71 year old female with Dx cataracts has scheduled bilateral cataract implantation, the right eye was to be done in September 2023 and then left eye in October. It was agreed upon that both eyes would be treated with the same model implant.
September of 2023 has intraocular lens implantation to her right eye (model used was a SA6AT3). October 3, 2023, the left side was done, however it was a different lens. (It was the Panoptix TFAT50). This was not revealed to the PC until a month later during follow up.
The attached screenshots show an inconsistency in the lenses that were selected for each surgery, unsure why it was changed and the PC claims to be unaware of why they are different. You'll also find pertinent office notes.
The provider admits that the implants were “not what was agreed upon” and offers to exchange the right eye free of charge, which they perform in November of 2023.
After the exchange, PC struggled with continued headaches, pain, difficulty reading and severe glare to the right eye. She is diagnosed with posterior capsular opacification and has had managed treatment since. The ophthalmologist reports that this may or may not improve. Per the PC, she says her vision in her right eye continues to worsen.
Vision prior to procedures:
Before: OD 20/200 OS 20/100
After: OD 20/50 Glare 20/400 OS 20/30 Glare 20/400.
Obviously our concern is regarding the incorrect implants, additionally the inconsistent documentation prior to each surgery. It appears visual acuity has improved, but PC remains very symptomatic and claims to have failing overall vision.
Files:
No questions yet!
Do you believe there might have been medical error?
Unfortunate case, but should be easily resolved. Of course, we have limited chart notes here. It appears that the original lens selection was a multifocal IOL (Panoptix), that was then subsequently changed to the monofocal toric (SA6AT3) on a visit with the patient counselor on 9/14/23. The counselor notes indicate the change, but it appears this was not relayed to the surgeon or the ASC. Thus, the correct type of lens (toric) was placed in the first eye, but the communication about the change to non-multifocal was not communicated adequately for the second eye. This was a system process failure, one which can be avoided with proper software help (Veracity is what I use). The options for correction are exchange or observation, as they described. If I read the notes correctly, the exchange happened on the RIGHT eye, thus removing the toric lens (non multifocal), but it is not clear whether a Panoptix was used in the RIGHT eye. The clinic notes indicate that the exchange to a Panoptix would incur a charge (surprising approach!), but your notes indicate it was free of charge. I am assuming the RIGHT eye was done, with placement of a Panoptix lens. thus, her complaint of reduced reading vision is pertinent, as the Panoptix bilaterally would allow her to achieve good reading vision. There are many details missing in this brief report that would help elucidate the extent of the problem/error.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
System procedure failure with patient IOL selection change. Hard to tell if medical error with regard to surgery itself.
What makes you a good expert for this case?
I am a Refractive Cataract Surgeon, practicing for 25 years, implanting hundreds of multifocal lens implants every year. My preferred lens choice for patients is the Panoptix. I have been using the Panoptix for the past 5+ years, having to exchange only one of those lenses. My experience as a refractive cataract surgeon, and owner/previous medical director of an ambulatory surgery center positions me in a unique position to evaluate the processes that lead to this error in the first place.
How often do you encounter cases similar to this one in your practice?
Fortunately, we use a software system that does not eliminate wrong lens problems, but significantly reduces the chances of this happening. We have had to do lens exchanges over my 25 year career, but fortunately they are few and far between.
Do you believe there might have been medical error?
wrong implant agreed to by both parties and doctor replaced free of charge. PCO is very common and can be fixed wiht an office procedure most of the time unless there are other reasons such as retinal edema. since both parties agreed to replacement and if PCO can be fixed with a simple 30 second in office yag laser procedure i see no malpractice unless inflammation present or other factors involved . PCO never causes headaches and only causes blurred vision
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
causation and results that are permanent not present here
What makes you a good expert for this case?
i have been head of a major trauma center for 30 years and teach everyday residents about this I also defend my own malpractice carrier as well as go against them
How often do you encounter cases similar to this one in your practice?
not uncommon to here this as this is one of the many causes for lawsuits
Do you believe there might have been medical error?
The surgeon admitted that the implant lens in the left eye was "now what was agreed upon". She continues to experience severe glare following cataract surgery in both eyes and has limited visual acuity.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
The surgeon admitted that the implant lens in the left eye was "now what was agreed upon".
What makes you a good expert for this case?
I have 36 years of experience in the medical and surgical treatment of eye disease. I have performed over 35,000 cataract surgeries.
How often do you encounter cases similar to this one in your practice?
I have dealt in referral with patients who have had the "wrong implant" placed in the eye. Often, this will require me to do an exchange for a new implant lens. I also frequently deal with the glare issues following cataract surgery that this patient is experiencing.
Do you believe there might have been medical error?
Patient was implanted with an incorrect IOL in her left eye. She was not told about the wrong lens implant until a month later. The malpractice was the lack of early notification and incorrect implant, The positives for the physician is that he or she offered to exchange at no additional cost for the right eye. The concern is have is that this was not the intended lens or plan and the doctor is back tracking after the surgery.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Because the physician offerred to exchange the right eye at no additional cost it does release him of patient neglect.
What makes you a good expert for this case?
I perform 1000 caract cases per year and deal with IOL exchanges for unhappy patients referred from outside doctors. I perform complex anterior segment reconstructions. My experience surgically and clinically would be an assistance to your case.
How often do you encounter cases similar to this one in your practice?
This is a never event. The plan to implant was not checked during and immediately after the case. The lens that was implanted is a upgrade option and has to have proper counseling by the physician to make sure the patient understands the risks and benefits of a trifocal lens.
Do you believe there might have been medical error?
The provided records are scattered and difficult to follow. They fail to distinguish which lens was chosen and what the goal of surgery was. It appears patient agreed to toric IOL in both eyes and was accidentally implanted a multifocal toric in the left eye. However it appears that the right lens was exchanged for unclear reasons which is confusing as the notes make it seem that the left lens was the one that was incorrectly implanted thus was found a left lens exchange. The lack of appropriate documentation on the provided notes make it difficult to further clarify the situation but there does appear to be a medical error in which lens was discussed and what was implanted. The issue here is appropriate consent and discussion with the patient as well as mutually agreed on surgical planning.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
The implanted lens did not result in injury to the eye however it is reasonable to think that there was negligence in IOL implantation.
What makes you a good expert for this case?
I perform hundred of cataract surgery and in academics, I am involved with resident training of cataract surgeries. The pre-operative discussion with the patient and surgical planning is absolutely crucial and important in having great outcomes. I provide expert witness and independent medical examination on a contract basis and have been deposed in traumatic, legal and malpractice cases.
How often do you encounter cases similar to this one in your practice?
Never, there must be a systems process flat in this practice for this sort of mis-implantation of the lens to happen. it is not common.
Do you believe there might have been medical error?
The documented pre-op plan conflicts with the surgery that was performed. There was no discussion of risks involved with the Panoptix lens prior to the surgery.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
There are risks associated with multifocal lenses such as the Panoptix. Patients implanted with multifocal lenses should be educated with regards to these risks and then only have these lenses implanted once the risks have been accepted.
What makes you a good expert for this case?
I perform more than 500 cataract surgeries a year with various types of lens implants, including multifocal lenses such as the Panoptix. I am familiar with this type of lens and risks involved. I serve as Medical Director for a large academic department of Ophthalmology and am familiar with the processes that should be in place to minimize these types of medical errors.
How often do you encounter cases similar to this one in your practice?
It is very rare for a wrong intraocular lens to be placed.
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