Ophthalmology expert witness advises on failure to diagnose corneal disease from LASIK surgery


Ophthalmology expert witnessAn ophthalmology expert witness advises on a case involving failure to diagnose corneal disease that led to long-term damage from LASIK surgery. The plaintiff, located in New Hampshire, who was in his late 20s, was evaluated by the defendant ophthalmologists for possible LASIK laser eye surgery. Corneal topography studies were normal, but the plaintiff had worn his contact lenses the day of the study and during the five previous days. Repeat testing without the contact lenses several days later revealed corneal abnormalities. Despite the test results, the plaintiff was cleared for and received LASIK surgery that day.

Two years later, the plaintiff reported to the defendants that he had symptoms of monocular diplopia, halo, glare and decreased vision. The defendants did not tell the plaintiff that he was suffering from post-LASIK ectasia.

The plaintiff sued the ophthalmologists for medical malpractice.

Question(s) For Expert Witness

  • 1. Should the LASIK surgery have been performed?
  • 2. What should the defendants have told the plaintiff about his condition?
  • 3. Was this medical malpractice?

Expert Witness Response

The second pre-surgery testing showed corneal abnormalities bilaterally. Specifically, the right eye showed clear abnormalities in three of four studies and borderline abnormality in the fourth. Orbscans of the right eye showed asymmetrical elevation, abnormal topography with an irregular asymmetric corneal astigmatism centrally and paracentrally, and thinnest portion of the cornea was not in the center of the cornea as it normally should be. Corneal topography of the left eye demonstrated borderline abnormalities.

Taken together, the corneal topographies showed that the patient was suffering from corneal disease — form fruste keratoconus, a dormant, sub-clinical condition — which is a well-known, generally accepted contra-indication to doing LASIK, because of the risk, among others, of developing corneal ectasia, a progressive thinning, warping and irregular bulging of the cornea, with attendant progressive severe visual problems. It usually takes one to two years before the patient begins to experience symptoms because the ectasia is progressive.

Orbscan studies two years later in the defendants’ office showed a high degree of irregular corneal astigmatism, with progressively worsening corneal topographies, consistent with the complication of post-LASIK ectasia. At this point, the defendants knew, or should have known, before the expiration of the 2½ year statute of limitations, that the patient was suffering from post-LASIK ectasia but did not tell the patient. Medical records prepared by the defendants contain no progress notes for the patient’s subsequent orbscan studies, as would be good practice. This may suggest reluctance on the part of the defendants to put in writing what they already knew or suspected, as was the sudden, unexplained cancellation by one defendant of previously scheduled enhancement surgery. It is also noteworthy that the defendants did not provide the patient’s subsequent treating ophthalmologist with copies of the incriminating report of the orbscan studies of the right eye from the pre-LASIK visit.

In my opinion, the patient’s LASIK-induced keratoconus or post-LASIK ectasia was a direct and proximate cause of his LASIK surgery. Medical malpractice was committed in this matter, in clearing the patient for LASIK, and in performing LASIK on this patient.

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

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