Part 2 — Continued 

Clinical Contradictions Between 2018 and 2026

This section examines the direct contradictions between the 2018 specialist neuro‑visual assessment and the 2026 routine optometric findings. These two assessments describe entirely different clinical realities — one neurological, one ocular. They cannot both be correct.

The 2018 specialist findings

In 2018, the specialist documented:

• vertical nystagmus present and consistent
• permanent impairment of eye‑movement control
• non‑fluctuating neurological visual impairment
• functional‑vision limitations in real‑world environments

These findings align with the established 30‑year baseline. They reflect a neurological condition that does not change, resolve, or vary.

The 2026 routine assessment findings

In contrast, the 2026 routine optometric assessment described:

• “intermittent” nystagmus
• “variable” presentation
• “inconsistent” features
• findings that appeared to fluctuate during the appointment

These descriptions are characteristic of ocular conditions — not neurological ones.

Why these two sets of findings cannot be reconciled

Neurological nystagmus:

• does not come and go
• does not vary between appointments
• does not present as “intermittent”
• does not resolve spontaneously
• does not fluctuate based on environment or fatigue

It is a permanent feature of neurological injury.

If a clinician reports that neurological nystagmus is “intermittent”, this indicates:

• the wrong tests were used
• the impairment was not measured
• the clinician interpreted neurological features through an ocular lens
• the assessment method was not appropriate for the condition

The contradiction exposes the methodological failure

The 2018 findings reflect:

• specialist assessment
• correct methodology
• accurate measurement of neurological impairment
• consistency with the long‑term baseline

The 2026 findings reflect:

• routine optometry
• incorrect methodology
• misinterpretation of neurological symptoms
• absence of functional‑vision testing

These two assessments are not describing the same condition. They are describing two different types of impairment — one neurological, one ocular. 

Only one can be correct.

Why the 2018 findings align with clinical science

Neurological visual impairment:

• is permanent
• is non‑variable
• does not fluctuate
• does not resolve
• does not present intermittently

The 2018 findings match this.   The 2026 findings do not.

What this means for governance

The contradiction is not a matter of clinical opinion. It is a matter of clinical possibility.

A neurological condition cannot behave in the way the 2026 letter describes. Therefore, the 2026 findings cannot be clinically valid.

This contradiction is central to understanding why the 2026 assessment was not appropriate, and why its conclusions cannot be relied upon for decision‑making, safeguarding, or continuity of care.

These contradictions are not differences in interpretation — they are clinical impossibilities. With the conflict between the 2018 and 2026 findings established, the next section explains why the 2026 conclusions cannot be clinically correct under any neurological framework.

Next 

2.5 — Why the 2026 Findings Cannot Be Clinically Correct

Design & Copyright Owner Maureen Booth-Martin (MBM) © All rights reserved