PT had a cataract extraction with intraocular lens implant on 9/10/24 at the subject facility.
PT initially presents to subject facility for glaucoma and cataract evaluations in 2024. PT returns on 8/7/25 and Pt states that he feels like his vision has gotten worse since his last appt, states that he is having difficulty seeing things on his phone. Pt states that his distance vision is hazy and cloudy, doctor notates PT last A1c: 6.2. Physician diagnoses the patient with Lens PCO – Obscuring vision, noting visually significant symptoms of decreasing distance and near vision along with worsening glare in bright lights and while driving, schedule for laser YAG capsulotomy OD, patient to assess contralateral eye later; Retina DM Type 2 DM w/o ocular complications, stating “no evidence of macular disease, no CSME”.; Corneal dry eye syndrome, and glaucoma suspect/on cupping retinal nerve fiber layer IOP stable.
On the subject date of incident, 9/29/25, YAG Laser Capsulotomy was performed at the subject facility on the right eye for a cataract. Then, 6.0 mJ of energy were used to perform a circular posterior laser capsulotomy through the visual axis. total of 10 applications were used. "The patient tolerated the procedure well and there were no complications." The lens remained well centered and stable. Postoperative instructions were provided. Brimonidine ophthalmic drops times were instilled prior to his dismissal.
10/13/2025 PT returns post op and reports severe blurry vision when the physician finds a "new macular hole", notates it as a new macular hole seen today, and refers the PT to a retina specialist. PT states he started having a vision decline OD 2 days post op from the YAG Laser Capsulotomy.
Retina specialist notates that PT is a diabetic, last A1C was 5.7%, he locates a full thickness hole in the macula measuring 469 microns hold OD on exam and imaging and suggested to close macular hole and improve overall macular contour. The retina specialist performed a right eye post retina surgery involving vitrectomy, membrane peel, and gas bubble placement, which was successful in closing the macular hole in the right eye.
Based on the aforementioned, the key question is whether the macular hole was present before September 29, 2025 YAG laser capsulotomy, or whether the YAG laser capsulotomy caused the development of the macular hole.
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Do you believe there might have been medical error?
The amount of energy and shots fired in the YAG procedure was very normal. It’s true that an error from YAG laser can cause macular damage, but it would manifest immediately after the procedure (not 2 days), and would not be in the formation of macular hole. Could the hole have been there before the YAG and the doctor failed to diagnose it? Possibly, but the patient had a drop in vision after the YAG, not before. So more likely than not, the hole developed after the procedure.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Same rationale: normal power settings on the laser and a presentation that is not consistent with damage from YAG.
What makes you a good expert for this case?
The expert is a board-certified vitreoretinal surgeon at Colorado Retina Associates in the Denver metro area. He trained at the University of Colorado (undergraduate, medical school, and residency) and completed a two-year vitreoretinal surgery fellowship at Emory. He spent nine years on the faculty of the University of Colorado School of Medicine as Associate Professor of Ophthalmology, building a high-volume medical and surgical retina practice across UCHealth, Denver Health, Children’s Hospital Colorado, and the Denver VA, and treating the full range of vitreoretinal disease — retinal detachment, diabetic vitrectomy, macular surgery, and pediatric and posterior segment trauma. He is a member of the Retina Society, has received teaching awards in 2019 and 2025, and serves as a peer reviewer for the Colorado Medical Board. He provides merit analyses and expert testimony in vitreoretinal cases. The combination of high case volume, academic appointment, ongoing peer review for a state medical board, and a documented record of teaching gives him both the technical command of the literature and standard of care, and the ability to explain it clearly to attorneys, judges, and juries.
How often do you encounter cases similar to this one in your practice?
Macular holes - all the time. Issues from YAG laser - commonly but usually the issue is floaters.
Do you believe there might have been medical error?
Known risk of yags is disruption of the vitreous
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Yags by nature cause disruption and a plasma wave of the vitreous which can cause retinal tears and macular holes
What makes you a good expert for this case?
I do yags and am a retinal expert on macular holes for many years
How often do you encounter cases similar to this one in your practice?
Very rare but I have seen this happen 3 times. No fault of surgeon I was one of first in the world in 1980 to do yags Not much has changed
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