Ophthalmic Prognosis Evaluation
An ophthalmic prognosis opinion states, to a reasonable degree of medical probability, what will happen to an injured or diseased eye over time — whether the condition is stable or progressive, what future treatment is likely, and what risks the patient carries going forward. Marc H. Shomer, MD, PhD, QME, a board-certified ophthalmologist with more than 13 years of medical-legal consulting experience, provides prognosis opinions in personal injury, workers' compensation, and disability matters.
Prognosis is where damages live. Present impairment can be measured; the value of a claim often depends just as much on what the next twenty years hold, and that projection must be grounded in the natural history of the specific condition rather than optimism or advocacy.
The Medical-Legal Question
Courts and claims administrators need more than a diagnosis; they need to know whether the current visual state is the endpoint. Prognosis opinions address whether the condition has stabilized, whether deterioration is expected and on what timescale, what surveillance and treatment the future requires, and how confident the medicine allows anyone to be. In California workers' compensation this connects directly to whether the condition is permanent and stationary — addressed on the permanent and stationary evaluation page — and to future medical care awards.
Stability Versus Progression
Ophthalmic conditions divide roughly into those that reach a stable endpoint and those that do not. A healed corneal scar or a repaired, attached retina may remain unchanged for decades. Glaucoma, diabetic retinopathy, and age-related macular degeneration are chronic diseases that can progress for life, so prognosis for them is a statement about trajectory and management, not a fixed endpoint. Trauma adds delayed sequelae with known latencies: an eye that suffered blunt injury carries elevated long-term risk of traumatic cataract, glaucoma from angle damage, and retinal detachment years after the event. The most reliable evidence of trajectory is serial objective data — visual acuity over time, visual fields, and OCT (optical coherence tomography) imaging, whose evidentiary use is described in the OCT evidence guide. Two or three data points spanning months establish a trend; a single snapshot does not.
The One-Eyed Patient and Fellow-Eye Risk
When one eye has been lost or severely impaired, prognosis for the remaining eye becomes the case's central issue, for two reasons. First, the functional stakes of any future problem in the fellow eye are catastrophic rather than partial — the person has no reserve. Second, for many conditions the fellow eye carries elevated risk: retinal detachment, glaucoma, and macular degeneration all show meaningful fellow-eye involvement rates, and some traumas and surgeries carry small but real risks to the other eye. A complete prognosis report addresses fellow-eye surveillance, protective eyewear, and the lifetime monitoring a one-eyed patient requires, which feeds directly into future-care valuation.
How Honest Prognostic Statements Are Framed
Medicine predicts populations better than individuals. A sound prognosis opinion states the expected course, the realistic range around it, and the factors that would move the outcome within that range — and it distinguishes between what is established (structural damage already documented) and what is projected (the probability of future events). Phrases of false precision serve no one under cross-examination. Where the literature supports a quantitative risk estimate, it can be given as a range; where it does not, the honest formulation is qualitative. Prognosis opinions should also be explicit about their assumptions: continued treatment adherence, no new trauma, no intervening disease.
What This Evaluation Cannot Do
No examination can guarantee an outcome, and no expert should predict the result of litigation or promise visual stability. Prognosis is also sensitive to time: an opinion rendered three months after injury, before scarring and healing have declared themselves, is necessarily more provisional than one rendered at maximal medical improvement, and re-evaluation is sometimes the correct recommendation. These limits are stated in the report, consistent with the analytic approach described on the causation page.
What Attorneys Should Provide
The complete longitudinal record — every acuity measurement, field, and scan, with dates — plus operative reports, the current treatment plan, and any records for the fellow eye. For workers' compensation matters, prior ratings and the procedural posture help frame the report; the related impairment analysis is covered at whole person impairment for vision.
Frequently Asked Questions
What is an ophthalmic prognosis opinion?
It is an expert statement, to a reasonable degree of medical probability, about the expected future course of an eye condition: whether it is stable or progressive, what treatment and monitoring the future requires, and what risks remain. It is grounded in the documented trajectory of the individual eye and the established natural history of the condition.
Why does prognosis matter so much for a one-eyed claimant?
Because the remaining eye carries all of the person's visual function, any future problem in it is catastrophic rather than partial. Several conditions also confer elevated risk to the fellow eye, so a complete report addresses lifetime surveillance, protection, and the future care a one-eyed patient requires — all of which bear on damages and future medical awards.
Can an expert say whether an eye condition will get worse?
Often, within honest limits. Serial acuity, visual field, and OCT data establish whether a condition is stable or progressing, and the natural history of the diagnosis supplies the expected trajectory. The opinion is properly expressed as a probable course with a realistic range, not a guarantee, and its assumptions — continued treatment, no new injury — should be explicit.
When is it too early to give a prognosis?
Soon after injury or surgery, while healing, scarring, and inflammation are still evolving, any projection is provisional. A prognosis rendered at or near maximal medical improvement, supported by a stable trend across serial measurements, is substantially more reliable, and an honest expert will sometimes recommend re-evaluation rather than premature certainty.
Educational information only. This page provides general information for attorneys and other medical-legal professionals. It is not medical or legal advice, does not address any particular case, and does not create a physician-patient, attorney-client, or expert-client relationship. Opinions in any matter are formed only after review of the specific records, examination findings, and applicable literature. Past engagements do not guarantee any result.
Board-certified ophthalmologist; Adjunct Associate Professor of Ophthalmology, Keck School of Medicine of USC; active California Qualified Medical Evaluator. Full biography · Curriculum vitae
Published August 2, 2026 · Last substantive review August 2, 2026 · Medical reviewer: Marc H. Shomer, MD, PhD, QME
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