Conduct
Optometrists & Dispensing Opticians must abide by the:
Health & Disability Commissioner Complaint Report
24 September 2002
Decision of the Health & Disability Commissioner
The Opticians Board has received a report on a complaint from the Health and Disability Commissioner and this is summarised here for your information.
The Consumer presented at the optometrist in question with a grey "part disc" shape in the peripheral vision of their left eye. The patient had a history of floaters and had been seeing an ophthalmologist for 15 yrs. They had seen their ophthalmologist a year previous as their floaters had been getting worse but was advised nothing could be done about them.
The patient advised the optometrist that 2 hours before the appointment they became aware of the black disc shape in the lower area of their left eye. No flashes or knocks to the head were reported.
Vision was measured and direct ophthalmoscopy (undilated) was performed. After the ophthalmoscopy it was explained to the patient that a floater was present but there were not any holes, tears or haemorrhages. The patient then made enquiries as to whether the optometrist intended to dilate. The optometrist then explained that they preferred to refer patients requiring dilation. In this case the optometrist did not think it was necessary. A posterior vitreous detachment was diagnosed and it was stressed to the patient that there were no signs to suspect retinal detachment. The optometrist then warned the patient of the symptoms of a retinal detachment and offered the option of a second opinion and dilation by their regular eye specialist. A full eye examination was then completed.
However, the patient is of the opinion that they were not advised that the sudden onset of floaters is a warning sign for a retinal tear or detachment. The patient stated they felt the optometrist was very confident in the diagnosis of a floater and felt that to seek a second opinion was to express disbelief in their diagnosis.
Three days later the patient phoned the optometrist to advise the floater was bigger and more central. The optometrist then decided that as there had been a change, a specialist appointment was required urgently. The patient was seen at 11.30am that day by an ophthalmologist, who dilated and diagnosed a large retinal tear and retinal detachment. The patient was admitted immediately and underwent retinal detachment surgery the next day. The registrar at the hospital advised the patient the tear had most likely occurred about 2 weeks prior to the consultation with the optometrist.
Consumer's rights under the Health and Disability Services
The following Rights in the Code of Health and Disability Services Consumer's Rights are applicable to this complaint:
Right 4 Right to Services of an Appropriate Standard Every consumer has the right to have services provided with reasonable skill care and skill
Right 6 Right to be fully informed Every consumer has the right to the information that a reasonable consumer, in that consumer's circumstances, would expect to receive, including -
An explanation of his or her condition; and An explanation of the options available, including an assessment of the expected risks, side effects, benefits, and costs of each option;
With respect to Right 4 (1), appropriate investigation is an integral part of the diagnosis and the use of dilation drops may have assisted the optometrist to make a diagnosis. Evidence provided to the Commissioner from an expert optometrist was that a dilated fundus examination should have been done at the first appointment. Evidence from an expert ophthalmologist was that it was uncommon for optometrists to perform dilated fundus examinations at that time. The Commissioner accepted the advice of the ophthalmologist. Therefore, it was the opinion of the Commissioner that failure to use dilation drops did not amount to a breach of Right (4) of the Code.
It was also the opinion that Right 6 was not breached.
While the board cannot disagree with the Commissioner's findings, several Board members felt the optometrist was rather fortunate to be found not in breach of the Code. The Board would like all optometrists to be aware of this situation. While it may not have been common practice to use dilation drops in the diagnosis of a posterior vitreous detachment 2 years ago, it certainly is now. In this situation a breach of patient right (4) may have been found if this case was investigated today.
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