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Assessment by optometrist (13HDC00696)

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(13HDC00696, 12 June 2015)

Optometrist ~ Prescription ~ Assessment ~ Information ~ Informed consent ~ Documentation ~ Rights 4(1), 4(2), 6(1), 7(1)

A mother complained about the care provided to her four-year-old son by an optometrist. The main reasons for their first visit were that the boy had failed his B4 School Check, and his mother had noticed that occasionally he had a "wandering eye".

The optometrist carried out retinoscopy, an Ishihara colour vision test, and pupil reactions to assess the boy's ocular health. She also tested his eye alignment and arranged a further appointment so that she could test further for amblyopia (lazy eye) with the aid of cycloplegic drops.

At the second appointment, the optometrist re-examined his eyes using cycloplegic drops to obtain a more accurate prescription. The results, as documented in the notes, showed that the boy was somewhat long sighted with a low degree of astigmatism. The optometrist recommended that the boy wear single vision distance spectacles full time and return for a review in six weeks' time. Very little of this appointment is recorded in the notes, including what was discussed or regarding any management plan.

The boy's parents sought a second opinion with another optometrist, who diagnosed an alternating exotropia (a divergent squint, where the direction of the eye deviates), and advised that glasses were unnecessary to treat the condition. This optometrist then referred him to a consultant ophthalmic surgeon, who agreed with this diagnosis.

By not carrying out a thorough and appropriate eye health assessment at the first appointment, for not repeating the measurements of vision, and for prescribing spectacles when they were unnecessary, the optometrist breached Right 4(1).

The optometrist did not fully inform the boy's parents of the diagnosis and prognosis, including the reasoning behind why spectacles were prescribed, or of the plan to manage his condition. Accordingly, the optometrist breached Right 6(1).

It was also held that the parents did not receive sufficient information about the diagnosis and intended management of their son's condition. Without this information, they were not in a position to make an informed choice or give informed consent for their son regarding an agreed course of management, including the prescribing of spectacles. Accordingly, the optometrist breached Right 7(1).

By not following the professional standards relating to documentation, the optometrist breached Right 4(2).

The clinic was not found liable for the optometrist's breaches of the Code.

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