Ophthalmology Independent Medical Examinations

Ophthalmology medical examinations are often requested to assist counsel, juries, and judges understand the technical aspects of a case.  An independent examination needs to be a comprehensive and objective.  A well written report based on a carefully conducted independent examination reflects well on the examiner and is likely to hold up under careful scrutiny.  The examiner who follows this basic principle best serves retaining counsel and the legal process.

Ophthalmology independent medical examinations are generally conducted at the office of an ophthalmologist.  A well-equipped ophthalmologist office has essential instruments that are used for comprehensive testing.  A slit lamp microscope is used to inspect the front segment of the eye, an ophthalmoscope is used to examine the back of the eye, and a phoroptor is used to determine the refractive status of a claimant.  The refractive status is the state of nearsightedness (myopia), farsightedness (hyperopia), and astigmatism.

Ophthalmology offices for independent medical examinations often have specialized equipment such as am optical coherence tomography unit for analyzing the retina and optic nerve, topography for analyzing the shape of the front window of the eye (cornea), and fundus photography for memorializing the appearance of the back of the eye.  All of these devices can be helpful for diagnosis and documentation.

A concise history that provides a description of events and their time is part of an ophthalmology independent ophthalmology examination.  Quotes that come directly from the claimant are recorded for use in the final report.  The eye examination needs to be comprehensive and yet focused on the alleged impairments.  The examiner methodically records the results so as not to leave important details to memory.

An expert ophthalmology report is a natural extension of the examination that serves as an essential document.  The expert report needs to meet legal standards and be clear about opinions and the basis of opinions.  Findings from the examination should be integrated into the report to serve as supporting documentation.  The words for the report are chosen for their precise meaning.

Examinations need to address the concerns of litigation.  If possible, concerns that may arise in the course of litigation are anticipated and addressed at the time of examination.  Experienced examiners are well aware that the legal process usually imposes a limit on the number of independent medical examination.  Typically, only one independent examination is permitted for a given specialty.

A study published in the British Journal of Ophthalmology by Schulz and Mavrakanas concluded that an ophthalmologic independent medical examination is useful for detecting malingering, as well as symptoms and pathology not causally related to a claimed accident or injury or for detecting issues that existed prior to a claimed state.  A claimant may not be aware of the presence or severity of preexisting issues until an ophthalmology independent medical examination is performed.

Cases in Point

Retention to analyze a slip and fall in a restaurant causing alleged loss of vision in one. eye.  A review of the records and independent examination showed scar tissue in the retina and a history of visual loss related to a longstanding retinal detachment.

Retention by insurance company to assess extent of visual damage and facial deformity resulting from a gunshot injury.

Retention by an employer to assess extent of visual damage resulting from a blow to the eye.

Retention by a medical malpractice attorney to assess the extent of visual impairment following cataract extraction with an incorrect lens power.

Retention by a medical malpractice insurance company to assess allegations of visual loss following exposure to a potentially toxic preoperative disinfecting solution.

Michael Reynard, M.D. is board certified by the American Board of Ophthalmology.  Dr. Reynard performs ophthalmologic independent medical examinations (IME) in his Santa Monica-Los Angeles office, where he uses advanced instruments for testing and documentation.

1) Schulz, JS, Mavrakanas, NA. The value of the ophthalmologic independent medical examination: analysis of 344 cases. British Journal of Ophthalmology. October, 93(10): 1371-5, 2009

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