Simon Butler succeeds in Civil Trial for Clinical Negligence against a Specsavers Optometrist

In Jonathan Bond v (1)  Specsavers International Healthcare Limited (2) Mr Mahmoud Moustafa [2021] EWHC (QB), Liverpool District Registry, the claimant brought a claim against the defendants alleging that Mr Moustafa, Optometrist, had failed to safely and effectively manage the claimant, in that he failed to diagnose the early stages or keratoconus during an eye examination at Specsavers. 

The claimant was aged 15 years at the date of the negligence.  The claimant is now registered severely visually impaired, and has had corneal transplant surgery for visual rehabilitation. 

Mr Moustafa asserted that there was no suspicious pathology, unusual results or response during the examination.  Mr Moustafa stated that he had performed all the necessary tests; retinoscopy, slit lamp exam, autorefractor and refraction tests.  The claimant asserted that Mr Moustafa had misled the court, in that he had not performed any of the routine diagnostic tests.  The claimant confirmed that he had only undertaken a refraction test using a trial frame.

Further, Mr Moustafa defended the claim on the grounds that even if he had referred the claimant to the local hospital, cross-linking would not have been performed due to lack of cross-linking services in the North West.   

Following a contested trial in Liverpool District Registry, Knowles J held that the large change in astigmatism in the left eye was of sufficient magnitude over a sufficiently short period of time to raise suspicion of keratoconus or other pathological cause and should have raised concerns. 

Mr Moustafa was under a duty to investigate the large change.  Knowles J rejected Mr Moustafa’s evidence and concluded that he had not performed the necessary tests.  The failure to investigate the large change and/or refer to a Consultant Ophthalmologist was a breach of duty (Bolam); the Judge accepted the joint statement of Mrs Gillian Whitby and Mr Ian Cameron, Optometrists, namely that notwithstanding the subtlety of the evidence, interpreting prescription changes are a core competence of optometry and in failing in some way to evidence recognition of the significance of the changes he measured, Mr Moustafa had fallen below the standard expected of a reasonable body of optometrists.

In respect of causation, Knowles J preferred the claimant’s expert, Mr Mark Batterbury, Consultant Ophthalmologist.  Mr Batterbury informed the court that had the claimant been referred to an Ophthalmologist, the claimant would have been seen within a few weeks, would have had the diagnosis confirmed and would have been referred to a centre providing corneal cross-linking.  He would then have had that treatment and on the balance of probabilities the treatment would have been successful in stabilising his keratoconus condition.  The claimant would have retained useful glasses visual acuity.

Knowles J had no hesitation in rejecting the views of Mr Martin Leyland, Consultant Ophthalmologist.  Mr Leyland informed the court that if the claimant had been referred to a general ophthalmologist and been diagnosed with keratoconus then he would have been referred to a corneal subspecialist within the same hospital.  The examining ophthalmologist may have advised monitoring the condition with a view to referral to Liverpool for cross-linking if the keratoconus worsened.  Mr Leyland believed this course would have been adopted due to the condition being “mild”.

Judgment for the claimant with damages to be assessed.

Simon Butler acted for the Claimant (instructed by Acklam Bond Solicitors).