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How to stay out of trouble

The AOP’s clinical adviser, Kevin Wallace, explored common complaints and what can go wrong during his presentation at 100% Optical

29 Jan 2019 by Andrew McClean

Newly-qualified optometrists were told how to avoid the mistakes that some optometrists commonly make at 100% Optical (12–14 January, ExCeL London).

The AOP’s clinical adviser, Kevin Wallace, explored common complaints and what can go wrong during his presentation, Newly-qualified? – top tips for staying out of trouble, at the AOP Lounge.

He asked attendees what they felt the most important thing is to consider during an eye examination in order to avoid getting into trouble.

“History and symptoms,” he shared, adding that all optometrists should write down what the patient told them and what advice was given before they leave the practice.

“These two things should make sense together. If they don’t make sense, you’ve missed something,” he said.

Common complaints

Mr Wallace detailed that the two most common complaints – retinal detachment and glaucoma – jointly account for approximately 80% of legal complaints about eye conditions.

“It is hard to defend someone who records suspicious symptoms of retinal detachment but doesn’t examine the patient properly,” he said.

Mr Wallace highlighted that patients often do not present with textbook symptoms, so it is important to clarify what they mean when they describe what is wrong with their vision.

He added that the optometrist should then look to prove retinal detachment by examining the patient properly. He said not to rely on visual fields, intraocular pressure and visual acuity when checking for retinal detachment as these results can be normal and a detachment could still have happened.

“Give good advice and refer appropriately. They need to go urgently. There’s no other referral that’s appropriate for a retinal detachment. Referring through the GP isn’t nearly quick enough,” he said.

On suspicion of glaucoma, which Mr Wallace said can be “subtle in the early stages,” he shared that intraocular pressure, optic nerve examination and measuring visual fields are the standard tests to carry out.

“If these things are ok, it’s absolutely fine to discharge the patient and then get them back at an appropriate time,” Mr Wallace told attendees.

He highlighted risk factors, such as intraocular pressure, to keep in mind and common errors, such as not noticing a change from previous results.

Mr Wallace added that the AOP’s patient leaflets are good tools to use so that patients are reminded of what was discussed during an examination. 

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