While there are no guarantees an optometrist won’t miss an ocular disease, adopting a diligent approach certainly minimises the risk.
For example, examining babies requires patience, can be time-consuming and is notoriously difficult because of extremely limited cooperation, often shaking the head, crying and closing the eyes as soon as a light is shone in their direction.
Some years ago, a mother brought her 18-month-old daughter to me because she suspected she had a turn in the eye. I was unable to detect a turn, but as in this case, babies at this age frequently have an epicanthus, a fold of skin which partially covers the white of the eye, giving the impression of a turn.
Fortunately, when I shone my retinoscope (an instrument that is used to determine the focus of the eye) at the eyes, although the baby did rapidly close the eyes, I was able to get a glimpse of a yellow reflex, indicating there was an abnormality. She was subsequently referred to an ophthalmologist who performed an examination under general anaesthetic which confirmed a rare tumour behind the eye
Sadly, the eye had to be removed but this did save the baby’s life.
An optometrist in the UK, working in a large commercial optometric franchise was found guilty of negligent manslaughter in 2016 because she failed to take sufficient care to diagnose swelling of the optic nerve in an 8-year-old, which indicated a buildup of fluid in the brain, ultimately leading to his death. The judgement was later downgraded to professional negligence, resulting in the optometrist being prevented from practising in the future.
The moral to the story … quick eye exams especially when built into the mode of practise, increase the risk of missed diagnoses.
