Patient Left Blind After Ophthalmologist Refuses To Prescribe Steroid Treatment

Case Overview

This case involves a 35-year-old female patient who presented with blurry vision in her left eye after a lengthy sinus infection. The patient’s ophthalmologist diagnosed her with a swollen optic nerve and determined that the nerve would heal on its own in 8-10 months. The patient made a request for a prescription for steroids but the physician denied the request claiming the case was not extreme enough to merit steroids. 4 months later, the patient began to have complications in her right eye. She returned to her ophthalmologist and he promptly wrote her a prescription for intravenous steroids and referred her for treatment at the hospital. The patient underwent a series of tests at the hospital and was informed that the damage to her right eye stemmed from lack of treatment on her left eye. In spite of eventual steroid treatment, the patient lost sight in both eyes. It was alleged that these complications could have been avoided if the patient’s ophthalmologist had treated her with steroids months sooner. An expert in ophthalmology was sought to review the records and determine if the correct diagnosis was made and if anything could have prevented this patient’s eventual prognosis.

Questions to the Ophthalmology expert and their responses

How often do you diagnose patients with a swollen optic nerve?

I see at least 20-40 patients/year with this problem.

What are the treatment options for a swollen optic nerve?

The options for treatment depend on the cause of the swollen optic nerve (e.g. ischemia, inflammatory, raised intracranial pressure, compression, genetic). Treatment depends on the individual diagnosis and could involve doing nothing or treating with steroids or surgery in the case of papilledema or compression.

About the expert

This board-certified expert has over four decades of experience in his field with a focus on neuro-ophthalmology. He received his BS, PhD in pharmacology, and his MD from the University of Iowa. He then went on to the Gundersen Clinic and Lutheran Hospital in Wisconsin for his internship before returning to the University of Iowa to complete a research fellowship and residency in ophthalmology, as well as a clinical fellowship in neuro-ophthalmology. He has published over 240 peer-reviewed articles, over 25 book chapters, and books, as well as lectured and presented widely on topics in his field. Additionally, he has received a number of grants for his research. Formerly, he served as an assistant and then associate professor of ophthalmology, as well as the director of neuro-ophthalmology at the University of Iowa?s College of Medicine. Currently, he is a professor of ophthalmology at a major research university in Iowa and also serves as ophthalmology staff at a VA Center and as a director of their preventative ophthalmology research center.

E-006715

Specialties:

Ophthalmology

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