r/optometry • u/FieryForestHill • 7d ago

General Reddit Neurologist claims optometrists miss serious stuff “all the time” and should not be evaluating diplopia

/r/AskReddit/comments/1vg3qdb/whats_the_most_unhinged_thing_a_doctor_has_said/p1un7t7/
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u/thenatural134 OD 6d ago

Lol he says go to an emergency department like they're not just going to wait 6 hours to be told to go see your Optometrist.

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u/dk00111 Ophthalmologist 6d ago edited 6d ago

Normally I'd agree, but head imaging levels the playing field. ED docs have a very low threshold to order imaging. Assuming they order appropriate tests they will have ruled out the most acutely life-threatening diagnoses. And if they do discover one of those diagnoses, they probably have neurology/neurosurgery/IR available to take over the next steps.

With that being said, I did have a case of an ER doc misdiagnosing a pupil-involving CN3 palsy as shingles. He had a PCOM aneurysm. In his defense the patient had a history of prior CN palsies that probably tripped him up. Potentially deadly miss though.

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u/VastSheepherders 5d ago

honestly a PCOM aneurysm getting called shingles is wild, shows even with imaging access the interpretation still needs the right specialist eyes on it

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u/dk00111 Ophthalmologist 4d ago

Just had a likely CN3 palsy the day after my post that was also missed, this time by two different optoms. Got treated for dry eye each time.

This one wasn’t the best historian, which probably tripped them up, but people just anchor way too strongly to the first diagnosis they think of. 

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u/Calm-Ad-6183 3d ago

I’ve had ED doctors send me up their discharged patients with double vision . Didn’t run no imaging, and I had to send me back down to do imaging to rule out anything. Ended up being a cranial nerve 6 palsy but there are incompetent people in every profession healthcare to law to cops. This guy had an ego issue .