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  • Comprehensive Ophthalmology, Neuro-Ophthalmology/Orbit

    Review of: Patient harm due to diagnostic error of neuro-ophthalmologic conditions

    Stunkel L, Sharma R, Mackay D, et al. Ophthalmology, in press

    This study assessed the frequency of misdiagnoses of neuro-ophthalmic conditions by referring providers and how the errors impact patients.

    Study design

    The authors conducted a prospective, cross-sectional study of 496 new adult patients managed at 3 university-based neuro-ophthalmology clinics in the United States.


    The study found that the referral diagnosis was incorrect in 49% of cases referred to the neuro-ophthalmology clinic, with 26% of these patients experiencing harm. Nearly all these cases could have avoided harm with an earlier referral to a neuro-ophthalmologist.

    The most common sources of diagnostic error were physical examination (36%), generation of a complete differential diagnosis (24%), history taking (24%) and use or interpretation of diagnostic testing (13%). Approximately one quarter of patients underwent inappropriate management or testing before the referral, and this was more common in those with a misdiagnosis. Almost all the patients benefited from the neuro-ophthalmology consultation; in 2% of cases, the evaluation directly saved the patient’s life or vision.


    There is some subjectivity to some of the variables, such as appropriateness of a referral and whether harm occurred due to diagnostic error.

    Clinical significance

    This study demonstrates that misdiagnosis of neuro-ophthalmic conditions by non-neuro-ophthalmologists is common and can lead to patient harm, and that much of this can be avoided with early referral to a neuro-ophthalmologist. Although these findings highlight the importance of neuro-ophthalmologists in caring for patients with neuro-ophthalmic conditions, the current shortage of neuro-ophthalmologists poses additional challenges.