Retinal detachment and the risks of the eye clinic shuffle

When it comes to eye care, it’s important to realize that there are two different types of eye doctors who have rather distinct roles.

Optometrists focus on generalized eye exams and prescribing corrective lenses (eyeglasses and contact lenses). They didn’t attend medical school, but rather received doctoral degrees from the school of optometry. When they encounter complex medical issues of the eye, they should refer patients to an ophthalmologist.

Ophthalmologists are physicians who attended medical school and have advanced clinical training on treating eye diseases.

It can be confusing because both of them are correctly referred to by the title “doctor.” It can be even more confusing to patients when optometrists and ophthalmologists work together in eye clinics, as they frequently do. While there is nothing wrong with having a practice set up in this manner, there are some risks to patients if the eye clinic team isn’t well trained and managed.

Getting past the gatekeeper

The unfortunate fact is that many eye clinics are set up to where the front-office staff is the gatekeeper, making the decision on whether a patient requesting the same-day urgent appointment is seen by an optometrist or the medically trained ophthalmologist. For some patients, the wrong decision by the non-medical staff can essentially be a sentence to a lifelong eye condition or partial blindness.

Here at Painter Law Firm, we are currently representing multiple patients who had existing relationships with an ophthalmologist related to cataract surgery. When they called later because of visual problems (often floaters or flashes of light) and asked to be seen the same day, the receptionist sent them to the in-house optometrist, instead of the ophthalmologist, at the same eye clinic.

In each case, the optometrists missed classic signs that should have led to prompt diagnosis of retinal detachment. By the time the patients got appropriate care from an ophthalmologist, it was too late to avoid permanent partial blindness.

A well-trained eye clinic staff will know the questions to ask to get the key information from patients—things like family history, eye conditions and surgeries, and current symptoms. This information should help guide the receptionist to schedule the patient with the correct type of eye doctor, and then provide relevant facts for the treater to consider.

Medical malpractice: Missing risk factors and signs of retinal detachment

The retina is the part of the eye that allows you to see. If the retina detaches or starts to separate from the eye, it’s a medical emergency.

Whether it’s an optometrist or ophthalmologist, every eye doctor should know the risk factors of retinal detachment:

• Age: Over 50 years old.

• Prior personal or family history of retinal detachment, severe eye traumatic injury, or certain eye diseases. If a patient experiences retinal detachment in one eye, there is a 10% increased risk of developing retinal detachment in the other eye.

• Extreme myopia, or nearsightedness: Nearsighted people have difficulty seeing things far away. With extreme nearsightedness, a person with uncorrected vision would have a tough time seeing something farther than around a foot from his or her face.

• Cataract surgery: Around 1% of cataract patients experience retinal detachment. The medical literature reflects a particular association to young age, male sex, long axial lengths, and having any complication during the cataract surgery.

• Posterior vitreous detachment: Vitreous is the jelly-like substance of the eyeball. When there is a vitreous leak, it causes traction and pulls on the retina.

• Lattice degeneration: This is also called thinning of the retina and is found in about 6-8% of patients.

The appropriate workup

The standard of care requires a dilated fundus (eye) exam for any at-risk patient. This is a detailed examination of the entire fundus with indirect ophthalmoscopy (using powerful light and lenses to examine the internal structures of the eye) and scleral depression.

In case after case that we’ve seen, an optometrist makes the decision to clear an at-risk patient without a dilated exam. If this happens to you, speak up and insist on the appropriate exam, or, better yet, asked to be seen by an ophthalmologist.

If there are abnormalities on the dilated exam, a same-day referral to a retinal (vitreoretinal) specialist may be necessary.

If you’ve experienced a permanent eye injury because of poor optometrist or ophthalmologist care in Texas, then contact a top-rated experienced Texas medical malpractice lawyer for free consultation about your potential case.

Robert Painter
Article by

Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.