Optometry 101 for GPs

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Optometry 101 (for GPs)

• Presented by
• Andrea Saetre, B.Sc., O.D.
• and
• Heing Taing, B.Sc., O.D.
• August 6, 2009
• University of Calgary

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A little bit about us..

• Dr. Andrea Saetre
• Born and raised in Calgary
• Graduated from U of C in 1999 with Bachelor of
  Science (biochemistry)
• Doctor of Optometry degree from UW 2003
• Practised in Germany, Alberta
• Special interests binocular vision, pediatrics

• Dr. Heing Taing
• Raised in Ontario
• Graduated from U of G in 1999 with Bachelor of
  Science (biology)
• Doctor of Optometry degree from UW 2003
• Practised in Ontario, BC and Alberta
• Special interests contact lenses, dry eye
  ocular therapeutics

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Our Practices

• 3 Calgary locations
• South Calgary Eyecare
• 105-40 Sunpark Plaza SE
• [phone]
• Health Plus Family Vision Care
• Suite 215-290 Midpark Way SE
• [phone]
• Sunridge Vision Care
• 104 Sunridge Professional Centre, 2674-36 St. NE
• [phone]
• 1 Satellite office
• Three Hills Optometry
• Box 656, 1041 2nd St. N, Three Hills
• [phone]
• Our website www.myvisioncalgary.com

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Who are we?

• What is an optometrist?
• Optometrists are university-educated, primary
  health care practitioners that specialize in the
  examination, diagnosis, treatment and management
  of vision and vision-related diseases and
  disorders
• What is included in a full oculo-visual
  assessment?
• Visual acuities (distance and near)
• Ocular motility assessment
• Refraction
• Pupil assessment
• Anterior segment examination (slit lamp)
• Posterior pole examination (with or without
  dilation)
• Intraocular pressures, visual field screening,
  fundus photos

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• Legislated Scope of Practice
• Examine, assess, measure and diagnose disorders
  and diseases of the human visual system, the eye
  and its associated structures
• Provide and prescribe treatment, management and
  correction

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Optometrists Scope of Practice in Alberta

• Prescribe and dispense corrective lenses
• Prescribe the following drugs for the purpose of
  diagnosis
• Mydriatics, cycloplegics, miotics
• Prescribe the following drugs for topical
  application in the treatment of ocular anterior
  segment disorders
• Mydriatics, cycloplegics, miotics, non-steroidal
  anti-allergy medications, non-steroidal
  anti-inflammatory medications, corticosteroids,
  anti-infective medications (including steroidal
  anti-infectives)
• Prescribe anti-glaucoma medication in a
  consultative, co-management arrangement with an
  ophthalmologist
• Foreign body removal

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Recommended Frequency of Routine Eye Exams
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• Childrens Vision and Eye Health
• Eye SeeEye Learn program in all Alberta School
  Districts more than 4000 pairs of free
  eyeglasses to date
• For all kindergarten students
• Amblyopia -- early detection best chance of
  vision correction
• Strong correlation between vision and learning

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Emergency Eye Care Coverage for Adults Aged 19-64
years

• Cornea
• Foreign bodies, ulcer, dystrophy,
  opacities/scars, herpes simplex keratitis, dry
  eye syndrome, keratoconus
• Conjunctiva/Sclera
• Conjunctivitis, subconjunctival hemorrhage,
  foreign bodies, pterygium, episcleritis,
  scleritis
• Lids/Lacrimal
• Ptosis, epiphora, blepharitis, meibomian gland
  dysfunction, stye, chalazion, dacryocystitis
• Iris
• Iritis/uveitis
• Lens
• Cataracts, other lens opacities
• Retina
• Retinal detachment, retinal holes, macular
  degeneration, macular holes, hereditary
  dystrophies

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Emergency Eye Care Coverage for Adults Aged 19 to
64 years

• Vitreous
• Posterior uveitis, hemorrhage, posterior vitreous
  detachment
• Neurologic
• Glaucoma, papilledema, abnormal pupil function,
  visual field loss, nerve palsy
• Systemic Disease Medications
• Diabetes, hypertension, MS, hydroxychloroquine,
  amiodarone,etc.
• Visual Disturbances
• Amblyopia, diplopia, visual field defects,
  unknown disturbances
• GP/Nurse Referrals
• Various reasons. Provide ULI number

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Case 1

• 54 yo AM
• Recent onset moving black spot in central
  vision OD
• No flashes
• No noted changes to vision
• Good general health
• No significant family history
• Question 1. Urgent or non-urgent?
• 2. Refer to ER or OD/general OMD?

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Case 2

• 32 yo WF
• Sore, red eye OD then OS
• Getting worse, feels like sand
• No pus, but has white, clear discharge
• Very sensitive, pressure behind eye, photophobic
• Meds oral contraceptive
• FxHx MGM with RA, MA thyroid condition
• Question 1. Who would treat with antibiotic?
• 2. Who would refer to OD or OMD

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Red Eye
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Differentials by SLE
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Red Eye

• Many different causes
• Conjunctivitis, allergies, episcleritis,
  scleritis, corneal ulcers, herpes simplex
  keratitis, angle closure glaucoma, iritis,
  foreign bodies, dry eye, blepharitis,
  subconjunctival hemorrhages, etc.
• Treatment depends on cause
• Diagnosis best done with a slit lamp
• Refer if unsure of cause, no improvement or
  worsening despite treatment

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Urgent Referrals to ODsRecent onset, associated
pain, vision loss /or severe

• Flashes
• Floaters
• Blurred/distorted vision
• Glare/haloes/photophobia
• Discharge/tearing
• Diplopia
• Anisocoria

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Urgent Referrals to ODsRecent onset, associated
pain, vision loss /or severe

• Corneal/conjunctival abrasion
• Welders flash
• Mild chemical burn
• Red eye
• Lid swelling
• Burning eyes
• Superficial foreign body

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Non-urgent referrals to ODs

• Eyelid lumps and bumps
• Longstanding floaters
• Myokymia (eyelid twitch)
• Decreased visual acuities
• Headaches/eyestrain
• Routine childrens examination
• Strabismus/amblyopia
• Routine diabetes eye examinations
• Taking medications with ocular side effects (ex.
  Plaquenil)

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• Diabetes and Optometric Care
• Annual eye exam, including dilation
• Eye health issues that can be detected/monitored
  by optometry include
• Fluctuating Rx
• Cataracts
• Glaucoma
• Diabetic retinopathy
• Retinal/vitreal tears/detachment

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Best to send directly to ophthalmology

• Penetrating foreign body/trauma
• Other severe trauma to eye
• Severe chemical burns
• Blown pupil
• White pupil in a child (possible retinoblastoma)
• Sudden loss of vision

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Working Together

• For the benefit of our patients
• Important to maintain visual function and ocular
  health of patients better quality of life
• Reduce wait times with OMDs and Hospitals
• ACH has a 6-8 month waiting list because routine
  exams, failed school screenings, colour vision
  defects, family history of ocular disease, etc.
  is being sent there
• Px with floaters was sent to ER, waited many
  hours to be seen. ER referred to on call OMD
  seen next day. Dx PVD.

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Working Together

• Provide quick correspondence
• Faster and more detailed referral to an
  ophthalmologist
• We are equipped (slit lamp, fundus camera, BIO,
  etc.) to thoroughly assess and diagnose anterior
  and posterior segment disorders
• About 75 of vision loss could be avoided with
  preventative measures or corrected with access to
  proven treatments CTV Tues. Jun.23/09

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How to Refer to ODs

• Call us!
• Send note with patient specify reason for
  referral
• Fax a referral letter to us if the referral is
  less urgent
• We will fax examination findings/report to you
• Be sure to include your name so we report back to
  the correct physician
• CSO optometry/ophthalmology referral manual

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Thank you!

• Contact
• andrea_saetre_at_hotmail.com
• taing.optometry_at_gmail.com