Issues With Assessment By Multiple Optometrists Result In Delay In Diagnosis Of Glaucoma

Health and Disability Commissioner, Morag McDowell, today released a report finding three optometrists and Specsavers Silverdale in breach of the Code of Health and Disability Services Consumers’ Rights (the Code), for failing to provide services with reasonable care and skill.

A woman was seen by three different optometrists at Specsavers Silverdale over approximately five years. In 2019, she was diagnosed with bilateral subacute angle closure glaucoma by an ophthalmologist, who noted that she had been symptomatic for possibly as long as five years.

Ms McDowell considered that the optometrists failed to carry out a comprehensive assessment, which should have included gonioscopy, a method of examining a specific part of the eye. She also considered that the optometrists did not properly document their assessment of the woman, and one presented information incorrectly, which did not include sufficient information in a later referral to a specialist.

Failure of the optometrists to fully document their assessment was a departure from the relevant Optometrists and Dispensing Opticians Board "Standards of Clinical Competence for Optometrists", and inconsistent with "Specsavers Best Practice Guide to Clinical Record Keeping & Registration Standards".

The multiple failures by the optometrists employed by Specsavers Silverdale indicated a pattern of poor care, for which Specsavers Silverdale ultimately was responsible, and therefore Ms McDowell also found Specsavers Silverdale to be in breach of the Code.

"Given the symptoms that the woman presented with, and the potentially serious consequences, angle closure should have been ruled out.

"Gonioscopy is the appropriate test to assess angle closure directly, and it is within the core competency of an optometrist to perform this," said Ms McDowell.

This case highlights the importance of documenting and considering all clinical assessments properly, and the importance of undertaking appropriate assessment and testing for the signs and symptoms of glaucoma, in particular gonioscopy.

"Critical thinking about the overall clinical picture, and potential diagnoses indicated by a patient’s symptoms, is of fundamental importance in optometry practice.

"Careful consideration and further investigation of potentially concerning symptoms is crucial for timely detection and treatment of eye diseases such as glaucoma," said Ms McDowell.

Ms McDowell recommended that the optometrists and Specsavers Silverdale each provide a written apology to the woman, and that the Optometrists and Dispensing Opticians Board consider whether review of the three individual optometrists’ competence is warranted.

She also recommended that Specsavers Silverdale provide the HDC with internal audit reports and a report on any remedial actions undertaken; use the HDC report as an education and training guide for its staff; and consider amending its assessment template to require optometrists to review and discuss previous visit records at every consultation with consumers.

Specsavers Silverdale has updated its policies relating to the requirement for staff to document all assessment findings, even when they are negative, and has made several changes to its practice. The optometrists have also made changes to their processes for record keeping and patient management, and undergone training to develop and improve their skills in gonioscopy.

"Complaints offer a significant learning opportunity, to reflect on how care could be improved - to create positive change for consumers and providers.

"I am pleased to see that the optometrists and Specsavers Silverdale have undergone training, and implemented changes to their practice and processes following this complaint," said Ms McDowell.

The full report for this case is available on the HDC website.

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