A Kendall optometrist didn’t act as glaucoma developed in a now-blind patient, state says
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As a patient at risk of glaucoma slowly got glaucoma and became legally blind, his Kendall optometrist of 17 years didn’t provide the minimum standard of care and didn’t see it happening, the Florida Department of Health said.
That’s from the administrative complaint the department filed against Dr. Terry Friedman on March 10. The complaint starts the discipline process with the state Board of Medicine. Friedman will have a chance to dispute the department’s assessment before the board decides if any consequences are necessary.
Reached Tuesday morning, Friedman declined to comment. An online check of the Florida license he’s had since January 1983 shows no previous complaints or discipline.
The coming of glaucoma
“Glaucoma is an eye disease that can develop slowly, over long periods of time, with the affected individual experiencing no symptoms until some loss of vision is permanent,” the complaint says. “Damage from glaucoma is permanent; however, treatments are available that can stop the progression of glaucoma so that the affected individual experiences no additional loss of vision, therefore, early detection of glaucoma is important.”
A man the complaint refers to as “R.G.” was over 40, of African descent and had a family history of glaucoma, each by itself a risk group for glaucoma.
“The standard of care for an optometrist treating a patient similar to Patient R.G.,” the complaint says, “is to take a thorough family history, administer a comprehensive eye examination, and conduct threshold visual field testing or similar tests.”
Friedman didn’t perform those exams or testing, the complaint says, though he started seeing R.G. in 2001.
The complaint says R.G. complained about vision problems during routine eye exams in 2015, 2016, February 2017 and December 2017 but Friedman did no additional testing even when R.G. said he was having a tough time focusing, “a symptom of glaucoma,” in February 2017.
The complaint says from January 2015 through June 20, 2018, there were seven visits and multiple phone calls to Friedman from R.G. about vision problems.
But, the state says, Friedman documented no complaints about vision on four of the visits, no family medical history and his “medical records for Patient R.G. are frequently illegible, thereby failing to adequately document examinations, treatments and prescriptions for Patient R.G.”
Diagnosis: legally blind
On June 20, 2018, the complaint says, Friedman tested R.G.’s intraocular eye pressure, the fluid pressure inside the eye. High intraocular eye pressure can indicate glaucoma. The Glaucoma Research Foundation says a measurement of 12 to 22 millimeters of mercury is normal. Friedman recorded R.G.’s right eye was 11 and the left eye was 10.
Then, Friedman measured the cupping, which the Glaucoma Research Foundation describes as “the size of the depression in the middle of the (optic) nerve when viewed from the front of the eye. When there is damage to the optic nerve, the cupping increases.”
Friedman measured 0.2 for the right eye and 0.3 for the left eye.
Three months later, R.G. went to the Center for Excellence in Eye Care in Kendall. The doctor there measured intraocular pressure of 35 in each eye, cupping of 0.95 in each eye and a loss of vision in all fields.
“The physician informed Patient R.G. that he had severe glaucoma and should no longer drive,” the administrative complaint said. A week later, “R.G. visited the Center and saw a physician who specialized in the treatment of glaucoma.
“Patient R.G. was informed that he was legally blind.”
