26 Trial Lawyer • Fall 2023 Vision Malpractice Continued from p 25 were recommended as a way patients can avoid the need for reading glasses as they age. Unfortunately, the client was not an appropriate candidate for surgery because of her dry eye and an abnormally shaped cornea. We brought negligence claims (specifically, we did not allege failure to obtain informed consent) and we argued she absolutely should not have had the surgery, and a Jackson County jury agreed.1 Silent thief Glaucoma is an eye disease that damages the optic nerve, which is the nerve responsible for transmitting visual information from the eye to the brain. This damage is often associated with increased pressure within the eye, known as intraocular pressure (IOP). If left untreated, glaucoma can lead to progressive vision loss and potential blindness. If diagnosed appropriately and treated properly, most patients will not lose functional vision. In short, although glaucoma is a progressive disease, it can be managed for decades without any loss of functional vision. There are different types of glaucoma, but the most common is primary openangle glaucoma (POAG). In POAG, the drainage angle in the periphery of the eye becomes partially blocked, leading to a gradual increase in IOP. This increased pressure can damage the optic nerve. The progression of glaucoma varies from person to person. Initially, it may not cause any noticeable symptoms, and vision loss may be subtle, which is why it is called the “silent thief.” As the disease advances, peripheral vision is typically affected first. The loss of peripheral vision is not immediately noticed by the individual, as the central vision remains intact until the later stages of the disease. Without treatment, the vision loss can progress, eventually leading to tunnel vision and, in severe cases, complete blindness. I have represented many clients whose glaucoma was mismanaged by general ophthalmologists. In a tragic case, an elderly woman lost all functional vision despite the fact her ophthalmologist was documenting years of elevated IOPs and decreasing optic nerve health yet failed to take any appropriate action to slow the progressive disease. Another type of glaucoma is acuteclosure or narrow-angle glaucoma. This condition is considered a medical emergency and requires immediate attention to prevent permanent vision loss. The symptoms of acute angle-closure glaucoma occur suddenly and may include severe eye pain, blurry vision, halos around lights, headache, nausea and vomiting. Sometimes symptoms occur shortly after a dilated eye exam. In one case, my client had immediate pain after her dilated exam. She called her ophthalmologist and was advised to take aspirin. As it turned out, the doctor failed to assess, resulting in permanent loss of vision in both eyes. In another case, our client lost functional vision after she suffered high IOPs following eye surgery and was untreated by her ophthalmologist for six weeks while he was monitoring her condition. In each of these cases, we were able to show that the eye doctors were aware of the high interocular pressures but did not take appropriate steps to lower the pressures before irreparable damage occurred A scan of a keratoconus patient will show red in the inferior portion of the scan, which indicates steepening of the cornea. The topography above 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.
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