Authors: Alex Ragan, Devesh Varma, Jit Gohill, Stephanie Dotchin

Author Disclosure Block: A. Ragan: None. D. Varma: Alcon, Allergan, Aerie, Glaukos, Johnson & Johnson Vision, Labtician, Labtician-Thea, New World Medical, Santen, Shire. J. Gohill: None. S. Dotchin: None.

Abstract Body:
Purpose: To investigate trends in litigation against Canadian ophthalmologists related to the performance of cataract surgery and ancillary services. 

Study Design: Retrospective file review of records of the Canadian Medical Protective Association. 

Methods: This study was a retrospective file review of all Canadian Medical Protective Association (“CMPA”) records for the period from 2013 to 2017. All legal actions and threats of legal action against Canadian ophthalmologists relating to the performance of cataract surgery, and that had been settled or terminated as of December 2017, were included. Legal actions filed outside of Canada, not reported to the CMPA, or that did not relate to the performance of cataract surgery or ancillary services were excluded. Data collected included the number of legal actions and threats, the specific causes alleged for such actions and threats, and the outcomes of such actions. 

Results: One hundred and seventy-five closed legal actions or settled threats of legal action against Canadian ophthalmologists for the period from 2013 - 2017 were considered and, of these, 58 (33%) cases involved the performance of cataract surgery or ancillary services and therefore met the inclusion criteria. Among the 58 included cases, 19 (33%) related to dissatisfaction with visual outcome, 19 (33%) to lack of informed consent, 11 (19%) to wrong intraocular lens implantation, 10 (17%) to inadequate post-operative follow-up and 6 (10%) to surgical complications including posterior capsular rupture, choroidal hemorrhage, retinal tears, or detachments. Some cases involved more than one complaint. Overall, a favorable legal outcome was achieved by ophthalmologists in 59% of cases. 

Conclusions: Based on a review of CMPA records, cataract surgery represents one-third of legal actions and threats against Canadian ophthalmologists. Major causes included dissatisfaction with visual outcome, lack of informed consent, incorrect intraocular lens implantation, and inadequate postoperative follow-up, all of which may have been preventable.