A Kendall optometrist will pay a total of $7,882 as part of his discipline from the state Board of Optometry after a state complaint accused him of not providing proper care as a patient went blind.
According to the settlement agreement approved by the state Board of Optometry, Dr. Terry Friedman officially doesn’t admit or deny the narrative in the Florida Department of Health’s administrative complaint.
But he does pay a $4,000 fine; reimburse the Florida Department of Health $3,882 in administrative costs; has to complete three hours of continuing education in comprehensive eye exams and another three hours in record keeping; and gets a letter of concern against his license.
Miami-Dade court records say a medical malpractice suit against Friedman by the patient, who holds a doctor of education degree, was settled with each side paying his own attorney’s fees.
Creeping cupping and glaucoma
Glaucoma “is one of the leading causes of blindness for people over the age of 60,” according to the Mayo Clinic. “Many forms of glaucoma have no warning signs. The effect is so gradual that you may not notice a change in vision until the condition is in its later stages.
“It’s important to have regular eye exams that include measurements of your eye pressure,” the clinic says. “If glaucoma is recognized early, vision loss can be slowed or prevented. If you have glaucoma, you’ll need treatment or monitoring for the rest of your life.”
The complaint says Friedman failed at early detection despite seeing the patient since 2001. Even at that time, the complaint said, the patient was over 40, as well as being of African descent with a family history of glaucoma. Each of those characteristics alone would put the patient at a higher risk of glaucoma.
Friedman, the complaint says, “fell below the standard of care by failing to administer comprehensive eye examinations and/or threshold visual field testing when [Friedman] knew or should’ve known that Patient R.G. had risk factors for glaucoma.”
The complaint said Friedman didn’t do additional testing when R.G. complained of vision problems in January 2015, January 2016, February 2017 or December 2017. During the first 2017 visit, R.G. said that he had an inability to focus, which the complaint says is an early sign of glaucoma. R.G. spoke of a glare in his vision during the second visit.
Part of the problem, the complaint said, was Friedman’s records were “frequently illegible, thereby failing to adequately document examinations, treatments and prescriptions for R.G.”
R.G. made seven visits and several phone calls to Friedman from January 2015 through June 2018 complaining about vision problems. In June 2018, Friedman measured R.G.’s intraocular pressure as 11 in the right eye with 0.2 cupping and 10 in the left eye with 0.3 cupping.
“A healthy optic nerve with all of its nerve cells is more densely packed so has thicker edges and a smaller central cup,” the Brisbane Eye Clinic explains. “Glaucoma is caused by high pressure in the eye damaging the optic nerve, which results in loss of individual nerve cells. This causes a subsequent increase in the size of the cup, also called cupping.
“As a general rule, the cup should not make up more than three tenths or 30% of the total area of the optic nerve.”
When R.G. went to the Center for Excellence in Eye Care on Oct. 15, 2018, the complaint said, the pressure measured 35 with 0.95 cupping in each eye. The Center told R.G. he had glaucoma and should no longer drive.
A week later, the Center told R.G. he was legally blind.