Laser Eye (LASIK and PRK) Surgery Negligence Claims

LASIK vs PRK: What do they mean?

To understand where errors may have occurred, it is helpful to first distinguish between the two most common procedures performed in Ireland: LASIK (Laser-Assisted In Situ Keratomileusis) and PRK (Photorefractive Keratectomy).

In simple terms, LASIK involves creating a thin flap on the surface of the cornea (the clear window at the front of the eye), lifting it, and using a laser to reshape the tissue underneath before replacing the flap. PRK (and its variant LASEK) does not involve a flap; instead, the surgeon removes the very top layer of cells from the cornea entirely and applies the laser directly to the surface. The outer layer then grows back naturally over a few days.

How LASIK differs from PRK, and why complications can differ

While both surgeries aim to correct short-sightedness, long-sightedness, or astigmatism, the surgical approach dictates the specific risks involved.

• Flap creation: This is the primary difference. LASIK requires a flap, which introduces risks related to flap wrinkles, debris under the flap, or the flap becoming dislodged. PRK eliminates flap-related risks entirely because there is no flap.
• Healing location: In LASIK, the healing occurs deep within the corneal interface, which is generally less painful. In PRK, the healing occurs on the surface, which leaves the nerve endings exposed for several days, making the immediate recovery more uncomfortable.
• Structural integrity: Because LASIK cuts deeper into the corneal structure to create the flap, it can theoretically weaken the cornea more than PRK. This makes patient selection critical, particularly for those with naturally thinner corneas.
• Visual recovery speed: LASIK patients often see clearly within 24 hours. PRK patients typically experience blurred vision for days or even weeks while the surface layer regenerates.

Typical recovery timeline

Recovery is rarely a straight line, but there are norms. With LASIK, most patients in Ireland return to work within a day or two, with vision stabilising over a few weeks. PRK recovery is slower; the eye may feel gritty and sensitive to light for up to a week, and vision may fluctuate for months. However, in both cases, severe pain, sudden loss of vision, or discharge are not part of a normal recovery and may signal an issue that requires immediate clinical attention.

Common LASIK complications discussed in negligence investigations

In negligence inquiries, we look for complications that should have been avoided with reasonable care or were not adequately disclosed to the patient.

• Flap-related issues and healing problems: The flap must be created with precision. If the flap is too thin, button-holed (incomplete), or wrinkled, it can permanently distort vision. Negligence may arise if a surgeon proceeds with the laser ablation despite a poor flap creation, or fails to smooth out wrinkles during the post-operative checks.
• Persistent dry eye and pain: Laser surgery severs corneal nerves, which temporarily reduces tear production. However, chronic, debilitating dry eye disease that persists for years can occur if a patient with pre-existing dry eye was incorrectly deemed suitable for surgery.
• Halos, glare, starbursts and night driving difficulty: These visual disturbances are common in the early healing phase. However, if they become permanent, it may be due to the laser treatment zone being smaller than the patient's pupil size in dim light. Failing to measure pupil size accurately is a significant area of scrutiny.
• Overcorrection, undercorrection and irregular astigmatism: While predicting healing is not an exact science, gross errors in data entry or calibration can lead to significant prescription errors. Irregular astigmatism (where the cornea is shaped unevenly) can make it difficult to correct vision even with glasses.
• Infection and inflammation concerns: Severe infections (like microbial keratitis) or inflammation (such as DLK or "Sands of Sahara" syndrome) require rapid identification and aggressive treatment. A delay in diagnosing these conditions can lead to permanent scarring and vision loss.

Common PRK complications discussed in negligence investigations

Because PRK involves surface healing, the complications often differ from LASIK and frequently center on how the healing process was managed.

• Surface healing issues and prolonged blurred vision: The epithelium (outer layer) must grow back smoothly. If the healing is delayed or the new layer is irregular, vision remains blurry. Negligence claims may investigate whether the bandage contact lens was fitted correctly or if post-op drops were managed properly.
• Corneal haze and scarring: PRK carries a higher risk of "haze",a cloudiness of the cornea caused by an aggressive healing response. Surgeons typically use a medication called Mitomycin C during surgery to prevent this. A failure to use this preventative measure in high-risk patients may be scrutinised.
• Pain control and post-op review gaps: PRK is painful. Patients must be adequately supported with pain relief and monitored closely. If a patient reports extreme pain that is dismissed by the clinic, and it turns out to be an infection or a melting cornea, this failure to act can be grounds for a claim.
• Infection risk and delayed treatment concerns: Because the eye has a large open wound for several days, the risk of infection is higher than in LASIK. Strict hygiene and immediate review of any redness are essential duties of care.

Suitability and pre-operative screening

The vast majority of laser eye surgery negligence cases in Ireland focus not on the surgeon's hand, but on the decision to operate in the first place. Medical professionals have a duty of care to decline surgery for patients who are not suitable candidates.

• Dry eye checks: Clinics must rigorously test for tear quality and quantity (Schirmer’s test, tear break-up time). Operating on a patient with established dry eye syndrome can exacerbate the condition to intolerable levels.
• Corneal thickness, corneal mapping and ectasia risk:This is critical. If a cornea is too thin or shows signs of an underlying weakness like keratoconus, laser surgery can destabilise the eye, leading to a condition called corneal ectasia (bulging of the cornea). This often requires corneal cross-linking or a transplant to fix. Failing to identify these warning signs on topography scans is a serious breach of duty.
• Prescription stability, expectations, and risk profiling: Surgery should generally not be performed if the patient’s prescription has changed significantly in the last 12 to 24 months. Furthermore, high prescriptions carry higher risks; patients must be warned specifically about the limitations of laser for their specific prescription.
• Contraindications and warning signs clinics should consider: Conditions like autoimmune diseases (e.g., Lupus, Rheumatoid Arthritis), pregnancy, or certain medications can affect healing. A thorough medical history is a mandatory part of the screening process.
• Documentation standards: A clinic cannot simply say they checked these factors; they must prove it. We look for contemporaneous notes (records made at the time) detailing the specific discussions about risks, the specific measurements taken, and the rationale for deeming the patient suitable.

Consent in elective refractive surgery

In elective procedures,surgeries you choose to have rather than those you need for survival,the standard for consent is exceptionally high. Informed consent is not just a signature on a form; it is a process of education. The patient must understand what they are agreeing to, including the "worst-case scenarios."

• Clear explanation of risks, alternatives, and realistic outcomes: The surgeon must discuss material risks,risks that would be significant to you. For example, if you are a professional driver, the risk of night glare is highly material. They must also explain that glasses or contact lenses are safe alternatives.
• Cooling off period: Best practice guidelines suggest a cooling-off period between the consultation and the surgery. This gives the patient time to digest the information and ask questions.
• Pressure to proceed: Aggressive sales tactics or "limited time offers" that pressure a patient into surgery without adequate reflection can undermine the validity of consent.
• Consent on the day of surgery: Meeting the surgeon for the first time on the day of the procedure is problematic. Consent should ideally be taken in advance, ensuring the patient is not under the stress of the immediate pre-op environment when agreeing to risks.

Intra-operative and equipment related issues in LASIK and PRK cases

Even with perfect screening, errors can occur in the operating theatre. These cases often turn on technical data and equipment logs.

• Laser calibration, data entry, and procedural checklists: The laser is a computer-driven tool. If the wrong prescription is entered, or if the astigmatism axis is keyed in incorrectly, the laser will permanently carve the wrong shape onto the eye. We investigate the nomograms (calculation tables) and verification checks used by the surgical team.
• Sterility, infection control, and theatre protocols: Infections are rare but devastating. Clinics must adhere to strict sterilisation protocols for instruments. If a cluster of patients develops infections, it often points to a breakdown in theatre hygiene or contaminated equipment.
• Recordkeeping: The laser machine generates a log for every treatment. These logs provide objective evidence of exactly what energy was delivered to the eye, irrespective of what the handwritten notes might say. Securing these logs is a vital part of the investigative process.

Post-operative care and escalation

The duty of care does not end when the laser is switched off. Post-operative care is vital to spot complications before they become permanent injuries.

Normally, follow-up involves checks at 1 day, 1 week, 1 month, and perhaps 3 to 6 months post-surgery. During these visits, the optometrist or surgeon checks vision, eye pressure, and corneal healing.

Negligence can occur if a clinic ignores or downplays the following symptoms:

• Worsening pain (especially after day 3 or 4).
• A sudden drop in vision in one or both eyes.
• Light sensitivity that returns after initially improving.
• White spots appearing on the cornea (visible to the clinician).

If a patient reports these issues and is told to "just wait and see" without a physical examination, and subsequently suffers injury, this may constitute negligence.

How LASIK and PRK negligence is assessed in Ireland

It is vital to understand that a complication is not the same as negligence. Medicine is not an exact science, and sometimes, despite the best care, outcomes are less than perfect. For a legal case to be successful, we must prove that the care you received fell below an acceptable standard and that this failure caused your injury.

To establish a case, we generally look for two key ingredients:

1. Breach of Duty: Proving that the optician, surgeon, or clinic did something no reasonably competent practitioner would have done (or failed to do something they should have done).
2. Causation: Proving that this specific error caused the harm you are suffering, and that the harm would not have happened otherwise.

The role of independent expert evidence

We cannot simply argue that the surgery went wrong. We must engage independent Consultant Ophthalmologists (usually from outside Ireland to ensure impartiality) to review your medical records. They will provide an expert opinion on whether the screening, surgery, or aftercare was substandard.

Time limits and date of knowledge

In Ireland, the Statute of Limitations generally allows two years to bring a claim for medical negligence.

However, this two-year clock does not necessarily start on the day of your surgery. It starts from the "Date of Knowledge",the date you knew, or ought to have known, that you had suffered a significant injury and that it was likely caused by the surgery. Determining this date is complex legally, so seeking advice immediately is crucial.

Records and evidence that are useful in laser eye surgery cases

If you are concerned about your outcome, the "paper trail" is your most valuable asset. The following documents are central to investigating a claim:

• Pre-op scans and measurements (topography, thickness, refraction history):
  These prove the state of your eyes before the laser touched them. They allow experts to determine if you were ever a safe candidate for the procedure.
• Consent documents, clinic information packs, and correspondence: These documents demonstrate what you were told. Did the brochure promise "perfect vision"? Did the consent form mention the specific complication you are suffering?
• Operative notes and laser settings logs:
  These technical printouts show exactly what happened during the surgery, including laser energy levels, treatment time, and pupil tracking data.
• Post-op review notes, prescriptions, and referral letters: These track how your recovery was managed. They show if your vision was improving or deteriorating and what actions the clinicians took in response.
• Symptom diary and timeline: A simple written record of your symptoms (e.g., "12th March: woke up with severe pain in left eye, called clinic, no answer") is powerful evidence. It helps reconstruct the timeline of care and lack thereof.

Practical steps if you are concerned about your outcome

If you suspect something has gone wrong, taking proactive steps can protect your health and your legal position.

• Seeking medical review for worsening symptoms: Your priority is your eyesight. If you are unsatisfied with your clinic's response, seek a second opinion from an independent eye doctor or your GP immediately. Do not wait for the original clinic to validate your concerns if you are in pain or losing vision.
• Getting copies of records and keeping communications in writing: Under GDPR and Data Protection Acts, you have a right to your full medical file. Request this in writing. Try to keep communication with the clinic via email so there is a record of what was discussed, rather than relying on phone calls.
• Preparing a timeline of appointments and symptom changes: Write down everything you remember while it is fresh. List dates of appointments, who you saw, what they said, and how your vision was at that time. This chronology is incredibly helpful for solicitors reviewing your case.

FAQs

Is dry eye after LASIK always negligence?

No. Dry eye is a known side effect of LASIK. However, it may be considered negligence if you had severe dry eye before surgery that was ignored during screening, or if the clinic failed to inform you that your pre-existing condition put you at very high risk of chronic symptoms.

What if I was not told about night vision risks?

A failure to warn about significant risks like starbursts or halos, especially if you have large pupils, can be a failure of informed consent. If you would not have gone ahead with the surgery had you known about this risk, you may have a case.

What if my symptoms were reported but follow-up was delayed?

This is a common basis for negligence claims. If you report a "red flag" symptom (like pain or vision loss) and the clinic delays seeing you, leading to a worse outcome than if you had been treated immediately, the clinic may be liable for that delay.

Are medical negligence claims handled by the Injuries Resolution Board?

Generally, no. The Injuries Resolution Board (formerly PIAB) handles personal injury claims like car accidents. However, most medical negligence claims are exempt from this process because of the complexity involved. Your solicitor will typically issue proceedings directly, though mediation is often encouraged later in the process.

We help you see the path forward

When elective surgery results in visual impairment, the sense of betrayal and loss can be overwhelming. You wanted to improve your life, not complicate it. At Michael Boylan LLP, we understand the specific clinical nuances of refractive surgery cases. We know how to analyse the topography maps, interpret the laser logs, and challenge the consent procedures.

Our team is dedicated to securing justice for patients who have been let down by the healthcare system. If you are struggling with the aftermath of laser eye surgery and believe standards were not met, let us help you investigate.

Contact our specialist medical negligence team today for a confidential discussion about your experience.

*In contentious business, a solicitor may not calculate fees or other charges as a percentage or proportion of any award or settlement.