Diagnostic Error of Neuro-ophthalmologic Conditions: State of the Science

Leanne Stunkel, David E. Newman-Toker, Nancy J. Newman, Valérie Biousse

Research output: Contribution to journalReview articlepeer-review

14 Scopus citations


BACKGROUND: Diagnostic error is prevalent and costly, occurring in up to 15% of US medical encounters and affecting up to 5% of the US population. One-third of malpractice payments are related to diagnostic error. A complex and specialized diagnostic process makes neuro-ophthalmologic conditions particularly vulnerable to diagnostic error. EVIDENCE ACQUISITION: English-language literature on diagnostic errors in neuro-ophthalmology and neurology was identified through electronic search of PubMed and Google Scholar and hand search. RESULTS: Studies investigating diagnostic error of neuro-ophthalmologic conditions have revealed misdiagnosis rates as high as 60%-70% before evaluation by a neuro-ophthalmology specialist, resulting in unnecessary tests and treatments. Correct performance and interpretation of the physical examination, appropriate ordering and interpretation of neuroimaging tests, and generation of a differential diagnosis were identified as pitfalls in the diagnostic process. Most studies did not directly assess patient harms or financial costs of diagnostic error. CONCLUSIONS: As an emerging field, diagnostic error in neuro-ophthalmology offers rich opportunities for further research and improvement of quality of care.

Original languageEnglish
Pages (from-to)98-113
Number of pages16
JournalJournal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society
Issue number1
StatePublished - Mar 1 2021


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