LOLA’S eye injuries are indicative of abusive head trauma, the first medical expert to take to the witness stand told Swansea Crown Court on Friday (Mar 10).

Dr Ian Simmons, Consultant paediatric ophthalmologist gave his opinion on the findings in his report into the retina injuries sustained by the toddler.

Dr Simmons has been an expert in the field since 1999 and has contributed to major studies and literature looking into retinal findings in non-abusive head trauma and abusive head trauma.

Including reviewing and contributing to a review into differential retinal injuries in abusive vs non-abusive head traumas in September 2020.

Swansea Crown Court heard how Lola had multiple haemorrhages in both her right and left eye, which also was evident in all four quadrants; during medical examinations, eyes are split into quarters and referred to as quadrants to locate any significant anomaly.

The injuries were detected through a range of diagnostic methods, including visual, 2d scans, retcams (3d) and the findings during the course of a post-mortem.

These included two large macular haemorrhages to the right eye which were present in all four quadrants, along with multiple other haemorrhages, noted there were too numerous to count.

The court heard how Lola’s left eye had a massive dic haemorrages along with others in all four quardants and macular changes due to retinal splitting. There was also bleeding to the oribital and optical nerve in both eyes.

Dr Simmons went on to say how bi-lateral retinal heamoraghes; those affecting both eyes, are highly indicative of an abusive head trauma as opposed to accidental.

He went on to say that injuries of the retina, such as those sustained by Lola are usually present in children who have sustained a very significant crush injury or a fall from a height such as a house window.

The court heard how the presence of macular folds is more prevalent in an abusive head trauma injury by the tenfold.

Dr Simmons confirmed that before compile his expert opinion report he was privy to reports from all medical professionals who treated Lola, including reports and scans, the autopsy report, police statements and photographs of the family home namely the stairs the defence claim Lola fell down.

The court heard that Dr Simmons bore no knowledge of a child presenting with optical nerve sheath haemorrhages in both eyes ever being presented in an accidental head trauma.

The court heard how Dr Simmons had gone through an extensive exclusion procedure and ruled out any underlying diseases, or anything within the statements from the police that would suggest anything other than abusive head trauma would cause the injuries.

Bevan’s Barrister, John Hipkins KC brought to the court’s attention a case study from 2013, by Dr Adams, another paediatric ophthalmologist, in which a child had a fatal fall down 10 steps, with multiple impacts and noted that the injuries received by that child were similar to that of Lola’s.

He explained that this was a witnessed accidental fall and the injuries were received as a result of accidental head trauma.

Dr Simmons went on to clarify that although those injuries bore a ‘striking resemblance’ to this case, that child did not present with peri-macular folding and sheath haemorrhages that Lola did, and those indicate it is more likely in this case as a result of an abusive head trauma.

In his report Dr Simmons said: “With a combination of extensive bilateral retinal bleeding in all four quadrants affecting multiple layers in both eyes with possible retinal splitting along with evidence of left per-macular retinal fold and presence of bilateral optic nerve sheath haemorrhages, that combination pointed towards abusive head trauma rather than an accidental fall down the stairs.

“Highly unlikely the above combination would have been caused by falling down 10 carpeted stairs.”

Dr Simmons suggested that based on the other injuries Lola had and reading the medical reports it points towards abusive head injury from that such as violent shaking with a possible form of impact.

John Hipkin KC, went on to question Dr Simmon on the language used in his report stating it was all based on medical science which meant they were left to deal with “likelihoods instead of certainties”.

Dr Simmons explained that medical science is not definitive, but certain retinal injuries are highly suggestive towards abusive head trauma based on medical evidence from data collection.

Mr Hipkin KC went on to ask if Dr Simmon had been given Bevan’s statement of his account of the accident, which he confirmed was received and had used that evidence to make his conclusion.

Suggesting that shaking could have been part of Bevans attempts to wake the tot.

However Mr Hipkin went on to say that Bevan’s statement was not included on Dr Simmons summary of evidence documents used to support his claims.

Dr Simmons could not recall whether he had simply forgotten to include them or whether they were together with another set of reports in a bundle which is included on the summary of evidence on the report.

James’ Barrister Mr Elias did not cross examine the witness.

The next medical expert witness is due to take the stand on Monday.

The case was adjourned and will continue on Monday, March 13 at 10am.