Avoiding refractive surgery lawsuits: research suggests ways to protect your patients--and yourself.(Research Review)

On any given day, anywhere from 100,000 to 125,000 medical malpractice suits are outstanding. And, although only 417 malpractice payments were made by optometrists between September 1990 and July 2003, refractive surgery malpractice cases are on the rise. (1-3) So, we must be vigilant about acting in our patients' best interests and staying up to date on the latest research on informed consent, pupil size and post-LASIK ectasia.

Pupil Size

Recent studies question the link between pupil size and poor night vision following LASIK. A study at the Naval Medical Center in San Diego showed that residual refractive error and optical zone size were the main contributors to night vision problems rather than pupil size. (4)

In this study of 100 patients, those with large mesopic pupils had significantly more reports of glare and halo than did those with smaller pupils at one month post-op, and significant symptoms of glare at three months. At six months, however, no relationship between pupils and symptoms was noted. Factors related to long-term symptoms included the level of treatment, preoperative contrast acuity, postoperative uncorrected visual acuity and residual cylinder. Most of the variation in visual quality could not be explained by preoperative or clinical outcome measures, including pupil size.

In a separate study of 795 patients, researchers found that the patient's age, postoperative spherical equivalent, attempted degree of spherical correction and optical zone were the major risk factors for night vision complaints, not pupil size. (5)

Post-LASIK Ectasia

Studies done before 1999 blamed post-LASIK ectasia on the removal of too much corneal tissue and failure to maintain 250[micro]m in the stromal bed. (6)