19 Dec 2016

Optometrist's error ended in partial sight loss

2:48 pm on 19 December 2016

An optometrist has been told to apologise for not examining a woman's eye properly when she consulted him at an eye clinic.

eye doctor, Opthalmology, optometrist

The optometrist failed to provide services with reasonable care and skill, the Deputy Health and Disability Commissioner has found (file). Photo: 123rf

The unnamed optometrist saw the 55-year-old woman in October last year, when she complained about an irritation in her right eye that felt like a hair in her eye.

Deputy Health and Disability Commissioner Meenal Duggal said the optometrist used a light to examine her eye, but found that her vision was clear with no pigment or blood indicating the formation of a tear, and without any colour defect.

He concluded that the cause of the irritation was a solid string of a gel-like substance called vitreous, and that it was not necessary to dilate her pupil for a closer examination of her retina.

He also gave her a prescription for a new pair of long-distance glasses as her others had broken.

However the woman remained concerned.

When she returned to the clinic five days later to pick up her glasses, she asked whether she could see the optometrist, Mr A, again, or, failing that, get a second opinion.

Ms Duggal said the woman, Ms B, was told by a dispensing optician, Ms C, that Mr A wasn't in.

Ms C also described the eye problem as "only a floater", adding that Ms B did not need a second opinion.

However, the next day Ms C helped arrange a second opinion, from a locum optometrist at another clinic, after Ms B's eyesight became cloudier.

This optometrist did dilate the pupil in her right eye, diagnosed a retinal detachment and referred her urgently to the public hospital for treatment.

Two days later, an ophthalmologist performed surgery to repair the detached retina, but Ms Duggal said Ms B had not regained her sight and only has 20 percent vision in her right eye.

An expert adviser, optometrist Greg Nel, told Ms Duggal that not dilating the pupil was a serious departure from usual standards for the optometrist, Mr A.

"He should have realised that in this situation he should give himself the best opportunity to examine the back of [Ms B's] eye and a dilated fundus examination is required for this."

Mr Nel said optometry was a diagnostic profession and adequate use of the appropriate diagnostic drugs was a professional obligation.

"[Mr A] chose not to use the appropriate diagnostic drug and [in] so doing, significantly increased his chances of missing a retinal tear and the precursors to a retinal detachment."

Ms Duggal said Ms B did not receive the relevant patient handout or any other follow-up advice from Mr A.

She said Mr A failed to provide services with reasonable care and skill, and thereby breached patient rights. He apologised on her recommendation.

Ms Duggal also recommended that the Optometrists and Dispensing Opticians Board consider whether to review Mr A's competence should he return to practice.

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