An independent provider in the Derbyshire area

3. Mrs A complains about the lack of appropriate, and conflicting, post-operative aftercare provided by a Derbyshire Eye Clinic, between August and December 2022, following a cataract procedure.

4. She says the lack of continuity in her eye care led to long-term pain and suffering, and loss of vision resulting in a permanent need to use a corrective lens.

5. She is looking to achieve an apology, service improvements and a financial remedy.

6. Mrs A was referred in March 2022 and attended the clinic on 31 August for cataract removal surgery.

7. Mrs A returned on 14 September 2022 complaining of pain and vision problems, and attended again on 17 September with the same complaint. On both occasions she was provided with advice and medication.

8. Between 21 September and 6 October 2022, Mrs A contacted or attended the clinic a further six times with similar complaints where she was provided with advice, medication and then a finally a referral to an NHS eye hospital.

Follow-up care

12. In our consideration of Mrs A’s complaint that follow up care provided was inappropriate, we have reviewed the records. We have seen cataract removal procedure occurred on 31 August 2022, with no complications recorded on the surgery record. Mrs A was discharged home on the same day with eye drops (Ketorolac trometamol and Dexamethasone) both to treat inflammation and discomfort. She was given an appointment for 18 September, to return for follow-up checks. Guidelines provided by the Royal College of Ophthalmologists, advise follow-up appointments should be no later than four weeks after surgery. The appointment timing therefore appears appropriate.

13. The guidelines also outline requirements in cases of post-operative complications, stating there must an agreed pathway for care and advice, so that patients and their carers can receive timely advice and treatment 24 hours a day, 7 days a week, to include contact numbers that work. Additionally, staff taking calls must be trained to recognise key red flag symptoms, including those of endophthalmitis (inflammation caused by infection), and take appropriate action to ensure patients can receive emergency care through the agreed pathway.

14. Mrs A has explained to us she contacted the clinic various times between 14 September and 6 October, with an appointment offered for the following on 14 September which she could not attend as she was away at the time. There is no dispute the clinic responded to all Mrs A’s enquiries promptly. Mrs A attended clinic on 17 September, and between 21 September and 6 October, either attended in person or made telephone contact with the clinic a further six times, all of which were responded to or acted upon in accordance with clinical guidelines and standards. As such, we have no concerns about their response to her concerns during the post-operative period. We will consider the approach taken in further detail below.

Post-operative treatment

15. In turning to consider the nature of the clinical response to Mrs A’s symptoms and the complaint that lack of appropriate treatment, and the provision of conflicting, post-operative aftercare and advice led to complications and permanent eye damage, we have again considered what should have been provided in accordance with clinical guidelines and standards.

16. On discharge following surgery on 31 August 2022, Mrs A was prescribed both dexamethasone, a steroid for treating inflammation and ketorolac, a non-steroid anti-inflammatory for pain relief. In consulting with the British National Formulary (BNF), the treatment provided at this stage was in line with guidelines and their use as noted in the BNF.

17. Mrs A returned on 17 September and was diagnosed with a corneal abrasion (a scratch or irritation of surface of the cornea). Our adviser has explained this is very common following cataract surgery. Systane eyedrops and Hylonight ointment, for lubricating dry eyes and improving blurred vision respectively, were prescribed meeting both College of Optometrists guidelines and recognised by the BNF for this use.

18. On 21 September, Mrs A attended and was diagnosed with the viral infection, herpes simplex keratitis (HSK). Mrs A was prescribed an antiviral treatment (Ganciclovir). Our adviser explains this is a common medication for the symptoms Mrs A was displaying and has no concerns with its use here.

19. Between 25 September and 6 October Mrs A contacted the clinic about her persisting symptoms, was advised to continue using the antiviral medication, and prescribed local anaesthetic eyedrops, as she was experiencing acute pain. The advice was to use these drops only in severe discomfort. Additional anti-inflammatory eyedrops were prescribed, which we note to be in line with national guidelines and met their published use under the BNF. We again asked our clinical adviser if they had concerns with this clinical approach and they advised of none.

20. We do sympathise with Mrs A here and accept she was experiencing considerable pain and discomfort. We also understand her concerns with the varying diagnoses and treatment which she believed to be conflicting. The records show Mrs A’s eye condition changed each time she was seen by the clinic which led to different clinical approaches and treatments. Having considered the records, treatments, and the views of our adviser, while we appreciate this was a difficult time for Mrs A, we cannot say and have seen no evidence to support the advice and treatment was contradictory.

21. We asked out adviser whether any of the prescribed medications could bring about permanent eye damage as Mrs A suggests. They have explained there is no record of the use of the eye drops and other medications prescribed post-operatively for Mrs A, having such an effect on eyesight following this type of surgery. They advised, permanent eye damage to sight, while rare, remains a recognised complication of cataract surgery and we can see this was discussed with Mrs A when she consented to the surgery. However, in this case, we cannot link any loss of sight to a failing.

22. Overall, having considered the available evidence and balanced this with national standards and guidelines in respect of complications and our own obtained clinical advice we have seen no indications the clinic did anything wrong here. Nevertheless, we appreciate these were very upsetting events for Mrs A.

1. We have carefully considered Mrs A’s complaint about the Derbyshire Eye Clinic (the clinic). We were very sorry to learn of Mrs A’s experiences and appreciate she has had a traumatic time following her cataract surgery, and the complications that developed for her.

2. Having reviewed all the evidence available to us, we have come to the view there is no indication the clinic did anything wrong here.

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