This case involves a middle-aged woman who was pregnant with her third child. Near the end of her pregnancy, the Plaintiff was admitted to the hospital for observation, during which time it was discovered that she was suffering from high blood pressure. The Plaintiff was placed on blood pressure medication for a week before when went into labor, after which she was taken off the blood pressure medication. The Plaintiff claimed that her treating physician had told her that her blood pressure would gradually decrease, despite the fact that she had been taken off of her medication. Only a few days after she was discharged, she suffered a retinal vein occlusion in her left eye, leaving her with permanent damage to her vision. It was alleged that the patient’s blood pressure was not properly managed by the treating physician, leading directly to her permanently damaged vision.
Question(s) For Expert Witness
- 1. Have you had experience with ophthalmic conditions secondary to pregnancy induced hypertension?
- 2. What is the standard of care with regards to hypertensive patients with ophthalmic conditions?
Expert Witness Response E-028436
I am an ophthalmologist who has been in clinical practice for over 20 years and am familiar with pregnancy-related ophthalmic issues. Typically, chronic high blood pressure is what leads to vein occlusions, which is why it is usually seen in older people. The mechanism by which this happens is that the arterial walls thicken which in turn, over time compresses the neighboring vein. This process can take decades before it becomes evident. In younger people, vein occlusions are due to clotting issues, which is well known and documented during pregnancy, or other blood cell disorders like sickle cell. It is not reasonable at all to attribute the elevated blood pressure to the vein occlusion.
Expert Witness Response E-007073
I have been in practice for over 27 years and have been consulted to evaluate patients with pre-eclampsia or eclampsia, since they are sometimes considered high risk patients. With these diagnoses, these patients have increased urinary protein, hypertension, in addition to other abnormalities. In general, the ophthalmic condition usually auto-corrects after delivery. In this particular case, it is difficult to say whether the retinal vein occlusion is directly linked to the hypertensive condition, and I suspect that the retinal vein occlusion is related to her blood viscosity and /or any other underlying hematologic conditions. The standard of care before delivery is to control blood pressure with medication and to monitor the fetus’ condition, both of which appear to have been done in this case.