"Failure to diagnose visual impairments"

Seen by Ophthalmologist at Glasgow Royal Infirmary after urgent referral by Optometrist due to steady deterioration in eyesight, unstable vision, regular double vision, onset of large dark floaters and misty area in both eyes told by optician due to posterior subcapsular cataracts centre of both eyes graded 2/4 and 3/4 (with "4" being blindness ).

They looked into eyes and said that retina looked normal (good to know as detachment is a risk) and that they couldn't see any obvious inflammation. Then said that the cataracts were too small to be causing these visual problems and that catarct surgery would not fix it. It was suggested that problems with the vitreous may be involved but they didn't seem sure.

They didn't seem knowledgeable about or interested in how connective tissue disease/collagen disorder which I have can affect the eyes or past record printouts related to this. 

Said I would be sent for further tests (fair enough). Was then sent to hospital optician and orthoptist. Hospital optician said that my current spectacles were the correct prescription which can't be true as I can no longer see properly with them. Orthoptist was very professional and kind (which was much appreciated), performed various checks but said that they couldn't find anything abnormal.

The 2nd time I saw the Opthalmologist at GRI some time later they looked into eyes again and said retina was still fine. However they didn't know what was causing my ongoing visual problems and deterioration. Instead of saying that they didn't know when asked if it was the cataracts, they hesitated then said in a completely inappropriate jocular tone that the Orthoptist thought so. (Orthoptist was skilled at the job but orthoptists are not eye doctors and it is not their job to diagnose patients - it is the Consultant's job, which they did not do.) Moreover deterioration in eyesight and visual problems are no laughing matter.

Then unexpectedly I was told that although cataract surgery would not fix the problems they would do it anyway but only if I consented immediately right there and then - this is a serious breach of the Consent Laws & GMC Guidelines and Royal College of Ophthalmologists requirements. It took me by surprise as tat the first appointment

When asked if my past history of abnormal wound healing and scarring  (involving abnormal fibroblastic proliferation and excess growth of tissue on wound sites and abnormal scarring) would affect the outcome of catarct surgery they said the didn't think so but it seemed like they didn't really know (and showed no willingness to find out or investigate further).Since this could potentially cause blindness or other serious bad outcome I found this appalling conduct  - is the patient seriously expected to risk blindness based on such uncertainty and apparent disinterest in obtaining clearing information (eg from another relevant Specialist or department).If a patient did this surgery proposal it would not Informed Consent because they did not take the time to properly explain and detail the possible risks or adverse outcomes; nor did they discuss at all the option of alternatives or consequences of no treatment.

Nor was I given proper detailed information about the risk of cataract surgery in general - they rattled off some things like a shopping list,so quickly that I could not make out what they was saying.Completely unacceptable.

I was then told I was being discharged with no treatment or help. When asked if any questions about the surgery proposal could be left with thier NHS secretary I was told No - You can only get re-referred by Optician or GP. (Despite being told that I do not have GP .)

I am being denied right as a patient to  right to sufficient information for Informed Consent for procedure. They did not find out if my past history with wound healing might increase the risk of the eye surgery causing blindness due to abnormal bad scarring or other problems related to collagen disorder/connective tissue disease. This contravenes all the NHS,GMC & RCS/RCO requirements and rules for good practice and puts my eyesight at risk.

Although I was grateful to have my retinas checked (due to my having several higher risk factors for retinal detachment or tears),overall this was a very negative experience due to the conduct and attitude of this member of staff and a failure to diagnose my visual impairment and discharging me without any treatment or answers.

The failure to diagnose my visual problems and offer proper advice about treatment options has caused long delays in accessing proper care as I had to get re-referred by community optician and although it was an Urgent referral again there are still long waiting lists to get seen.

Several experienced Optometrists at long term community Opician's practice are adamant that my ongoing visual impairment and eyesight problems are due to the cataracts in the middle of my eyes' lenses (and so the centre of my visual field.).They have sent another urgent referral to QEUH and put on it not to be given to this particular staff member at GRI.