Ophthalmologist inserts wrong lens in phacoemulsification surgery, causes blindness in patient's eye

The very thought of losing your vision is frightening.  As a Houston, Texas medical malpractice lawyer, I have been hired by a lot of clients who have experienced vision loss from sub-standard care by optometrists and ophthalmologists.

Many people are a bit unclear on the difference between these two types of healthcare providers.

Optometrists are not medical doctors, but rather have a doctor of optometry. They are basically the primary care providers of vision care, focusing on performing vision tests and prescribing and selling corrective lenses. In addition, optometrists do eye exams to look for abnormalities and treat some limited eye diseases.

Ophthalmologists are medical doctors with advanced training to diagnose and treat all eye diseases. They practice both medicine and surgery and prescribe and dispense corrective lens.

When clients hire me to investigate medical malpractice cases involving eye injuries or loss of vision, it almost always involves a botched eye surgery. These surgical procedures include things like Lasik laser surgery and cataract operations.

An actual Texas medical malpractice case of a cataract surgery gone amuck illustrates how badly things can go wrong when an ophthalmologist veers away from the standard of care designed to keep patients safe.

Cataract surgery

A man in his early 60s went to see an ophthalmologist after noticing a change in vision in both of his eyes. He wanted to see if the doctor could do anything for him that would allow him to be able to read without glasses.

The ophthalmologist diagnosed him with visually significant cataracts with glare and up-close (near) changes to his vision. He recommended to the patient a surgical procedure called phacoemulsification with posterior capsule intraocular lens implant with some monovision in the left eye.

Phacoemulsification is a rather new procedure. It involves using an ultrasonic device to emulsify (basically liquefy) the internal lens of the eye and then suck it out (aspirate it) with a syringe. After that procedure, the eye doctor then intended to place a new internal lens.

The patient consented to the proposed treatment and the procedure went forward about a month later. Things went smoothly during the operation and the ophthalmologist implanted a +18.5 diopter intraocular lens. 

Four days later, the patient went to see the ophthalmologist because he was having vision problems in his left eye. A vision test showed that the patient’s left eye vision was terrible 20/400. The eye doctor did a test called an A-scan biometry, which allows measurement of intraocular lens power. This test showed that the eye doctor had place the wrong lens during surgery. Instead of a +18.5 diopter lens, it should have been a +23 diopter lens.

The only option to correct the problem was another surgery. Three days later, the same ophthalmologist took the patient back to surgery to switch out the lens inside his eye.

During the second surgery, the eye surgeon ran into a complication. The patient’s posterior capsule ruptured and the vitreous leaked.

According to the journal Clinical Ophthalmology, one of the major complications from cataract surgery is posterior capsule rupture with vitreous loss (the gel-like substance that helps the eye keep its normal shape). The eye’s natural lens capsule holds either the natural lens or a replacement lens in place. The posterior capsule refers to the back side of the lens capsule.

The ophthalmologist saw the rupture and removed the vitreous from the front part of the eye, in a procedure called an anterior vitrectomy. The eye doctor then placed the new correct lens in.

The patient returned to the doctor’s office the next day for a follow-up visit. When they measured the pressure in his left eye, it was very abnormal at 46 mm Hg. The doctor treated him to lower the pressure. Two months later, the patient came back to the ophthalmologist, this time because of a “star burst episode” that was limiting his left eye vision. The doctor recommended another surgical procedure, a YAG laser capsulotomoy, but the patient decided to get a second opinion.

A new ophthalmologist diagnosed the patient with a displaced left lens, a condition called pseudophakia. At a visit a month later, the same eye doctor saw the patient and diagnosed him with pseudophakia, displaced left intraocular lens, detached vitreous, an inflamed eyelid (blepharitis).

Less than a month after that visit, the patient saw a third ophthalmologist after seeing floaters and flashes in his left eye. This eye doctor made some of the same diagnoses for the patient’s left eye, including pseudophakia and vitreous attachment. The doctor told him to come back immediately if things got worse because it could be a sign of retinal detachment, which could cause blindness.

In nine months, the patient experienced new symptoms, with some visual loss, flashers, and floaters. He was diagnosed with retinal detachment and referred to a retina specialist who recommended a surgery called pneumatic retinopexy. In this procedure, the eye surgeon injects a gas bubble in the middle of the eye that floats to the retina and holds in place. The doctor then uses a laser or freezing probe to attempt to seal the retina in place.

Unfortunately, the procedure did not work and the patient had to undergo another surgery called a pars plana vitrectomy with the injection of silicone oil. Even after this procedure, the patient still had visual loss despite the fact that the retina had finally been reattached. Around five months after that procedure, his left eye started deviating outward (to the left). He was diagnosed with sensory exotropia and had to have another surgery to correct the left eye’s cosmetic appearance.

Complications galore and original negligence

This poor patient experienced almost every conceivable complication that could occur with eye surgery. In addition, some of the other eye doctors down the line after the first surgery, did not provide proper care. The reality, though, is that the snowball that caused this avalanche was the first ophthalmologist’s negligence in not properly measuring the eye and placing the wrong strength lens during the first surgery. But for that, none of this would have happened.

Under Texas law, when one doctor wrongfully injures a patient, that doctor is liable for damages caused by negligent treatment of new doctors or surgeons who treat the patient for those injuries. In other words, the negligent doctor is responsible for all future complications, whether caused by negligent treatment of other doctors or not. This is called the original tortfeasor doctrine and was adopted by the Texas Supreme Court in its opinion styled Cannon v. Pearson, 383 S.W.2d 565, 567 (Tex. 1964). I have always found it interesting that, under this doctrine, medical malpractice is foreseeable.

We are here to help

If you or a loved one has been seriously injured by a medical malpractice, call Painter Law Firm, in Houston, Texas, at 281-580-8800, for a free consultation about your potential case.


Robert Painter is an attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, doctors, surgeons, pharmacists, and other healthcare providers. In 2017, H Texas magazine recognized him as one of Houston’s top lawyers.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.