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Andrew Robinson


By Helen Carter


Taking a fresh look at each patient and their symptoms can help prevent misdiagnosis, Brisbane optometrist Andrew Robinson will tell delegates at NQV 2015.

Mr Robinson will speak about diagnostic bias and error at the North Queensland Vision conference, organised by Optometry Queensland/Northern Territory.

At last year’s Australian Vision Convention he gave a brief presentation on a patient he had misdiagnosed. It struck a chord with the audience and he was asked to expand the topic for NQV.

He will discuss that case and another in which a patient referred to him was misdiagnosed by an ophthalmologist.

‘It comes back to how we think as practitioners and what leads to the errors we make,’ he said.

Mr Robinson’s interest in the topic stemmed from reading a book by American surgeon Dr Atul Gawande, who claimed that most errors in medicine were not due to what practitioners did not know but occurred because they did not apply their knowledge.

Mr Robinson’s case involved an elderly patient for whom he kept tweaking the spectacle lenses prescription when she complained of poor vision. He subsequently diagnosed a corneal condition.

The other case involved a patient who had been discharged from care by an ophthalmologist and referred to Mr Robinson for spectacles as vision was reduced in both eyes. High IOP had been missed by the ophthalmologist.

‘Misdiagnosis generally happens to every optometrist at some point. General cognitive errors and biases are human attributes,’ Mr Robinson said.

He advises optometrists against being biased towards finding information that supports their or another’s initial diagnosis, and to actively consider alternative diagnoses.

‘If a patient is referred with a diagnosis or repeatedly comes back with the same problem, the natural assumption is to run with that diagnosis but look at the patient with fresh eyes, look at the symptoms,’ he said.

‘If you are referring the patient, be sure not to trigger these biases in others. Word referrals carefully. If you are absolutely certain of a diagnosis, say so but if not, be more circumspect in how you word referrals and symptoms that may point in the same direction.’

This year’s presentations at NQV will be based around themes including retinal conditions, glaucoma, the anterior eye, contact lenses, paediatrics and therapeutics.

Other speakers include ophthalmologists Dr Michael Forrest who will discuss cataract surgery updates and paediatrics, and Dr Tai Smith who will talk on lashes and lacrimal and lid surgery.

Dr Stephen Vincent, senior lecturer at QUT’s School of Optometry and Vision Science, will speak about retinal pathology, OCT and low vision, and contact lens research.

Optometry Australia professional services manager Luke Arundel will talk about managing contact lens complications and give a Medicare update with case scenarios, behavioural optometrist Sarah Sweeney will discuss vision therapy, and Optometry QLD/NT president David Foresto will talk about contact lenses.

NQV offers 43.5 CPD points, including breakfast seminars and assessment. CooperVision will sponsor the Saturday breakfast at which optometrist Joe Tanner will give a presentation.

There will be a trade display, and a dinner outside Cairns on the Saturday night.

NQV will be held on 3-4 October at the Pullman Cairns International Hotel. Register at For more information email

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