TEXAS PATIENT WHOSE OPTOMETRIST RECOMMENDED LASER EYE SURGERY BY A LOUISIANA OPTOMETRIST. HEAR HER TELL HER STORY AND THEN LET TEXAS LEGISLATORS KNOW NOT TO LET THIS HAPPEN HERE:
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TEXAS OPTOMETRIST MISDIAGNOSIS OF GLAUCOMA FOR A 13-YEAR OLD CHILD AND MOTHER
In Jan. 2018, my 13-year-old son, my husband and I all went for our annual contact lens and eye checkup. During the visit, the optometrist notifies me that my eye pressure was a concern for her and that she needed to do more tests to rule out glaucoma.
She also proceeded to tell me that my 13-year son also had high pressure and needed to go through further testing. She called us back and we each went through a couple of hours of testing.
At the end of the tests she told me that my son and I both had glaucoma and that we needed to get on daily eye drops right away or face potential blindness. She also said that we both had to come back every 3 months for the rest of our lives.
When I went to fill the prescriptions, the pharmacist said that she had never filled this prescription for a 13-year-old which is what caused me some concern. The eye drops were also $120 per bottle per month which is really expensive plus there was something about the diagnosis that did not sit well with me.
I decided to go for a second opinion with an ophthalmologist. After further examination, it was determined that neither my son nor I had glaucoma. I was absolutely devastated - I spent over $1,000 plus allowed my son to put steroids in his eyes.A Concerned Patient, DFW Area
TEXAS OPTOMETRIST SUSPECTED BUT NEVER REFERRED PATIENT TO OPHTHALMOLOGIST
My optometrist] told me that I had glaucoma, but I was never treated.
I went to [another optometrist.] She detected glaucoma and referred me to [an ophthalmologist.]
He has treated me for glaucoma for a year now and has stopped it from progressing.
I should have had treatments, which consist of only eye drops, years ago.A Concerned Patient, DFW Area
LACK OF EARLY OPHTHALMOLOGIST GLAUCOMA CARE CONTRIBUTED TO VISION LOSS IN TEXAS
I have undergone glaucoma treatment in the past few years and without the intervention of a glaucoma specialist, I would not have my sight today…
Looking back, I wish that I had seen my glaucoma specialist sooner and perhaps I would not have vision loss today…
Only a specialist can properly monitor the course of the disease. Allowing optometrists and others to attend weekend seminars and perform as specialists is extremely dangerous for patients.A Concerned Patient, Panhandle
HOW TEXAS OPHTHALMOLOGIST HELPED PATIENT MANAGE GLAUCOMA
Some ten years ago I began to experience problems with my eyesight which became more and more alarming.
Even though I continued regular visits and was tested for glaucoma on numerous occasions by my optometrist and his staff, neither he nor his staff ever became concerned.
On several occasions he did prescribe eye drops, without any explanation other than he thought they would help… the drops he prescribed were never helpful or effective and usually too painful to administer on a regular basis.
Finally, on what became my last visit and while he was doing his usual examination, a grave look came over [his] face… and he admitted I had considerable glaucoma damage…
After six eye surgeries and numerous examinations and procedures over the past three years things seem to be under control. I am under the care to two brilliant and caring medical specialists…
Still, I have considerable damage, which is irreversible, none of which would have happened had my optometrist referred me to an ophthalmologist at a much earlier time.
A Concerned Patient, Panhandle
PATIENT STORIES FROM OKLAHOMA – WHERE OPTOMETRISTS CAN PERFORM LASER SURGERY DESPITE A LACK OF A MEDICAL DEGREE OR ADEQUATE SURGICAL TRAINING
OK PATIENT 1: The first patient is a lady with symptoms of distortion of the vision in one eye. The optometrist performed laser iridotomy. In this surgery, a laser is used to burn a small opening in the iris so that fluid can flow through the hole and exit through the eye drainage system. The objective of performing this procedure is to decrease the pressure in the eye. In this example, the optometrist performed this surgery in both eyes of the patient. The patient continued to have distortion and sought a second opinion from an ophthalmologist.
Records from the optometrist were obtained and reviewed. There was no documentation of history or examination findings to warrant the laser surgeries. There was documentation that insurance would pay for the laser surgeries. The ophthalmologist diagnosed the cause for the patient's symptoms of distorted vision—a wrinkle in the retina. The patient did not need the lasers and the insurance company paid for unneeded surgeries. Net result - patient risk without any chance of benefit, and increased health care costs. Exactly the opposite of the goal of medical care which is patient benefit and lowest risk with reasonable cost.
OK PATIENT 2: Another patient emergently came to the VA hospital after an optometrist attempted to do a laser iridotomy and encountered hemorrhaging at the laser site and could not proceed and left the opening incomplete. The optometrist then moved to the second eye and tried to do a laser iridotomy in the second eye and once again encountered hemorrhaging and could not complete the procedure. The bleeding in both eyes resulted in very elevated eye pressure, which then became an emergency which an ophthalmologist, a medical doctor and surgeon, came to the aid of the patient. There is no doubt, it requires medical education, clinical surgical experience and the judgment that comes with years of medical and surgical training to learn not to put patients' vision at risk.
Even with the training that has been established to perform eye surgery there can be complications. When you massively decrease the education and experience, there can be no outcome other than increased complications. In this patient's case, he realized that he had to go to another doctor who could take care of his problem and went to the VA hospital. It was identified that the patient was on anticoagulants, and it should not have been surprising for the patient to hemorrhage.
The patient said he told the optometrist about the anti-coagulant use and the optometrist said it would not be a problem. The patient was hospitalized and managed by ophthalmologists at the VA hospital. Ultimately it was determined that the patient did not even need the laser treatment. From the weekend laser course (which is all the “additional training” required for optometrists in Oklahoma to legally perform the procedure), the optometrist did not really know when to do the laser and did not recognize the risks for this patient. The patient suffered damage to both eyes and there were costs to the VA hospital that were unnecessary. Poor quality of patient care with increased costs is not what should be perpetuated.
OK PATIENT 3: Another patient was referred to a glaucoma specialist and underwent SLT glaucoma laser surgery. His follow up was with his local optometrist for pressure checks. At his first visit with the optometrist the eye pressure was elevated. Rather than talk with the ophthalmologist on the best management for the patient, the optometrist decided to do paracentesis—insertion of a needle into the eye and withdrawing some fluid to lower the pressure. The optometrist did not understand that the eye refills with fluid and the eye pressure returns to the same pressure within 15-30 minutes.
The patient returned one week later, and the pressure was elevated. He repeated the paracentesis and did this again a week later with the same result. Fortunately, the patient did not suffer an eye infection. But unfortunately, he was put at risk for infection without any chance of benefit of the procedure. This is due to lack of understanding from inadequate education, training, and clinical experience. The optometrist called the ophthalmologist to ask what to do next and the ophthalmologist assumed the care of the patient until his eye pressure was controlled.
OK PATIENT 4: The final patient complication to share involves a child. The child had blunt trauma to one eye. He was seen at the emergency room and referred to a local optometrist. The optometrist saw blood filling the front of the eye and measured an elevated eye pressure. The optometrist decided to manage the eye injury. He performed anterior chamber paracentesis on the child. The child developed inflammation and the eye pressure increased.
Ultimately the patient was referred to a glaucoma specialist. It was not clear how many times the optometrist placed a needle into the eye since no records could be obtained from the optometrist. The glaucoma specialist/MD recognized that the lens of the eye was ruptured and worsening the damage of the original blunt eye injury. The lens rupture was due to the optometrist's blind placement of a needle into an eye filled with blood. The optometrist's intervention actually worsened the child's eye injury and made the management much more complicated.
The ophthalmologist took the child to surgery and removed the blood from the front of the eye and also removed the ruptured lens. The child was left without a lens in the eye. Although the child had an eye injury, due to lack of education and experience, the optometrist made the eye injury worse.