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Optometry Australia NSW/ACT held its annual Super Sunday 2019 education event at Sydney’s Luna Park Big Top on 10 March.
May 2, 2019 - Lewis Williams PhD on Insight News
In part one of a series, LEWIS WILLIAMS details some of the topics covered at the event.
A wide range of topics were featured at Optometry Australia’s (OA’s) Super Sunday event for 2019, with presenters drawn from across Australia and New Zealand. For the first time, OA NSW/ACT also ran a parallel Practice Staff Program. During the program, both the H Barry Collin Research Medal and the Josef Lederer Award for excellence were presented. Super Sunday’s popularity also continued to increase, with this year’s event attracting some 460 delegates.
Beyond the eyeballs
Dr Kate Kalloniatis and Dr Chris Gilbert opened the formal part of the program with a presentation titled: What else is going on? Looking beyond the eyeballs. The thrust of the presentation related to communications between optometrists and GPs relating to the patients consulting them, using guidelines by the Royal Australian College of General Practitioners (RACGP).
The key issues related to vascular disease are: age, sex, smoking status, cholesterol (total and HD lipoprotein), systolic blood pressure, diabetic status, and left ventricular hypertrophy. It is possible for an optometrist to make an Absolute Cardiovascular Risk Assessment of a patient for the next five years, based on statistical data backing the RACGP Guidelines’ cardiovascular disease charts.
A GP’s interest is in prevention, and their heightened interest in cardiovascular disease kicks in at 45 years of age for the general Australian population. However, it starts a decade earlier for indigenous people. Current thinking on acceptable blood pressures (BP) is ≤140/90 mm Hg for adults and ≤130/80 for adults with chronic disease, measured on at least two occasions before a diagnosis of hypertension is made.
Decisions on BP significance are based on risk, lifestyle, family history, measured BP, and ethnicity. A hypertensive crisis is defined as BP of ≥180/120 and the patient being unwell as judged by at least one body system. Relevant issues include breathing difficulties, substance abuse, and pregnancy-related conditions, such as pre-eclampsia at ≥20 weeks gestation. Also of concern are: fresh, flame-shaped haemorrhages, exudates, and papilloedema. If necessary, repeat BP assessments 10 to 20 minutes apart were suggested. If the patient seems well, optometrists are advised to refer the patient to their GP within 24 hours. If they are unwell, an ambulance ride to an emergency department was suggested.
Screening for diabetes at least every two years was suggested in all those over 40 years of age or over 18 years of age if the patient is indigenous. A diabetic assessment was recommended every three years, or more frequently when there is a relevant history. The use of the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK) was recommended. Because symptoms do not become apparent until relatively late in the disease and progression can be rapid, screening was recommended strongly. Key risk factors are: the level of glycaemic control, type of diabetes (1 or 2), hypertension, smoking, dyslipidaemia, nephropathy, and pregnancy.
Smoking should barely rate a mention since its problems and sequelae are so widely known, but smoking rates remain at significant levels despite punitive pricing, deterring packaging, and public anti-smoking campaigns. Importantly, if smoking has been avoided for 12 months an ex-smoker’s risk of heart disease is halved. Ocular diseases linked to smoking include: AMD, cataract, inflammation, thyroid, retinal artery emboli, and strabismus if a patient’s mother smoked during pregnancy.
When dealing with a smoker, the 5AS framework for practitioners was recommended: Ask, Assess, Advise/agree to targets, Assist, and Arrange. A pharmacotherapy approach to quitting smoking was stated to be a rational consideration and most products are available over the counter, with the exception of nicotine patches.
Should an optometrist find papilloedema, the cause, usually raised intracranial pressure or benign intracranial hypertension (BIH), will not be immediately apparent. If the former is likely, an ambulance to an emergency department might be prudent. If BIH, the patient should be promptly seen by a neurologist, neurosurgeon, ophthalmologist, or at the very least their GP.
If Graves’ Disease/thyroid eye disease is detected, a GP referral is necessary to get suitable investigations underway. Those investigations can involve an ophthalmologist or an endocrinologist, and the referring optometrist can play a monitoring role.
The presenters gave the role of a GP as preventative health and chronic disease management, and requested that optometrists copy the patient’s GP on any action taken or relevant findings uncovered. This is because patients assume incorrectly that all health professionals communicate with one another. Having patients carry their information from the referring optometrist to their GP is acceptable. Patients who consult optometrists on their own initiative were identified as potential barriers to communication because of the lack of a referring ‘authority’.
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