Patient Is Left Blind Following Delayed Cataract Surgery

This case involves an elderly male patient from Seattle that presented with complaints of floaters in his left eye. He was diagnosed with age-related cataracts and age-related vitreous degeneration and was told to return for an examination if he experienced any changes. Several months later, he presented to the optometrist with complaints of constant floaters. He was counseled about the risks and benefits of cataract surgery and referred to an ophthalmologist for a cataract evaluation. During that examination, the ophthalmologist noted that the patient had advanced retinal detachment in his left eye. The examination resulted in a report of total retinal detachment with no indication for urgent surgical management due to the unclear time of onset. The patient continued to experience these symptoms and required 2 surgeries on his eyes which left the patient completely blind. It was alleged that the patient’s vision would have been markedly better if he had received surgical treatment sooner.

Question(s) For Expert Witness

1. Please describe your experience in optometry.

2. In a patient like this one, when should a referral be made?

3. Have you ever had a patient have the same outcome?

Expert Witness Response E-084653

I am a fellow in an optometry academy and have practiced for over 40 years in a group optometric specialty practice. I taught optometric 4th-year interns for 40 years and I'm currently on staff at a large hospital. All my licenses are current and in good standing. I have had numerous PVDs (Posterior Vitreous Detachments) over the years without retinal involvement and a few which did have a detachment complication. All the latter cased had favorable outcomes based on realistic expectations, whether surgery was required or not, all were referred to a qualified retinal surgeon STAT. I have reviewed a retinal detachment case with significant vision loss. I reviewed the depositions and provided an analysis to the legal team. Based on the presenting chief complaints in this case, I am at a loss why another dilated fundus exam was not done by the OD to rule out retinal detachment. Without another dilated exam, standard optometric care would be an immediate referral to a retinal specialist OMD to examine and rule out detachment. The referral for the cardiac duplex and cataract were not urgent or seemingly relate to the primary chief complaint.