Criteria section that follows). Outcome of vitrectomy for retained lens fragments after phacoemulsification. The cataract surgeon felt strongly that he was not at fault and wished to go to a trial rather than settle. Ways to reduce significant vision loss, including improved management of corneal edema and IOP, and timely referral to a subspecialist should be considered. Baker PS, Spirn MJ, Chiang A, et al. In one additional case, observation was recommended without further surgery because the retina specialist felt that the retinal detachment was inoperable. After your cloudy lens is removed, it will be replaced with an implanted clear artificial lens called an intraocular lens (IOL). The mean defense cost for 12 cases that went on to a trial was $96,464 with a mean defense cost of $97,924 for cases with a defense verdict and $95,004 for cases with a plaintiff verdict; the mean expense for claims that were dismissed was $9,226. In one of the claims, the cataract surgeon, who had some retinal training, attempted retrieval of the posteriorly dislocated lens material. 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. 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. An example of one unit change in visual acuity would be going from 20/20 to 20/200. 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. about navigating our updated article layout. ESTIMATES FROM THE MULTIVARIATE PROPORTIONAL ODDS MODEL FOR THE 3-WAY GROUPING OF THE OUTCOME FOR CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. Copyright 2023 MH Sub I, LLC dba Nolo Self-help services may not be permitted in all states. Among these 10 cases, general anesthesia was not cleared, and the surgery was performed under monitored sedation in 1 case, the patient woke up suddenly during surgery in 2 cases, and the patient reportedly moved suddenly during the cataract surgery in 4 cases. Financial Disclosures: Mr Weber is an employee of Ophthalmic Mutual Insurance Company. Of the 108 defendants, 105 (97%) were cataract surgeons and only 3 (3%) were retinal surgeons. Although there were no cases involving residents, there was one claim against a policyholder ophthalmologist who was overseeing a colleagues attempt at learning cataract surgery. official website and that any information you provide is encrypted In all cases, retinal detachment occurred, 5 after the cataract surgery and 2 after pars plana vitrectomy and lensectomy by retinal specialists. Among the 108 cases, two physicians had multiple claims relating to retained lens fragments, with 2 claims each. In contrast, 29 (45%) of 65 cases with no indemnity payment had final visual acuity of 20/200 or worse. Pars plana vitrectomy for the management of retained lens material after cataract surgery. 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. A retinal surgeon who was called into the operating room was able to remove the nucleus using 3-port pars plana vitrectomy. Many are related to retained lens fragments with 108 unique cataract surgeries, 97% against cataract surgeon and WebUltrasound: The predominant technology for cataract removal is ultrasound. The number of closed claims related to cataract surgery complicated by retained lens fragments each year from 1989 through 2009. In 7 cases, the cataract surgeon documented an intraoperative attempt at retrieval of the lens fragment (Table 2). Jena AB, Seabury S, Lakdawalla D, Chandra A. 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. For those claims with greater than 2 logMAR worsening in visual acuity, 62% resulted in an indemnity payment averaging $158,500. The same study showed that, in terms of compensation for medical errors, the system gets it wrong about equally on both sides such that 27% of claims involving errors were uncompensated and, on the flip side, the same percentage of compensated claims did not involve an error. Every year, millions of people have routine surgery to replace a cataract that is, a lens in the eye that has become clouded. 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. Learn how we can help. 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