Neil Hilton: “These are often genuine mistakes, the kind that could happen to any of us”

I didn’t set out with a clear plan to enter medico-legal work. In fact, I came across it quite organically. I was working alongside a consultant from the Royal Liverpool University Hospital who received referrals into a private eye hospital, and he began sending his medico-legal patients to me for supplementary testing. Over time, that professional relationship grew, and so did the opportunities.

Eventually, I was asked not just to support cases, but to contribute to expert witness reports from an optometrist’s perspective. The shift, from technician to opinion-giver, was, if I’m honest, initially quite daunting.

While these opportunities are relatively rare, when they come along, I take them. Early on, I recognised that if I was going to do this properly, I needed training. I enrolled on the Bond Solon Expert Witness course, and while it was incredibly valuable, it also highlighted just how rigorous and exposed this kind of work can be, especially when it comes to defending your opinion under cross-examination.

A key part of the process is knowing your limits, and I only take on cases that fall within my scope of expertise. Credibility is everything, and stepping outside your comfort zone can quickly undermine that

What the role involves

My first case was around seven or eight years ago. Since then, I’ve taken on a small number each year, and more recently, the workflow has become steadier. What has kept me engaged isn’t just the intellectual challenge, it’s the impact the work has had on my day-to-day clinical practice.

Most cases I see relate, in some way, to optometrist error or oversight, which is never comfortable. However, rather than viewing it negatively, I’ve always tried to take something constructive from it. These are often genuine mistakes, the kind that could happen to any of us, and that’s exactly why they matter.

I regularly bring these learnings back to my team. I may share, for example, “I’ve just worked on a case like this, this could happen here.” From there, we review our processes, strengthen our governance, and make practical changes. It’s one of the most effective forms of reflective practice in my opinion.

The role itself is structured but varied. Typically, I receive instructions through a medico-legal agency, often to provide an initial opinion on whether a case has merit, or to prepare a report for court. A key part of the process is knowing your limits, and I only take on cases that fall within my scope of expertise. Credibility is everything, and stepping outside your comfort zone can quickly undermine that.

When writing reports, objectivity is non-negotiable. Even if you’re instructed by one side, your duty is to the court. I make a conscious effort to approach each case with empathy, trying to understand the clinician’s perspective rather than criticise it. The benchmark isn’t what I would do personally, but what a reasonably competent optometrist would have done in that situation.

What’s striking is how often cases come down to similar themes: missed or incomplete tests. Failure to review results. Breakdowns in patient follow-up. Simple things, but with serious consequences.

I’ve seen cases where optical coherence tomography (OCT) scans were carried out but not properly reviewed and this led to missed pathology. There are others where visual fields haven’t been performed when they should have been, and where patients weren’t recalled appropriately, resulting in disease progression. These are not complex errors, but they are everyday risks.

Being involved in this work has made me more thorough and structured as an optometrist, as well as more aware of the importance of robust systems as a practice owner. In my own practice, we now use task lists to track outstanding tests and ensure follow-ups are completed. We’ve implemented clearer SOPs and placed greater emphasis on reviewing every piece of data we collect.

It can be uncomfortable at times, but that’s part of its value as it forces you to reflect, question, and ultimately, to improve

Diversification in optometry

Optometry offers more diversity than you may realise when you enter the profession, and expert witness work is just one example. In my experience, it challenges you, sharpens your clinical reasoning, and exposes you to the legal and professional frameworks that underpin our work.

It can be uncomfortable at times, but that’s part of its value as it forces you to reflect, question, and ultimately, to improve.

My advice to any optometrist considering this path? Take the opportunity if it comes. Even completing a single report can change how you see your practice. It will remind you just how important the small details are, and how much they matter to the people we care for every day.