Visual loss

A 63-year old man went to see his optometrist reporting a history of transient loss of vision and dizzy spells. Examination, which included intraocular pressures, was normal and the optometrist thought that the symptoms were consistent with a transient ischaemic attack (TIA).

The patient was referred to his general practitioner, a member of the MDU, who confirmed the history of a transient visual field loss and referred the patient to the local stroke unit, where TIA was diagnosed and the patient started on lifelong aspirin. The patient re-attended his GP nine months later with a persistent visual field loss. The GP referred him to a different optometrist who confirmed the visual field defect and found an abnormal disc on fundoscopy. On the basis of this report, the patient was referred to an ophthalmologist who diagnosed chronic simple glaucoma and felt that there was no suggestion of previous vascular episodes.

A claim was subsequently brought against the GP alleging that he should have taken a full history after initial referral from the optometrist and that referral to a stroke unit was inappropriate. The claimant also alleged that earlier referral to an ophthalmologist would have led to an earlier diagnosis and treatment of glaucoma, which would have prevented the progression in the visual field loss.

Expert opinion

The MDU asked an independent GP expert for an opinion on whether there had been any breach of duty. The expert stated that the visual field loss in relation to glaucoma is not usually transient, but progressive, and that it was therefore reasonable for the GP to conclude that the transient episode was vascular in origin. In addition, the expert was of the opinion that the GP’s diagnosis was supported by the normal optic discs and normal pressure measured by the optometrist before the initial presentation.

Outcome

On behalf of the GP, the MDU denied liability. After some negotiaton with the claimant's solicitors, the case against our member was discontinued.

This page was correct at publication on 01/08/2012. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.