The Role of the Paediatric Ophthalmologist in Medicolegal Practice: What Expert Witness Need to Know

a giving evidence in the court

Paediatric ophthalmology is one of the most complex and scrutiny-heavy areas of medico-legal practice. It requires a blend of clinical precision, developmental insight, safeguarding awareness, and the ability to translate nuanced medical reasoning into clear, court-ready opinion. For solicitors, choosing the right expert in this field is more than a matter of subspecialty alignment. It is an essential decision that may determine the strength of the entire case.

In this article, I outline the unique responsibilities of the paediatric ophthalmology expert witness and the key elements that solicitors should expect when instructing an expert in children’s eye care litigation.

1. Children Are Not Small Adults: Why Expertise Matters

Paediatric eye conditions develop within a narrow window of neurovisual plasticity. Decisions made at the wrong time, or clinical pathways that deviate from recognised standards, can have lifelong consequences.

A paediatric ophthalmologist understands:

• visual development from birth to adolescence

• amblyogenic risk factors

• the magnitude and timing of reversible versus irreversible harm

• how minor clinical delays may create major functional impairment

This insight is critical when addressing breach of duty and causation. What may appear insignificant in adult ophthalmology can be life-changing in a child.

2. Medico-legal Work Requires More Than Clinical Knowledge

An expert witness in paediatric ophthalmology must combine subspecialty expertise with:

• an understanding of CPR 35 and FPR 25 obligations

• the ability to remain impartial in emotionally charged situations

• familiarity with safeguarding frameworks

• clarity in explaining developmental vulnerabilities

• the ability to quantify visual, educational, and functional impact

Cases frequently involve competing narratives from parents, clinicians, or safeguarding professionals. The expert must remain anchored to clinical fact, guideline-based reasoning, and objective analysis.

3. The High-Risk Areas in Paediatric Ophthalmology Litigation

Certain scenarios appear repeatedly in medico-legal practice:

A. Missed or delayed detection of amblyopia

Failure to recognise risk factors, delayed patching, inadequate follow-up, or misinterpreted refractive errors feature prominently in claims.

B. Inadequate or incorrect cycloplegic refraction

Cycloplegia is the cornerstone of children’s refractive assessment. Incorrect technique or omission can be central to breach reasoning.

C. Strabismus management and misdiagnosis

Early recognition is essential. Missed esotropia or exotropia can have permanent visual consequences.

D. Delay in treating paediatric cataract

Timing is critical. Delays can lead to severe deprivation amblyopia.

E. Paediatric trauma and safeguarding assessments

Expert analysis may be required to differentiate between accidental and non-accidental mechanisms.

For solicitors, these scenarios require experts who understand not only the clinical pathway, but also how seemingly small decisions compound over time.

4. The Expert’s Duty to the Court in Paediatric Cases

Paediatric matters, especially those involving developmental harm, differ from adult claims because they require:

• explanation of age-specific causation

• prognosis extending into adulthood

• impact on education and long-term independence

• interpretation of evidence where clinical documentation may be sparse

Under CPR 35 and FPR 25 the expert must provide:

• opinion based strictly on fact and recognised evidence

• clear reasoning from fact to conclusion

• transparency about uncertainties

• an understanding of the range of reasonable competent practice

• avoidance of advocacy

Solicitors should expect this standard consistently throughout the report.

5. Communication With Parents, Clinicians, and the Court

The paediatric ophthalmology expert witness often finds themselves at the interface of:

• anxious parents

• varied healthcare documentation

• multidisciplinary teams

• safeguarding professionals

• inconsistent recall or retrospective accounts

Expert clarity becomes essential. A well-written, evidence-backed report reduces confusion and focuses the court on what matters. The expert must translate medical nuances into structured, accessible explanations without compromising accuracy.

6. Why Solicitors Benefit From Early Ophthalmic Input

In many paediatric cases, the timing of events determines the case theory. Solicitors benefit greatly by involving the expert as early as possible to:

• analyse the chronology

• identify critical thresholds for irreversible harm

• advise on further records required

• confirm whether breach or causation may be arguable

• guide formulation of Part 35 questions

Early engagement saves time, prevents unproductive litigation paths, and strengthens case strategy.

Conclusion

Paediatric ophthalmology expert witness work requires a combination of deep clinical proficiency, developmental understanding, safeguarding insight, and legally compliant reasoning. For solicitors, instructing an expert in this field is not merely a box-ticking exercise. It is a strategic decision that can significantly influence the quality and clarity of the evidence.

A strong expert understands not just the medicine, but the law’s expectations, the nuance of developmental harm, and the need for structured, transparent analysis. These elements together ensure that the court receives high-quality, impartial, and reliable ophthalmic evidence.