27 Trial Lawyer • Fall 2023 to the optic nerve. The prognosis for glaucoma depends on several factors, including the type and severity of glaucoma, the age of onset, the response to treatment, and the individual's overall eye health. Early diagnosis and intervention greatly increase the chances of preserving vision and slowing the disease progression. Regular eye exams, especially for individuals at higher risk (e.g., family history of glaucoma, older age), are crucial for early detection and appropriate management of glaucoma. It is incumbent on glaucoma patients to adhere to their prescribed treatment plan, attend regular follow-up appointments with their eye care professional and monitor their intraocular pressure. But it is the role of the ophthalmologist to diagnose and properly manage glaucoma. If both the patient and doctor accomplish this, many people with glaucoma can maintain good quality functional vision for the patient’s lifetime. Sickle cell trait and blindness In one case, our young African American client lost functional vision because his ophthalmologist neither recognized nor appreciated the risk of visual losses in a patient with sickle cell trait. Although he did not have sickle cell anemia, he carried the “trait” which put him at risk if trauma causes blood in the eye. This is known as a hyphema. It is known that patients with sickle cell trait may experience serious complications if they experience a hyphema, which is characterized by the presence of blood in the anterior chamber of the eye.2 In our client’s case, his eye was struck by a dirt clod, which caused the hyphema. He also carried sickle cell trait. In his case, the sickle cell hyphema was characterized by the presence of sickle-shaped red blood cells in the anterior chamber of the eye. Like glaucoma cases, these abnormal cells can cause a blockage in the drainage system of the eye causing increased eye pressure and damage to the optic nerve. The emergency room physicians and general ophthalmologists missed the diagnoses because they failed to ask our client’s parents whether he carried sickle cell trait. It was too late when the correct diagnosis was made, and he suffered permanent visual loss in one eye. Chemical burns I have represented several clients who suffered chemical burns to their corneas in ophthalmic and general surgery cases. Before LASIK surgery became mainstream, ophthalmologists performed Photorefractive Keratectomy (PRK) surgery. Like LASIK, PRK is laser eye surgery used to correct refractive errors in the eye and reduce or eliminate the need for glasses or contact lenses. While both procedures aim to correct vision, LASIK involves creating a flap in the cornea and reshaping the underlying tissue, whereas PRK involves reshaping the outer surface of the cornea, known as the epithelium. To prepare the eye for PRK surgery, surgeons routinely softened the cornea with mitomycin C before using the excimer laser.3 In one case, the mitomycin C was applied too long on the cornea resulting in bilateral chemical burns and causing the need for bilateral corneal transplants. I have represented clients who suffered chemical burns from chlorhexidine gluconate, often marketed as Hibiclens. This solution is commonly used in medical and healthcare settings as a surgical scrub and preoperative skin disinfectant. Hibiclens is effective when used for surgical preparation to disinfect the skin but should be carefully applied on or around the head as Hibiclens can cause permanent damage to hearing, smell, and eyesight. In the early 2010s, I represented a woman who suffered corneal burns while undergoing brain surgery at OHSU. As we later discovered, the preoperative protocol dictated the use of chlorhexidine gluconate to prep the scalp. In the operating room, my client was placed in the prone position and her posterior scalp was doused with the anti-bacterial scrub. Unknown to the surgery team, excess Hibiclens solution seeped down her face and into her right eye while the neurosurgeon performed the surgery. The result was a severe chemical burn. My 43-year-old client needed a corneal transplant and cataract surgery to regain some of her vision. The vision trail I have reviewed hundreds of eye cases in the past 23 years and have the pleasure of representing nearly 100 clients. The work is fascinating and has taken me across the country from Key West, Florida to Anchorage, Alaska. Along the way I worked with the nation’s top eye doctors and was asked to give my perspective to ophthalmologists at three of their national meetings. It has been a great journey. Greg Zeuthen is a personal injury attorney whose practice includes LASIK eye surgery, medical negligence and premises liability cases. He contributes to the OTLA Guardians of Civil Justice at the Guardians Club Stalwart level. His office is located at 210 SW Morrison St., Ste. 400, Portland, OR 97204. Zeuthen can be reached at gkz@ zlawoffice.com or 503-227-7257. 1 The Warren case was appealed by the defense who claimed the trial court erred in granting plaintiff's motion to exclude evidence relating to the informed consent discussion and related documentation. The plaintiff argued since there was no informed consent claim before the jury, such evidence had no bearing on the standard of care in the case. That is, it did not prove or disprove whether the defendant properly assessed plaintiff as an appropriate candidate for monovision eye surgery. The Court of Appeals upheld the verdict. See Warren v. Imperia, 252 Or App 272, 287 P3d 1128 (2012). 2 The anterior chamber is the space between the cornea (the clear front part of the eye) and the iris (the colored part of the eye). 3 Mitomycin C is a potent chemotherapy medication that is primarily used to treat various types of cancer. It belongs to a class of drugs known as alkylating agents. It is routinely used off-label by ophthalmologists in PRK surgery.
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