Scottish dispensing optician Ian Jordan was last week erased from the GOC register after it proved a raft of allegations including misconduct when recommending tinted lenses to children with sensory and behavioural difficulties.
Jordan’s high-profile case drew attention from national media, and responses from members of the profession standing by the evidence for other uses of colorimetry have followed.
Jordan, who had been suspended by the GOC since August last year, faced seven allegation categories that included failing to ensure findings were reviewed by an optometrist, obtain informed consent, maintain adequate records or make appropriate referral.
The fitness to practise committee also heard allegations relating to providing sufficient information on the risks and benefits of lenses, acting outside the scope of practice by diagnosing conditions and inappropriate assessment and recommendation.
It heard how the Ayr-based DO had treated ‘a significant number’ of children with developmental and learning difficulties. Jordan has a special interest in the provision of tinted lenses and the effects they may have on behaviours characteristic of autistic spectrum disorder (ASD).
From the outset, the GOC noted such provision as ‘a contentious area of practice’, but stressed it did not seek to take a position as to whether tinted lenses could or could not assist such patients. Instead, the council’s case was based solely on the registrant’s conduct in relation to the treatment he provided to patients.
Using the evidence
Within the unnamed practice Jordan worked, he was delegated the task of undertaking a Visual Processing Assessment (VPA) using his Orthoscopic Read Eye (RE) system following an eye exam conducted by an optometrist. GOC expert witness Professor Frank Eperjesi, who has specific experience in colorimetry, said the RE operated in such a way as to replicate many of the features of a more commonly used instrument the Intuitive Colorimeter (IC).
Jordan used the RE for a number of patients between 2007-2012, leading to the prescription of tinted lenses.
The committee noted Jordan was ‘both passionate and enthusiastic about the use of the RE’ and ‘said to be something of an authority on the use of that system’. He was also credited with a ‘well intentioned desire to assist those patients who sought his treatment’.
However, the FTP committee decided he was ‘less than objective regarding his own abilities and his ability to treat patients safely and appropriately given the experimental or low evidence base for many of his clinical procedures’.
He was deemed to be ‘personally convinced by the effectiveness of tinted lenses to alleviate a wide range of sensory and behavioural difficulties’, with ‘a misplaced idea of his own position in the hierarchy of clinical practitioners’.
Many of Jordan’s clinical actions, it said, were based on his own experience and anecdote rather than having a sound clinical foundation. ‘He also displayed inconsistencies in his approach, notably with regard to the potential harmful effects of wearing coloured lenses, at times emphasising the need for a comprehensive review of their effects on other sensory systems and at others minimising the risk of harm as “children aren’t daft” and opining that their wear would be safely self-limiting,’ the committee added.
It found each of the seven allegation categories proved, including inappropriately recommending tinted lenses for a patient with a brain injury, without full details of ocular history and overall health condition. There was no justified scientific basis for the recommendation of tinted lenses to treat the brain injury and resultant diplopia, the committee found.
All the allegations, taken separately and cumulatively, were deemed sufficiently serious as to amount to misconduct by the GOC.
In making its final verdict of erasure, the committee said there had been repeated and persistent departures from professional standards, and potential for harm to patients as a result of deliberate conduct which ‘though well-intended had been in defiance of professional limitations as a dispensing optician’.
‘This erasure order may have significant personal consequences for the registrant, but while important, was outweighed by the need for public protection and the maintenance of confidence in the profession in this case,’ the committee added.
Defending colorimetry
With the GOC ruling thrusting colorimetry into the limelight, practitioners were quick to defend its wider use and benefits for a range of patient problems.
Following the GOC ruling, Glasgow Caledonian University lecturer Dr Nadia Northway told the BBC: ‘The problem of having a number of people who do not practice in ways that are recommended is that it brings disrepute to the whole field. Good and legitimate practitioners find themselves defending what they are doing a lot of the time.
‘In the long term it is quite damaging when people take it upon themselves to say they are going to do more than they can actually prove that they can do.’
Meanwhile, a statement by Cerium Visual Technologies, added: ‘Cerium welcomes the GOC ruling. Those who over-claim the benefits from coloured filters undermine the very real benefits coloured filters can offer to some patients.
‘Cerium always encourages a responsible assessment protocol, and central to this is accurate and fully-informed patient consent. We remain committed to furthering the cause of colorimetry by encouraging best practice. Colorimetry using the Intuitive Colorimeter is available strictly under the auspices of a qualified optometrist.
‘Mr Jordan does not practice Intuitive Colorimetry, and is not a Cerium customer.’
A statement by the College of Optometrists said there was currently no strong evidence that tinted lenses are effective in improving visual function in patients with specific learning difficulties, but that optometrists who practise in this area report that some patients find them helpful.
‘We suggest that optometrists explain this to any patient asking for these interventions because they carry a cost in terms of expense, time, and raised expectations, and parents and patients seeking it might be vulnerable to the suggestion that any intervention may help,’ it added.
Meanwhile, ABDO deputy chief executive Barry Duncan commented on the role of dispensing opticians in the provision of such services.
He added: ‘Ian Jordan has been working in a complex area with little substantial evidence to support the methods and practice. While we recognise some patients will benefit from different techniques and approaches, it is essential that DOs work with competence and capability as outlined by the General Optical Council. Furthermore, it is important to ensure patients receive the most appropriate advice based on evidence available at that time.’