This case involves an elderly male patient from Seattle that presented with complaints of floaters in his left eye. He was diagnosed with age-related cataracts and age-related vitreous degeneration and was told to return for an examination if he experienced any changes. Several months later, he presented to the optometrist with complaints of constant floaters. He was counseled about the risks and benefits of cataract surgery and referred to an ophthalmologist for a cataract evaluation. During that examination, the ophthalmologist noted that the patient had advanced retinal detachment in his left eye. The examination resulted in a report of total retinal detachment with no indication for urgent surgical management due to the unclear time of onset. The patient continued to experience these symptoms and required 2 surgeries on his eyes which left the patient completely blind. It was alleged that the patient’s vision would have been markedly better if he had received surgical treatment sooner.
Question(s) For Expert Witness
1. Please describe your experience in optometry.
2. In a patient like this one, when should a referral be made?
3. Have you ever had a patient have the same outcome?
Expert Witness Response E-084653
I am a fellow in an optometry academy and have practiced for over 40 years in a group optometric specialty practice. I taught optometric 4th-year interns for 40 years and I'm currently on staff at a large hospital. All my licenses are current and in good standing. I have had numerous PVDs (Posterior Vitreous Detachments) over the years without retinal involvement and a few which did have a detachment complication. All the latter cased had favorable outcomes based on realistic expectations, whether surgery was required or not, all were referred to a qualified retinal surgeon STAT. I have reviewed a retinal detachment case with significant vision loss. I reviewed the depositions and provided an analysis to the legal team. Based on the presenting chief complaints in this case, I am at a loss why another dilated fundus exam was not done by the OD to rule out retinal detachment. Without another dilated exam, standard optometric care would be an immediate referral to a retinal specialist OMD to examine and rule out detachment. The referral for the cardiac duplex and cataract were not urgent or seemingly relate to the primary chief complaint.
About the author
Wendy Ketner, M.D.
Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.
Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.
Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.
