ABSTRACT
INTRODUCTION: Visual diseases are the fifth more frequent cause of labour permanent disability, what represents 4% of the total of them. In order to assess these cases we must take into account on one hand the visual requirements of each profession, and on the other hand the visual functional impairments that the worker is suffering. Special attention must be paid to situations of legal blindness and low vision, as a cause of serious disabilities. Despite the importance of the matter, we have hardly found any reviews about it in the consulted bibliography. MATERIALS AND METHODS: We have carried out a retrospective research of 321 disability claims due to ocular causes, assessed at the Ophthalmology Section of the Forensic Medical Clinic of Madrid, in the last 18 years. They account for 3% of the total disability claims raised in our field. RESULTS: The most frequent professions involved have been administrative services, construction, hotel workers, cleaning and professional drivers. In 90% of cases these professional activities had medium or low visual requirements. The plaintiff in 40% of cases was unemployed. The most frequent visual pathologies we found out were myopic complications (especially myopic maculopathy) 17%, and eye trauma (16%). To a lesser extent: retinal detachment (12%), optic neuritis (7%), glaucoma (6%), diabetic retinopathy (6%), pigmentary retinitis (4%), non-myopic maculopathies (2%) and melanomas (2%). In 23% of cases no significant visual limitation was found (it was lower than 33%). Out of these, 9% were diagnosed as NOVL (non-organic visual loss), 3% of them being very obvious cases of simulation. CONCLUSIONS: In 82% of the cases the expert's report pointed out a significant global (visual and non-visual) functional limitation (greater than 33%) of their work capacity. In the previous administrative phase of all these cases the recognition fo disability had not been granted. From the results obtained it turns out the importance of an ophthalmologist acting as an expert in this type of demands.
Subject(s)
Disability Evaluation , Occupational Health , Vision Disorders/diagnosis , Vision Disorders/epidemiology , Adult , Female , Humans , Male , Middle Aged , Retrospective Studies , SpainABSTRACT
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Subject(s)
Humans , Medication Errors/legislation & jurisprudence , Antibodies, Monoclonal/administration & dosage , Intravitreal InjectionsABSTRACT
PURPOSE: We reviewed 90 complaints for allegedly incorrect ophthalmic procedures. Most of these complaints (33%) were related to cataract and refractive surgery (18%). In third position in terms of frequency (14%) were complaints concerning oculoplastic surgery and in fourth position were complaints related to retinal detachment (13%). This was followed by a miscellaneous group, which represented 10% of complaints. About 9% of complaints were related to emergency ophthalmic procedures, while just 3% of complaints were related to glaucoma. METHODS: We analysed within each subgroup the characteristics of the claims; the information given to the patient, those cases in which there existed grounds for considering the ophthalmologist's performance as being incorrect, and court orders that were adopted. RESULTS: The most common groups were cataract and refractive surgery, which together represented more than a half of the complaints. We found in 26% of cases, reports from other doctors criticizing the professional performance a posteriori of an accused ophthalmologist, incorrect or incomplete documents of informed consent, as well as patients asserting that their surgeons made them promises of results, or minimized risks about the proposed operation. CONCLUSIONS: In the great majority of cases, the claim was settled due to a characteristic complication inherent in the surgical technique and present in the document of informed consent signed by the patient. We also observed a minority of cases, particularly in refractive surgery, in which a foreseeable and avoidable complication related to incorrectly prescribed surgical techniques was produced. In these exceptional cases, expert evidence is usually unfavorable and charges are typically laid. It is probable that improved information for patients would reduce the number of these claims.
