LASIK Expert Witness

Why LASIK Cases Center on Patient Selection

LASIK reshapes the cornea with an excimer laser beneath a hinged flap. The operation itself is brief and highly automated; the professional judgment concentrates in deciding who should not have it. An elective procedure on a seeing eye also raises the consent bar — a patient who was never an appropriate candidate, or who was not told of a specific risk that materialized, presents a fundamentally different case from one whose known risk simply occurred. The general framework is discussed on the standard of care expert page.

Screening: What the Standard of Care Requires

Preoperative evaluation includes corneal topography (a map of corneal shape used to detect keratoconus and other irregular patterns), pachymetry (measurement of corneal thickness), a stable refraction over time, and calculation of the tissue that will remain after ablation. The purpose is chiefly to identify eyes at risk of ectasia — progressive post-LASIK corneal bulging and distortion that can cause permanent visual loss. Recognized risk factors include abnormal or asymmetric topography, thin corneas, high corrections leaving an inadequate residual stromal bed, and young age. Screening records also address dry eye, pupil size, and unrealistic expectations. In ectasia litigation, the preoperative topography is usually the single most contested exhibit: reasonable experts can disagree about borderline maps, and an honest opinion says so when a map is genuinely borderline.

Common Allegations

• Negligent screening — proceeding despite topographic warning signs, thin corneas, or an excessive planned ablation.
• Inadequate informed consent — failure to disclose ectasia, permanent dry eye, night-vision symptoms, or the possibility of needing glasses despite surgery.
• Flap complications — incomplete, buttonholed, or free flaps at surgery; later flap dislocation, wrinkles (striae), epithelial ingrowth, or inflammation beneath the flap. Most are manageable; the analysis concerns recognition and response.
• Ectasia — the most serious claim category, combining screening, consent, and causation questions.
• Chronic dry eye and night-vision complaints — glare, halos, and starbursts; frequency and severity vary, and preoperative counseling is the usual battleground.
• Enhancement decisions — whether a second treatment was appropriate given residual corneal thickness and refractive stability.

Records Commonly Reviewed

All preoperative topographies and pachymetry (as images and maps, not just summary numbers), manifest and cycloplegic refractions, the consent packet and any videos or quizzes used, laser treatment printouts, operative and postoperative notes, and — critically in ectasia cases — years of follow-up records establishing when distortion began. Comparison of preoperative maps with postoperative tomography often drives the causation opinion. Organized assembly of this record is described under medical record review and what records to provide.

Causation Considerations and Honest Limits

Ectasia can occur, uncommonly, in eyes with normal preoperative screening; keratoconus also exists in people who never had surgery. So causation analysis asks whether the preoperative maps showed recognized risk markers and whether the postoperative pattern is consistent with surgically induced weakening. Dry-eye and night-vision complaints are partly subjective, and an expert should distinguish measurable findings from symptom reports. No review can establish what a patient was told orally beyond what the record and testimony support.

What Attorneys Should Provide

The complete refractive-surgery chart including all imaging in native or image form, prior optometric records establishing refractive stability, subsequent-treater records (cornea specialists, contact-lens fitters), and both eyes' data even when one eye is at issue — the fellow eye often serves as a valuable internal control.

Frequently Asked Questions