Deteriorating visual acuity

A 32-year old patient attended a consultant ophthalmologist member of the MDU regarding the possibility of undergoing laser eye surgery for myopia. His visual acuity was 6/24 unaided, improving to 6/9 in the right eye with glasses. The consultant felt that the patient would be a suitable candidate for photorefractive keratectomy (PRK). They discussed the procedure in detail and the patient decided to proceed. There were further discussions about the surgery when the patient came in for the operation three weeks later.

Post-operatively, the patient's visual acuity deteriorated and it was noted that he had a moderate amount of haze. The consultant prescribed steroid drops. Two months later the patient indicated that his visual acuity was not acceptable. It was now 6/18 unaided improving to 6/6 with lens correction.  The consultant proposed a LASIK enhancement to the right eye, which he performed a few days later.  Unfortunately, the patient's condition worsened post-operatively, resulting in his vision deteriorating to 6/24, improving to 6/7 with correction. Although this visual acuity represented an improvement on the patient's pre-operative vision, he was unhappy with his surgical outcome. 

Three years after the surgery the patient brought a claim against the ophthalmologist. He alleged that he was not adequately counselled regarding the risks of the various procedures and that he had not received sufficiently informative written material. He alleged that he had been given the impression that he would never need to wear glasses or contact lenses in the future. Had he been advised that there may be the need to wear glasses or contact lenses, he would not have undergone the first procedure. 

He further alleged that the second operation was performed too soon after the first, at a time when it was not yet possible to assess the stability of the refractive outcome of the first procedure. He made a claim for the cost of the two operations, pain and suffering, loss of earnings and a modest care claim.

The MDU obtained an expert opinion from a consultant ophthalmologist. The expert pointed to the factual dispute between the MDU member and the patient about what information had been provided pre-operatively, both written materials and oral discussion. The consultant was clear that he specifically warned the patient orally that he would still need glasses at the end of the procedure. 

The expert advised that the second procedure ought to have been delayed until such a time as the patient's condition had stabilised. It was the expert's view that the patient's outcome may not have been materially worse as a consequence of the timing of the procedure. However, he added that a properly delayed treatment could have been more effective, improving the patient's myopia.

He made a claim for the cost of the two operations, pain and suffering, loss of earnings and a modest care claim.

The consultant, having reviewed the evidence, was concerned about the timing of the second procedure and expressed a preference that the case was settled. It was noted that the patient's condition was now stable and unlikely to deteriorate. The MDU argued that the patient's vision had improved as a result of the surgery. An offer was made to settle the claim in the sum of £2500 directly to the claimant, which was accepted.

Dr Sharmala Moodley
Deputy head of claims

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