Acute macular neuroretinopathy.

Acute macular neuroretinopathy is an infrequently encountered condition in which there is a sudden mild central vision loss, photopsia and red-brown wedge-shaped lesions in the macular region with corresponding scotomata in the central visual fields. The condition may be associated with the use of oral contraceptives or with a recent febrile illness. It is self-limiting and non-recurrent. The clinical features of a patient with acute macular neuroretinopathy are described and the nature of the vascular aetiology is discussed.

Diagnosis and management of open angle glaucoma: suggested guidelines for optometrists.

OBJECTIVE: The aims of this review are to define open angle glaucoma, to outline its prevalence and its financial and personal costs, to discuss the difficulties encountered in establishing the diagnosis and monitoring treatment, and to suggest initial clinical guidelines for the comanagement of glaucoma between ophthalmologists and optometrists. METHODS: The literature was selectively reviewed to permit deductions that can be directed toward an effective comanagement strategy for patients with open angle glaucoma. CONCLUSIONS: Comanagement of patients having open angle glaucoma is a viable option, provided the opportunity for improved monitoring and better compliance is available. The basis for successful management rests with the ability to detect change in the optic disc and surrounding retina, visual fields and intraocular pressure. All these signs are continuous variables for which there are no known limits of normality. The division of responsibilities of management will be established initially by legislation and in the future modified according to experience and the emergence of new therapies.

Clinical features of pseudoexfoliation of the lens capsule: suggested management.

BACKGROUND: Pseudoexfoliation of the lens capsule (PEX) is found in widely varying proportions across the population of regional groups. It is strongly associated with open angle glaucoma and to a lesser extent angle closure glaucoma. This association makes PEX a very important risk factor for glaucoma, which should be sought actively in all patients over 50 years of age who seek eye care. Our ageing population may give rise to a future high caseload of PEX glaucoma, which will create challenges in diagnosis and treatment. METHOD: Selected literature is reviewed. It includes a description of the course of PEX and suggested optometric clinical procedures to diagnose and assess the significance of PEX. An algorithm for guidance of optometric and ophthalmological management is presented. CONCLUSIONS: PEX is a common condition in the aged. It is an easily detected strong indicator of open angle glaucoma and to a lesser extent the risk of angle closure glaucoma. The presence of PEX should alert the clinician to the need for a full glaucoma assessment.

Herpes zoster opthalmicus.

INTRODUCTION: Herpes zoster is a common disease which may cause serious ocular sequelae when it affects the trigeminal nerve. Although involvement of the nasociliary branch of the first division of the trigeminal nerve is well recognised to be associated with serious and direct ocular morbidity, the need for careful long-term follow-up of cases of frontal branch involvement is perhaps less well known. METHODS: The pathogenesis, epidemiology, risk factors, clinical course and treatment of herpes zoster are discussed with emphasis on trigeminal nerve involvement. A case report is presented which illustrates the importance of continuing management when the frontal branch of the trigeminal nerve is affected. DISCUSSION: Clinical guidelines are suggested for optometric management of these cases in cooperation with medical practitioners.

Diabetic retinopathy: classification, description and optometric management.

BACKGROUND: Diabetes mellitus is an important cause of visual loss, which can be moderated by treatment at specific stages of diabetic retinopathy. Existing monitoring for retinopathy has been shown to fall short of ideal, resulting in unnecessary visual loss. Using appropriate guidelines, optometrists should be well-placed to contribute to the management of patients having diabetic eye disease. METHOD: The underlying pathology of diabetic retinopathy is reviewed as a basis for recognising the various stages of diabetic retinopathy, including macular oedema and risk of progression of disease. These stages are detailed in terms of classification, prevalence and appropriate examination techniques. An illustrated guide summarises these features and provides a suggested management regimen for continued monitoring, reporting, referral and ongoing management by optometrists. CONCLUSIONS: The majority of optometrists have the diagnostic skills and the clinical equipment required for efficient monitoring of diabetic retinopathy. Inclusion of optometrists in the team providing health services for diabetes is an economic and practical solution to improving the primary eye care of people having diabetes and ensuring a significant reduction of unnecessary visual loss caused by diabetic retinopathy.