I spend much of my time looking at other optometrists’ clinical records. This is part of my work as an expert witness. When a patient complains about treatment to the regulator, and it is considered necessary to look in detail at what happened, the regulator will ask someone like me for an opinion on what the optometrist did.

When a patient makes a claim through a lawyer for clinical negligence, the lawyer will ask someone like me for an opinion on what the optometrist did. I’ve dealt with cases involving one examination and cases with 300 examinations. I read and reread the clinical records making sense of what was done. The lawyers always ask if there was something more the optometrist should have done. The answer to this question is nearly always yes. The optometrist should have done more.

Often my ‘should have done more’ response stems from one or more presenting symptoms that have not been addressed. What I mean by this is that the patient has mentioned one or more symptoms that have been noted in the clinical records but the cause of those symptoms has not been found. It is clear from the clinical records that a reason for the symptom has not been found but the patient has been put on a one or two year recall with words such as ‘everything is okay’ or ‘I can’t find anything wrong’.

What often happens next is that the patient seeks a second opinion from another optometrist who advises treatment and/or referral to an ophthalmologist for further investigation.

The patient perceives poor treatment from the first optometrist and makes a complaint to the regulator. Or the patient accepts the first optometrist’s advice and then a few weeks later there is vision loss leading to another opinion from an optometrist or ophthalmologist and then some management occurs. The vision loss is often permanent and this leads to a letter from the patient to a lawyer with a view to financial compensation.

Symptoms which are often not dealt with adequately include flashes, new floaters, cloudy vision, misty vision, reduced vision and pain (all usually in one eye) and eye ache.

In order to avoid a fitness to practise hearing or letters from lawyers chasing financial compensation, note in the clinical records each symptom, the cause of each symptom and the management for each symptom. If you can’t find a cause for a symptom then make a referral to another eye care practitioner who has access to procedures that you don’t. Never be the last person to examine an eye that goes blind.


  1. Avatar

    Very useful resource

    • Frank Eperjesi

      Thank you for being part of the EyeTools community and for your comment. I’m glad you found this article useful.

  2. Avatar

    Thanks for the advice. I always refer my patients to Ophthalmologists if there is suspicious condition in their eyes/vision that only Ophthalmologists can detect.

    • Frank Eperjesi

      Thank you for your comment. It’s good to hear that you work in partnership with ophthalmologists. In my experience, optometrists are the experts at refraction with a reasonable knowledge of eye diseases while ophthalmologists are the experts at eye diseases with a reasonable knowledge of refraction.

  3. Avatar

    That’s a perfect advice sir.

    • Frank Eperjesi

      Thank you for your comment. I’m glad to hear that this EyeTools’ resource was useful to you.


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