Source: MIL-OSI Submissions
Source: Health and Disability Commissioner
Deputy Health and Disability Commissioner Deborah James today released details of a case highlighting the importance of adequate and appropriate eye testing and record keeping. An optometrist has been found in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for delays and failures in the care of a woman who had multiple risk factors for glaucoma (a group of eye conditions that damage the optic nerve and lead to vision loss).
The woman first saw the optometrist in 2004, when she was 62 years of age, and returned a number of times in 2014, 2017, and 2018. During the consultations, the optometrist failed to carry out a number of tests and assessments, such as gonioscopy, eye dilation, or optical coherence tomography.
In addition to this, the optometrist’s notes were missing key information, including details of medications (particularly steroid emphysema medication), family medical history, and whether the woman smoked or had had any surgery. The woman did tell the optometrist that she had a family history of glaucoma at the appointment in 2004.
The optometrist’s notes were also missing expected information following examination, such as pupil reflexes, colour vision, macular health, and peripheral retina. There was only minimal comment about the binocular vision findings, and no notes about allergies or previous eye surgery or trauma.
The optometrist told HDC that having reviewed the visual field test results from 2014, with the benefit of hindsight she accepts that she “should have determined the visual field result as suspicious for glaucoma and referred [the woman] to a specialist”.
The Deputy Commissioner identified three key concerns about the care provided by the optometrist: the failure to undertake adequate assessments in 2014 and 2017; delays in referral to a glaucoma specialist in 2014 and again in 2017 when signs of glaucoma were present; and incomplete record keeping.
Deborah James was particularly critical that the optometrist did not carry out appropriate testing at any of the 2017 appointments, given that the woman was presenting with visual disturbances, and had eye changes. In addition, the woman had reported a new risk factor for glaucoma (steroid medication) against a background of other pre-existing risk factors.
“In my view, taking into consideration the full clinical picture, the optometrist should have recognised the need to undertake glaucoma screening tests, including visual fields and gonioscopy,” said Deborah James.
The Deputy Commissioner recommended that the optometrist provide results from the Optometrists and Dispensing Opticians Board Competence Review Committee audit; undertake a recording-keeping audit to check that notes are complete; complete further glaucoma training; and provide a written apology to the woman’s family.
