Case Archive
Ref. # 43738

Since age 12, a 33 year old New York man with a family history of glaucoma had been under the care of an optometrist. At no time was the cup to disc ratio recorded or the intraocular pressure measured. The patient consulted another optometrist, who noted an elevated intraocular pressure: tonometry readings were 19, 17. After four exams and two and a half years, pressure was again measured: tonometry readings were 25, 26. Another year and a half later, the optometrist noted a cup to disc ratio of .3. Two months later, the patient consulted an ophthalmologist, who recorded a larger ratio of .8 in each eye, with applanation tensions of 28 OD and 30 OS. The assessment of the patient's visual field showed extensive damage typical of glaucoma. The patient requires medication changes, laser treatments and surgical intervention. A medQuest optometrist reported that, after the patient's elevated tonometry readings, there was a negligent failure to further evaluate his condition and establish a base line of information. This would have included a dilated fundus evaluation with detailed observation of the optic nerve, a quantitative perimetric exam for visual field testing, and ophthalmic photography. The optometrist's ultimate disc to cup of reading of .3 was inaccurate in light of subsequent readings, likely due to the failure to dilate the pupil and observe the true topography of the optic nerve head. With appropriate care or timely referral to an ophthalmologist, damage to the man's vision would have been significantly reduced.

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