Failure to verify treatment parameters can lead to LASIK errors

SAN FRANCISCO — Preoperative verification of a patient’s refractive error and treatment parameters are crucial in avoiding mistakes during LASIK, Sonal Dave, MD, said.

Dr. Dave said she assessed factors involved in the mis-programming of LASIK cases, and found a need for greater pre-operative evaluation and involvement by surgeons.

“In all of these cases, the errors were avoidable,” Dr. Dave said.

A retrospective chart review found programming errors for 10 eyes of eight patients who received LASIK. In three cases, the errors involved entering incorrect astigmatic axis. Two cases involved entering the incorrect quantity of sphere, and one case each involved programming the wrong astigmatic power, performing a myopic correction on a hyperopic patient and performing the treatment on the wrong patient.

In the last case, the patient allowed the surgeon to call him “José” several times, believing the surgeon was making a joke. Only after one eye had been treated incorrectly did he clarify his name was “Carlos,” Dr. Dave said.

“One might wonder how it is possible to misidentify a patient,” Dr. Dave said. “But it does occur, and medical errors result.”

The cases that involved incorrect astigmatic axis data resulted in mild to moderate postoperative refractive errors, which were corrected with subsequent laser enhancement, Dr. Dave said. The cases involving inputting significantly incorrect astigmatic power or sphere resulted in severe over-correction, making enhancements difficult, she said. All the patients in these cases needed corrective lenses. The patient who received another patient’s correction suffered moderate myopia, which was re-treated with LASIK.

All the errors were a direct result of minimal preoperative evaluation by the surgeon. In some cases, the surgeon did not assess the patient at all before entering the laser suite for treatment, Dr. Dave said.

“Remember the four S’s,” she said. “Remember to check the sticker, site, screen and source document. You don’t want to discover that you have the wrong information after it’s too late.”

She presented her results here at the American Society of Cataract and Refractive Surgery meeting.