Navigating optometric litigation

Key Points

Baltimore-Malpractice litigation against optometrists is rare. To keep it that way, optometrists must take the proper steps to reduce any risk of such litigation, especially when dealing with patients with retinal detachments, amblyopia, contact lenses, glaucoma, and tumors, said Lindsey Hardy, OD, here at the 5th annual Evidence Based Care in Optometry conference.

Where and why of claims

Dr. Hardy added that data also showed that malpractice payments by optometrists were relatively small, with almost 50% being less than $50,000. More than 50% of all optometry claims came from 11 states: New York, New Jersey, Ohio, Pennsylvania, Florida, California, Oklahoma, Texas, Illinois, New Mexico, and Louisiana, she said.

Statistical paradox

During this period, the U.S. population grew 20%, while the number of practicing optometrists grew 11%, Dr. Hardy continued. "It's interesting to note, however, that the frequency of annual claims increased only marginally during that time period," she noted. "So is this due to more rigorous training for the boards, state standards, or are we, as optometrists, practicing defensive medicine by performing some unnecessary tests to protect ourselves from litigation?"

Several presenters at the conference, all residents at the Baltimore VA, provided the following insights to help optometrists navigate away from potential litigation.

Glaucoma

The most common source of lawsuits against optometrists involve cases alleging misdiagnosis or missed diagnosis of glaucoma, according to Abby Thompson, OD.

"Optometrists need to be aware of the risk factors for glaucoma because it gives us a better idea of the prognosis of the disease in our patients. Be aware that a small number of patients, even if treated, will progress in their disease," she said.

Establish a checklist of diagnostic and treatment procedures

For a good diagnosis of glaucoma, Dr. Thompson advised obtaining and documenting a dilated stereoscopic view of the optic nerve. If you suspect that is not glaucomatous, rule out all other differential diagnoses.

For the proper work-up in patients with glaucoma, always check eye pressure, look at central corneal thickness, do any necessary ancillary testing, and perform gonioscopy to evaluate the angles, she said. In addition, establish a baseline pressure.

If you decide to treat, always educate the patient on drug side effects, genetics of the disease, the significance of family history, and the importance of medication compliance, Dr. Thompson said. Give patients a specific schedule for medication use, she added, and make sure they understand it. If patients must go on to further treatment that includes more than just topical therapy, make sure they are educated about their co-management.