is doctor responsible

I had a cataract surgery with IOL implant. Anasthesia was administered by an injection under the eye. The same was done by a paramedic staff. The very next day when doctor removed the bandage, I had no vision. Doctor told me that two things have happened: first my lens is not properly centered and is too small foe which I am going to replace it with a bigger lens and properly centre it after another surgery, more seriously, blood has come behind blocking the vision. This would probably dissolve in a certain period of time. I trusted his word. The lens was changed there and then and for blood in the eye he gave me intense medication regime to follow. He told me there is a possibility of major surgery to clean the blood but he did not ask me to consider it. He basically did not inform me about the gravity of the situation. After a few days (5 or six) I again went to see him and I told him that there is no vision and eye look like not responding to treatment. But he asked me to continue the medicine. In fact dilated eye exam was of no use since nothing could be seen. After two or three days I again went to him and  my eye was diagnosed NLP (no light perception). A scan showed retinal detachment. The doctor told me I should have surgery within ten days. I had surgery retinal reattachment within 5 days but it was unsuccesful.The long and short of it, I lost vision in left eye.This is about 2 months back.

A few days back I consulted another eye surgeon (professional rival of my former doctor)) and he said that you had a vitrous heamorrage due to anasthesia needle. I am confused; leaving aside the criminal negligence about the injection did the doctor who treated me misinformed and misled me? Could my eye have been saved by timely surgical intervention which he did not advice for fear of leak out of real motive? please send ur comments

[JodieJ]

I'm very sorry to learn about your awful experience.  I'm not sure whether the forum M.D.'s will agree with me, but I think you should consult a medical malpractice lawyer who is experienced with cases similar to yours.  You need more information before you can determine whether there is malpractice involved, but an experienced lawyer will know how to best represent your interest.

I have trouble understanding why some surgeons are still using needle anesthesia when topical anesthesia (eye drops) is so much safer.
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[John C Hagan III, MD, FACS, FAAO]

1. to Haider    I'm sorry for your experience.  Assuming the risk of total blindness is 1 in 5,000 cataract operations (and that is on the lower end of incidence) and there are two million cataract operations in the US alone each year, then at least 400 eyes will go completely blind due to UNAVOIDABLE complications mainly infection, massive bleeding (expulsive hemorrhage) or unrepairable retinal detachment.

Every consent for for cataract surgery normally lists loss of eye as a possibility. I am currently writing an essay "When Should Cataract Surgery Be Done" for my Eyecare Blog as I think the risks of cataract surgery have been trivialized.

These Eye Forums do not give legal advice. If you are interested in determining if there was legal fault and negligence then I agree with JodieJ that you should consult a lawyer that does medical malpractice.

TO JODIEJ:  While you are usually well informed, your comments about all surgeons using needle anesthesia is incorrect and needs correcting. There are no surgeons that use topical anesthesia 100% of the time. There are many patients that need injection (needle) anesthesia. For example: patients that cannot keep their eye still, patients that cannot cooperate or follow orders (example Alzheimer's, stroke damage, etc), patients with low pain tolerance, patients that have had topical anesthesia on the first eye and had too much pain, patients with severe photophobia to name a few.

Injection anesthisia is the preferred method of doing cataract surgery for perhaps 30 % of cataract surgeons in the US and a much higher percentage elsewhere.  The advantages of injection anesthesia: the eye doesn't move as much, pain relief is better, the eye does not have pain from the bright light.  There are instances in which patients have sued surgeons for using topical anesthesia instead of injection anesthesia because of complications that have arisen from eye movement. Moreover a survey of patients having topical anesthesia on one eye and injection on the other showed patients prefer injection.  Each year Dr. Leaming does a survey in the US on anesthesia over the last 2-3 years the percentage of surgeons preferring topical has had little increase.

So the correct answer is topical anesthesia works best for some surgeons on some patients.

JCH III MD

[JodieJ]

Thank you very much for your clarification about this issue.

[John C Hagan III, MD, FACS, FAAO]

JJ  Keep up the good work.  JCH III MD