An optometrist who failed to spot symptoms of a life-threatening brain condition during a routine eye test of an eight-year-old boy who later died has been given a two-year suspended prison term.
Honey Rose, 35, failed to notice that Vincent Barker had swollen optic discs when she examined him at a branch of Boots in Ipswich.
The abnormality is a symptom of hydrocephalus - fluid on the brain - and Vincent died in July 2012, about five months after the eye test.
Rose, of High Street North, East Ham, east London, was convicted of gross negligence manslaughter at Ipswich Crown Court.
Her 10-day trial heard "any competent optometrist" would have spotted the swollen discs and Vincent's death could have been prevented if she had "done her job properly".
Sentencing Rose, Judge Jeremy Stuart-Smith said it was the first case if its type, as convictions for manslaughter by gross negligence generally involve multiple lapses over time in the face of patients who were displaying obvious symptoms that called for immediate treatment.
Rose was also ordered to complete 200 hours of unpaid work and given a 24-month supervision order.
A written statement from Vincent's mother, Joanne Barker, said: "The knowledge our loss should have been prevented and Vinnie should have been saved is intolerable to live with."
She said the family still struggled to accept that Vincent was not coming home and the impact on his siblings had been "immeasurable".
A letter from the Association of Optometrists said there had been an increase in practitioners' concerns about the way they were doing their job and whether they were following procedure, said Jonathan Rees QC, prosecuting.
There was no evidence that practitioners were becoming more risk-averse and referring more patients to other professions, the letter added.
Ian Stern QC, mitigating, described Rose's failure to examine the back of Vincent's eyes as an "inexplicable lack of action" and a "one-off".
He added that there were no overt symptoms which suggested risk in the case, and Rose thought she had completed the examination and was following a "programmed course of action".
"For whatever reason, she did not look at the back of the eye," said Mr Stern. "She had no foreseeability as to the consequences."
He said Rose had worked "extremely hard" to qualify in India before moving to the UK and qualifying as an optometrist here.
"The loss of that vocation, which undoubtedly will happen when she comes before a fitness to practise panel, will affect her self-respect as someone who worked so hard to obtain those qualifications," said Mr Stern.
Rose has three children aged eight months, five years and 10.
She has not worked since March 2013, and legal proceedings had hung over her for four years since she learned of Vincent's death in September 2012.
Her husband, Louis Kennedy, fought back tears as he took to the witness box and said "sorry" to the Barker family, who were in court.
The sole trader solicitor moved his business to Leicester due to "media intrusion" in London, Mr Stern said.
He added that the landmark court case had "sent shockwaves round the optometric practice".
"The impact is there are innumerable questions and queries," said Mr Stern. "They have great concerns.
"One of the problems with this that will affect patient care significantly is that, often as a result of something like this, optometrists immediately act in a more defensive way.
"Health professionals practise more defensive medicine."
He added: "Hospital waiting gets longer, patients that don't have anything much wrong with them are seen by doctors which takes up valuable NHS resources and time, and the consequence is people who are genuinely ill have to wait longer."
Rose had a formal diagnosis of depression, Mr Stern said.
Judge Stuart-Smith told Rose: "One thing is certain: in the course of a routine eye investigation such as you had carried out thousands of times before, you did not carry out an examination of the back of Vinnie Barker's eyes with an opthalmoscope or inspect retinal images that were presented to you as those of Vinnie Barker.
"If you had done either of those things, you would immediately have seen the pathology that would have caused you to refer him urgently for further investigation."
He added: "You simply departed from your normal practice in a way that was completely untypical for you, a one-off, for no good reason."
The failure was "a single lapse" and "there was nothing in (Vinnie's) general presentation that should have rung particular alarm bells for you".
Judge Stuart-Smith described the conviction as "apparently the first case where an optometrist has been convicted of manslaughter by gross negligence".
He said convictions for gross negligence manslaughter generally involved multiple lapses over time where patients had displayed "obvious symptoms that called for immediate treatment or response".
He said months after the examination, when Rose was confronted by the awful fact of Vinnie's death, she "constructed a story that was essentially a cover-up".
She had suggested that Vinnie had "shown signs of photophobia and non-compliance" and attempted to shift responsibility to others for her failure to pick up on warning signs in the retinal images.
"I am certain that your story was not based on actual recollection," he said.
He praised the Barker family for showing "dignity and restraint", and noted they had called for leniency in sentencing.
He added that an immediate custodial sentence was not required to bring home the importance of optometrists properly discharging their duty to patients, as the case had been highly publicised and had already caused great concern to the optometry profession.