25 Trial Lawyer • Fall 2023 See Vision Malpractice p 26 was contraindicated for the patient because of a pre-existing eye condition. Second, there was a surgeon error during the procedure. And finally, post-operative complications were neither recognized nor treated properly. Patients with eye diseases such as keratoconus or patients who have a history of retinal detachments are universally considered to be poor candidates for LASIK surgery. Other disqualifying facts include large pupils, corneas that are too thin or other eye diseases affecting the cornea. Many times, a thorough eye examination prior to LASIK will determine the absolute or relative contraindications to LASIK surgery and surgery will not be performed. However, we saw several refractive surgeons who were willing to push the limits and take risks with their patient’s eyesight and perform surgery despite the contraindications. Ross was not a good candidate for LASIK because of her large pupils. But more than that, we discovered that during her surgery the corneal flap was cut too deep, and the laser penetrated the anterior chamber. Thereafter, the surgeon altered the surgical record and misled Ross and her husband. Ross’s case was settled in mediation after her claim for punitive damages was granted by the court. While Ross’s case was much more than a candidacy case, many clients suffered from corneal thinning and were at risk of developing keratoconus. Keratoconus is a progressive eye disorder affecting the cornea. In a healthy eye, the cornea is smooth and round, but with keratoconus, the cornea thins and gradually bulges outward into a cone-like shape. This distortion of the cornea can lead to various vision problems. Keratoconus is a contraindication for LASIK surgery. Early signs of keratoconus can be detected by topography scanning machines available to all refractive surgeons. A scan of a keratoconus patient will show red in the inferior portion of the scan, which indicates steepening of the cornea. The scan on the following page is from one of my cases. The topography was taken two days before surgery, then faxed to the surgeon for review. The fax was black and white, so the surgeon failed to see what was evident on the color scan. My client needed corneal transplants after the original LASIK surgery. We had several cases where the LASIK surgeon misprogrammed the laser causing the permanent removal of tissue and permanent damage to the eye. For example, the laser was programmed to treat for nearsightedness, yet the patient was farsighted. In other cases, the wrong magnitude or angle of astigmatism was programmed into the treatment plan. In those early cases, a typical post-op complication was an infection that developed under the LASIK flap. If not recognized early on, it could result in corneal “melt” with devastating impact to the quality of vision. To the medical profession’s credit, these complications were identified in the literature early on and steps were taken to prevent these serious complications after the first several years of LASIK. Conductive Keratoplasty We represented a high school science teacher who wanted relief from the effect of presbyopia, which is the inability to read up close as one ages. She agreed to a CK (conductive keratoplasty) procedure, which is another type of refractive surgery. CK is considered a minimally invasive procedure that reshapes the cornea by using radiofrequency (RF) energy to specific points on the cornea. The RF energy heats and shrinks the collagen fibers in the cornea, reshaping and steepening the cornea slightly to improve near vision. The goal in CK is to improve near vision in one eye, while the other eye is used for distance vision. This is known as monovision. Both CK and monovision
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