Optometry clinics : the official publication of the Prentice Society最新文献

Information provided by doctors of optometry to the primary care providers of patients with hypertension provides one of the few objective means of assessing the status of these patients. The optometrist may also be the first to suspect primary or secondary hypertension in the course of a comprehensive eye examination. In this paper the pathophysiology of essential, malignant, and secondary hypertension is reviewed. The treatment and management of the systemic and ocular effects of hypertension are discussed along with the pivotal role that doctors of optometry play in co-managing patients with hypertension.

Co-management is a relatively new health care delivery system. It represents a coordinated approach to the delivery of eye care involving the local primary care provider (optometrist) and the regional secondary and tertiary center. The history, philosophy, and future of co-management are discussed, as are keys to the development of a successful co-management team.

Hyperthyroidism is a condition in which the thyroid gland produces a greater than normal amount of hormone. The cause of this overproduction may be a direct result of many systemic disorders. If hyperthyroidism is associated with diffuse goiter, exophthalmos, or pretibial myxedema, it is commonly known as Graves' disease. The clinician is faced with a multifaceted disorder that has a predilection for the orbit. This orbitopathy places the patient at risk for visual loss. The diagnostician is better equipped to treat and manage visual anomalies if the pathophysiology of the systemic disease is understood. Such insight promotes a better co-management environment between optometrist and internist or endocrinologist. This chapter provides the reader with basic clinical guidelines to the disease process. It also offers a stepwise approach for diagnosing and treating the ocular changes that may be encountered.

Cosmetics, as broadly defined, are used by almost all contact lens wearers of both sexes. Because of the composition of various cosmetic products, contact lenses can be soiled or damaged. The improper use of cosmetics can even cause damage to the eye. More commonly, allergic reactions occur that can jeopardize the continued wear of lenses. This paper reviews the complications that can occur, the available treatment options, and the recommendations for the safe and prudent use of cosmetics.

Contact lens practice is the leading source of liability claims involving optometrists. Claims most often allege negligence, although informed consent or product liability may also be causes of legal claims for damages. For daily wear patients, the most likely causes of claims are nonapproved use of lenses or solutions, monovision contact lenses, negligence by a contact lens technician, failure to verify lenses before dispensing, mismanagement of contact lens-related corneal abrasions, and inadequate monitoring of ocular health. For extended-wear patients, the most common sources of liability claims are inappropriate patient selection, inadequate training of patients, improper wearing schedules, improper management of contact lens-related corneal complications, and inadequate monitoring of ocular health.

The interdigitated mechanisms by which an organism protects itself from microbiological infection have been collectively termed the immune system. We have been given the impression that the eye is "immunologically privileged" because the cornea accepts allografts. Despite the common success of corneal grafts, however, the ocular surface must perpetually combat infection with an array of immunological machinery. This includes mechanical protection as well as elements of humoral, cellular, adaptive, and innate immunity in the tears, conjunctiva, and even the cornea. Optometrists who fit contact lenses strive to help patients achieve safe contact lens wear by minimizing the risk of corneal infection and overaction (hypersensitivity) of the immune system in response to contact lenses and related care products. An understanding of immunology in general and the ocular response(s) in particular enables the clinician to provide a broader scope of care.

The connective tissue diseases are musculoskeletal disorders that have an autoimmune basis. They can affect the internal organ systems and may have numerous ocular manifestations. This chapter discusses both the systemic and ocular findings of certain connective tissue diseases, specifically cranial arteritis, Sjögren's syndrome, rheumatoid arthritis, scleroderma, and lupus erythematosus. Treatment for the clinical manifestations of each disease is also reviewed.

Cataract extraction is a common ophthalmic surgical procedure. Many, if not most, patients will require it at some point in their lives. Cataract postoperative care is now routinely co-managed by many optometrists and ophthalmic surgeons. Postoperative management of the cataract patient in the optometrist's office is beneficial to the patient, and allows involved providers to practice to the full extent of their training and expertise. This paper sets forth a clinical perspective on co-management of cataract postoperative care. Included are suggested protocols for examination intervals and examination components, as well as expected clinical findings and potential complications.