Vision Loss Following Surgery: An Idiosyncratic Outcome V. Medical Explanation?

By: Ronald M. Zakarin, Esq.

The general population as a whole has probably never heard of anyone who has undergone a surgical procedure and awakened blind or severely visually impaired. For those unfortunate few who have suffered this malady, however, the results can be devastating. Many people elect to undergo a surgical procedure with the hope and expectation of an improved quality of life. Others may be undergoing life threatening and medically necessary procedures. It is likely that none of those people are forewarned of this potential risk factor. Since vision loss following surgery is rare, when it does occur, the medical community will inevitably defend this outcome by concluding that there is no scientific explanation as to the cause of this catastrophic result, and that it is idiosyncratic, or in layman’s terms, it just happened. The patient may be told that something unique to his/her physiology resulted in some oxygen depravation to the optic nerves resulting in the visual loss.

The reality of the situation is, however, that an unexpected outcome may be rare due to the fact that most patients are properly managed by the medical community during and post surgery. Patients place their trust and confidence in the medical team assigned to care for them while undergoing general anesthesia as well as the health care providers who assume responsibility after surgery. When an unexpected outcome occurs, there is often a sound, reasonable explanation. This is particularly true when a patient sustains what is termed posterior ischemic optic neuropathy. Posterior ischemic optic neuropathy (PION) is a medical term used to describe those situations where a patient typically loses vision bilaterally. One eye may be affected more than the other, but generally both eyes are involved. The vision loss may be minimal, or severe, depending on the circumstances. The explanation for this result is that the optic nerves were deprived of adequate oxygenation for too much time.

Could this outcome have been avoided? Astonishingly, for those patients who have sustained PION, the answer in many cases is yes. PION is known to occur in those instances where patients are undergoing surgeries of relatively long duration, usually several hours. There is typically extensive blood loss with severe intraoperative hypotension. The patients are often in the prone position. Unfortunately, since this outcome is rare, many physicians are complacent, and may not properly attend to the needs of the patient during surgery. They may not monitor the patient’s blood pressure at an appropriate frequency to ensure there are no marked drops in pressure that need to be attended to. At other times they may respond to drops in pressure by utilizing what is known as volume expanders, yet fail to order appropriate tests to track drops in the patients hematocrit and/or hemoglobin (red blood counts). The bottom line is that there is in fact a sound, medically reasoned explanation for those patients who awaken from surgery with visual loss which is diagnosed as PION. In summary, for those patients planning on undergoing an elective procedure, and those who have no alternative but to subject themselves to surgery, it is recommended that he/she be proactive and discuss with the surgeon, anesthesiologist and the remainder of the surgical team all known concerns. While most often, the procedures will be performed without incident, discussing issues with the medical community such as ensuring their awareness of PION, including the risk factors associated with this diagnosis is recommended.

If you, or someone you know has sustained a loss of vision following surgery, or some other unexplained and unanticipated outcome, please contact me with your situation. I will promptly review your facts and contact you to discuss your case. Our consultations are offered to you without charge.