Malpractice claims against ophthalmologists that were closed with patient indemnification of at least $250,000(18% of all eye claims closed with payments to patients) were analyzed for risk prevention. The incident of alleged malpractice occurred within 1 month of the initial physician-patient encounter in 43% of claims and on the initial encounter in 17%. Cataract was the most frequent problem for which these patients sought treatment. Eighty-four percent of these patients sustained injuries resulting in legal blindness or worse. The most frequent complication of treatment (25%) was failure or delay in diagnosis of detached retina, or negligent treatment resulting in a retinal detachment. The most frequent factors influencing the decision to seek a settlement included altered records, poor documentation, informed consent problems, failure to see the patient promptly, and failure to obtain or follow the advice of a consultant.