Failure to diagnose retinal detachment results in permanent visual impairment

This case takes place in Alaska and involves a twenty-two-year-old male patient with no significant past medical history. The patient had good eye sight, attended regular eye examinations and did not require glasses or contact lenses. The patient presented to an optometrist with complaints of a five day history of eye irritation and pain. The patient also described experiencing a black spot in the visual field of his right eye The optometrist examined the patient’s eye briefly with no pupil dilation. The patient was allowed to leave the optometrist’s office with no explanation as to what was the cause of his eye pain. The patient’s symptoms persisted and three weeks later he patient presented to another optometrist. Yet again he was discharged from the office without a definitive diagnosis or treatment plan. Two weeks after this second visit to an optometrist the patient’s sight continued to worsen and so he sought treatment with a third optometrist. The patient was seen by a physician at a larger, university medical center and was finally diagnosed with a detached retina after careful examination. The patient was promptly treated for the retinal detachment however due to the significant delay in diagnosis the damage to the patient’s vision was irreversible. The patient was left with permanent reduced visual acuity in the right eye.

Question(s) For Expert Witness

What is the standard of care for working up a patient who complains of symptoms as described above? Should a more thorough workup have been ordered for this patient, considering her complaints? If the patient was diagnosed and treated on the first visit, would this have changed the overall prognosis?

Expert Witness Response E-006715

Complaints of a black spot are very unusual in a patient of this age. As such its presence demands a full evaluation including an examination of the dilated retina. The black spot is highly suggestive of a retinal tear which preceded the retinal detachment. Had the diagnosis and proper treatment of the retinal tear occurred, it would usually have prevented a retinal detachment from occurring and thus preserving the patient’s eye sight. The patient could have undergone photocoagulation or cryoplexy, two simple outpatient procedures, which would have quickly fixed the tears and preventing the retina from becoming detached. The delay in diagnosis meant that a more difficult repair was required. Reattachment of a retina does not always restore vision, as was the case for this patient. It was below the standard of care for the first two optometrists that the patient sought treatment from to discharge him from their care without further evaluation given his concerning symptoms.