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Biomedical subjects

J G Classé

Publications and source records attributed to J G Classé.

At least 19 recordsLinked to original sources
PubMed1992

Liability and ophthalmic drug use.

Ophthalmic drug use has been an aspect of optometry for more than two decades. Although utilization of these drugs has produced significant changes in the clinical and legal responsibilities of optometrists, the liability posture of the profession has remained unaltered. Studies of malpractice claims against optometrists and ophthalmologists have demonstrated that ophthalmologists are much more likely to be charged with negligence for adverse drug reactions and that drug-related malpractice claims are not a liability issue for optometrists. Based on the experiences of both professions, this paper describes the adverse effects of common ophthalmic drugs, with emphasis on those drug reactions that have resulted in litigation.

Eye Diseases↗
PubMed1992

Dapiprazole: will it affect the standard of care for pupillary dilation?

One of the most controversial clinical issues in optometry is the use of "routine" pupillary dilation. Many optometrists are still reluctant to employ routine dilation because of concerns regarding patient inconvenience, angle-closure glaucoma, or systemic side effects. Dapiprazole, a new alpha-adrenergic blocking agent, is now available to reverse the effects of tropicamide- or phenylephrine-induced mydriasis. This article discusses the advantages, clinical uses, limitations, and legal aspects of this mydriatic antagonist in optometric practice.

Adrenergic alpha-Antagonists↗
PubMed1992

Pupillary dilation: an eye-opening problem.

Dilation of the pupil is a procedure with both clinical and legal ramifications. Optometrists must be familiar with the requirements of informed consent, which must be met when utilizing dilation on the 4-8 percent of patients with anterior chamber angles that are narrow enough to cause an angle closure. Optometrists also must recognize those circumstances under which pupillary dilation is necessary, both for symptomatic and asymptomatic patients. The correct drug regimen must be selected, whether it is for "routine" pupillary dilation or for a patient with a condition requiring a special drug regimen. Patients with dilated pupils must be appropriately managed, and failure to warn a patient of common and expected side effects may create liability if the failure to warn is the cause of injury. If complications--such as acute angle closure--occur, the optometrist must be prepared to manage the situation so as to minimize the risk of injury to the patient.

Eye Diseases↗
PubMed1992

Clinicolegal aspects of vitreous and retinal detachment.

Failure to diagnose retinal detachment is an important cause of professional liability claims involving optometrists. To comply with medical standards, dilation of the pupil and examination of the retinal periphery are required, both for patients who are at risk for retinal detachment and for patients who are symptomatic. Important risk factors include a history of previous detachment, myopia, lattice retinal degeneration, aphakia and pseudophakia, YAG capsulotomy, treatment of primary open-angle glaucoma with miotic drugs, blunt ocular trauma, and the proliferative retinopathies. Patients with the symptoms of acute posterior vitreous detachment must receive a dilated fundus examination, evaluation of the retinal periphery, and assessment of the vitreous. If examination results are negative, the patient should be warned of the symptoms of retinal detachment and scheduled for reevaluation in 4 to 8 weeks. Examination findings, warnings, recall appointments, and referral for treatment should be documented in the patient's record of care.

Diagnostic Errors↗
PubMed1992

Hypertension and diabetes: a clinicolegal review.

The optometric management of patients with essential hypertension and diabetes mellitus is determined by both clinical and legal requirements. The most common cause of litigation is failure to recognize retinal changes requiring treatment, combined with a failure to refer. To comply with appropriate standards of care, an optometrist should perform a thorough eye examination (including evaluation of the retina with a dilated fundus examination), educate patients concerning the risks of hypertension or diabetic retinopathy and the need for periodic assessment, describe pertinent findings to the patient's treating physician, schedule patients for periodic reevaluation (as required by examination findings), and refer patients promptly if sight-threatening retinal changes are encountered.

Diabetes Mellitus↗
PubMed1992

Legal aspects of clinical laboratory testing.

The use of clinical laboratory testing by primary care optometrists has several legal ramifications. Because laboratory testing is largely controlled by state law, optometrists must comply with the specific statutory provisions that pertain to the ordering of tests. If patients present with ocular signs or symptoms indicative of systemic disease, optometrists should order the appropriate tests or refer the patient to another health care provider so that the appropriate testing can be obtained. In ordering clinical laboratory tests to confirm a presumptive diagnosis, optometrists will be held to a medical standard of care with respect to the interpretation of results, the prompt communication of results to patients, and the reordering of tests that have produced questionable or incorrect findings. Test results, communications with patients, and recalls and referrals should be documented in the record of care.

Clinical Laboratory Techniques↗
PubMed1991

Liability for extended-wear contact lenses.

Because of the risk of serious complication that accompanies the extended wear of contact lenses, clinical management should emphasize adequate communication with the patient and a systematic program of examination and follow-up. Management should be in compliance with informed consent requirements, which obligate practitioners to document instructions, findings, warnings, and recall examinations. The most likely legal claim is one of negligence, and the most common causes of liability are inappropriate patient selection, improper wearing schedules, improper management of contact lens-related complications (especially corneal abrasions), and inadequate monitoring of ocular health. In determining the liability of optometrists, a medical standard of care may be applied.

Contact Lenses, Extended-Wear↗
PubMed1991

Standards of care when diagnosing or treating the glaucomas.

Negligence claims against ophthalmologists alleging failure to diagnose glaucoma have resulted in legal precedents with important clinical ramifications for optometrists. These cases have established that tonometry should be performed as a routine eye health procedure, regardless of patient age, and that suspicious findings, such as elevated intraocular pressures, should be communicated to the patient as required by the doctrine of informed consent. When treating patients with glaucoma medications, drugs should be selected that minimize the risk of injury or adverse effects, and, unless clearly contraindicated, a topical route of administration should be used for initial efforts at medical management.

Glaucoma↗
PubMed1991

Cataracts and co-management: a clinicolegal view.

Optometrists frequently diagnose and manage patients with age-related cataract. During the period before surgery, patients must be warned concerning the deleterious effects of the cataract on vision, and an appropriate eye health assessment must be performed to rule out the presence of coexisting disease. When optometrists refer patients to ophthalmologists for cataract surgery, if the surgery is negligently conducted, the optometrist is not responsible for the patient's injury unless the surgeon was not selected with due care. Optometrists who co-manage patients during the postoperative period should develop protocols for examination and communication with the surgeon because joint liability can result, involving both practitioners.

Cataract↗
PubMed1991

Liability for the treatment of anterior segment eye disease.

About 25% of large professional liability claims against optometrists involve misdiagnosis of anterior segment anomalies, most notably corneal abrasions (especially secondary to contact lens wear), tumors of the lid (principally basal cell carcinoma), pigmentary and angle-closure glaucoma, and, less commonly, anterior uveitis. Treatment of anterior segment eye disease is an infrequent cause of litigation involving optometrists. Potential causes of litigation include mismanagement of corneal abrasions and ocular foreign bodies, side effects of topical and systemic steroids, and adverse effects of glaucoma medications. In determining an optometrist's liability for care, a medical standard of care will be applied.

Anterior Eye Segment↗
PubMed1991

Premises liability.

Like other health care providers, optometrists have a duty to maintain offices and equipment in a safe condition. Failure to meet this duty results in premises liability. This article discusses premises liability with particular emphasis on pupillary dilation as a causative factor for patient injuries.

Humans↗
PubMed1990

Professional liability and the Federal Tort Claims Act.

Professional liability claims against military optometrists must be brought in federal court under the Federal Tort Claims Act, which establishes rules of procedure that are somewhat different from those found in malpractice claims against private sector optometrists. Despite these differences, cases litigated against military optometrists may potentially be used as precedents to be applied to cases involving private practitioners. Recent decisions of the federal courts have in fact set such precedents, in cases alleging misdiagnosis of ocular disease, failure to refer for medical treatment, and failure to warn of the significance of symptoms.

Diagnostic Errors↗
PubMed1989

Legal aspects of visual field assessment.

Visual field testing can fail to satisfy the standard of care if the optometrist does not test the patient's visual field when it is necessary, and if, even when testing is performed, it is of insufficient sensitivity. In general, the duty to test the visual field arises when examining symptomatic patients and when a suspicious finding is encountered, but "routine" eye health assessments should include a screening visual field test. In some cases the doctrine of informed consent will require the optometrist to inform the patient that testing of the visual field at threshold should be performed. Documentation of both test results and patient communications should be retained in the record.

Documentation↗
PubMed1989

The eye-opening case of Keir v. United States.

In a case involving a 4-year-old esotrope with retinoblastoma, a federal appellate court has held that, as a matter of law, the standard of care expected of an optometrist requires a dilated fundus examination conducted with the binocular indirect ophthalmoscope at the initial visit and periodically thereafter.

Child, Preschool↗
PubMed1989

Documenting informed consent for patients wearing disposable lenses.

Disposable contact lenses present new clinical and legal challenges to the contact lens practitioner. Although a frequent lens replacement program should reduce the opportunity for contact lens complications and improve patient compliance with lens care and follow-up procedures, problems still may arise from the manufacturing or packaging of lenses or the failure of the patient to comply with wearing instructions. Because there yet remain significant risks associated with the extended wear of hydrogel lenses, practitioners should use an informed consent agreement to assist in the communication of these risks to patients. Such an agreement also serves as evidence of the practitioner's compliance with legal requirements.

Contact Lenses↗
PubMed1989

A review of 50 malpractice claims.

A study of 50 malpractice claims reveals that, although claims against optometrists have increased in number over the past two decades, the relative cost of professional liability insurance coverage has remained stable. The most common cause of claims is misdiagnosis of intraocular disease, principally retinal detachment, open-angle glaucoma, and tumors. Corneal disease and complications of contact lens wear also contribute to errors of diagnosis. The great majority of claims alleging misdiagnosis involve optometrists who have failed to use diagnostic drugs for dilation of the pupil; few claims are due to adverse responses to ophthalmic drugs. Failure to prescribe polycarbonate plastic as the spectacle lens material for patients at risk for ocular injury constitutes another cause of claims. A small number of claims allege failure to offer binocular vision therapy to amblyopic children.

Amblyopia↗