Expert Witness Journal Issue 64 December 2025 - Flipbook - Page 80
Discussion
Legends for Figures
It is not well recognised or understood in the
ophthalmological fraternity that minor optic nerve
damage can leave a healthy looking optic disc with
varying degrees of visual 昀椀eld loss. [Ref.1]
Fig. 1a shows a healthy appearing optic disc
Fig. 1b shows the retinal nerve 昀椀bre layer thickness of both
the Right and Left eyes and both are comfortably within the
normal range
Fig. 1c shows a signi昀椀cant visual 昀椀eld loss of the Right eye of the
outer 昀椀eld
In the United States where research has been done
on army veterans who have su昀昀ered blast injuries,
this phenomenon is more widely recognised. [Ref. 2]
Fig. 2 shows extensive visual 昀椀eld loss on the Left eye showing
widespread lateral loss of the visual 昀椀eld and also superior loss
medially
However such papers, whilst showing that varying
visual 昀椀eld damage and varying appearance of optic
nerve are found, have not directly tallied the visual
昀椀eld tests to the optic nerve appearances speci昀椀cally,
as in this series.
Fig. 3 shows a superior temporal loss of the Right visual 昀椀eld
In relation to blunt eyeball injury minor optic nerve
damage is also poorly recognised. [Ref. 3]
Ref. 2 Traumatic optic neuropathy management: a systematic
review
Blanch R J, Joseph I J, Cockerham K
Eye (2024) 38: 2312 - 2318
References
Ref. 1 Traumatic Optic Neuropathy
Sarkies N
Eye (2004) 18: 1122 - 1125
There are varying reports of the usefulness of OCT
scanning and whether the visual 昀椀eld test is in fact
required, as the OCT might give the abnormal
result in any event. [Ref.4]
Ref. 3 Blunt Eye Trauma
Mohseni M, Blair K, Gurnani B, Bragg B N.
StatPearls National Library of Medicine National Centre for
Biotechnology Information NIH Last update June 11 2023
Ref. 4 A systematic review of optical coherence tomography
昀椀ndings in adults with mild traumatic brain injury
Lyons H S et al
Eye (2024) 38: 1077 - 1083
In my series of thirteen cases the six OCT scans
that were carried out were entirely normal in 昀椀ve.
In the sixth the a昀昀ected eye gave a borderline result
which did not correspond with the visual 昀椀eld
defect. Therefore it would have been an unreliable
diagnostic tool.
Speaking
as
an
experienced
Consultant
Ophthalmologist with an interest in glaucoma,
patient B (Fig 2) showing a healthy looking optic
disc, a normal OCT scan and a 60% visual 昀椀eld loss
is, in my experience, something quite extraordinary.
Mr Nicholas A Jacobs
Consultant Ophthalmologist
Conclusion
MBChB FRCOphth
In conclusion, for anyone involved in an injury where
there is a signi昀椀cant blow to the head which does
not necessarily result in a loss of consciousness, it is
mandatory to carry out a visual 昀椀eld test. Relying on
an OCT scan is not good enough. This also applies
to a blunt injury to the eyeball itself where a visual
昀椀eld test is feasible.
Mr Jacobs trained as a Senior Registrar at Charing Cross, Westminster and
Moorfields Eye Hospital. He was an NHS Consultant at Kingston Hospital
and later at Rochdale Infirmary for 27 years. He then worked for 10 years as
Glaucoma Lead at The Practice Group (later Operose) until 2019.
Signi昀椀cant visual 昀椀eld loss in one eye is compatible
with a normal driving licence but not with a heavy
goods vehicle licence.
Mr Jacobs has undertaken medico-legal work for personal injury cases for over
20 years and medical negligence work in general ophthalmology with a special
interest in glaucoma, for the past 3 years.
This investigation is critical, both for the patient, as
loss of visual 昀椀eld may a昀昀ect all aspects of their daily
life, and for medico-legal clients in relation to their
claim for compensation.
Mr Jacobs has made overseas aid trips. In May 1992 he went to Albania as part
of a team to operate mainly on children who were orphans from the town of
Shkoder where over a period of five days he assessed sixty out-patients and
carried out twenty surgical procedures. There were three further such trips to
Mostar in Bosnia, to Russia and then back to Albania.
Mr Jacobs has published numerous peer-reviewed papers covering topics such as
ocular neovascularisation, light damage and the eye, and visual field research over
the years and in February 2022 wrote an article on non-organic visual loss published in PI Focus. He also wrote an article for the October 2023 edition of the
Expert Witness Journal, entitled Post Head Injury Cataract - Traumatic or Not?
Mr Jacobs attends Bond-Solon and Premex courses regularly to keep updated.
Tel: 0208 9461369
Email: office@najacobs.co.uk
London Eye Diagnostic Centre, 25 Harley Street, London, W1G 9QW
Area of work: Clinics in London and Manchester
EXPERT WITNESS JOURNAL
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