Optometry : journal of the American Optometric Association
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Comparative Study
Optimal clinical management of eye problems: the role of optometrists in managed care plans.
Recent developments in the education and licensure of optometrists have created new opportunities for more-efficient provision of eye care. This study was conducted to determine the extent to which optometrists provided various kinds of eye care independently in managed care organizations. We compared optometric practices in health plans located in states in which the legal authority of optometrists was limited, to optometric practices in plans situated in states in which optometric licensure permitted broader prescribing authority. The volume and nature of referrals to ophthalmologists were assessed in relation to state law and organizational protocols. ⋯ There is no single reliable predictor of whether optometrists will be used at the highest level of their abilities and scope of license. Although state licensure sets the overall parameters for care, optometric practice in managed care plans may be modified by internal protocols and organizational factors.
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Cerebrovascular disease is the most common cause of neurological disability in Western countries. Patients who survive cerebrovascular accidents exclusive to the occipital lobe often have no significant neurological deficits other than visual-field loss. Visual-field defects from occipital lobe stroke typically include congruous homonymous hemianopsias or quadranopsias, with or without macular sparing. ⋯ Patients with infarction exclusive to the occipital lobe typically have no other neurological deficits except visual-field loss and are often easier to manage than patients with infarctions to other areas of the cerebral cortex or multiple infarctions. Visual-field loss from occipital lobe damage can be successfully managed with optical systems and/or visual rehabilitation. Factors related to management include location and extent of visual-field damage, functional visual needs, and both personal and health concerns of the patient. A discussion is presented on cerebrovascular disease, occipital lobe infarction, imaging techniques, and visual rehabilitation.
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Ischemic optic neuropathy refers to an acute event of ischemia, or decreased blood flow, to the optic nerve resulting in varying degrees of vision loss and visual field defects. Typically this disease affects the elderly population who experience systemic diseases that compromise the blood flow efficiency of the optic nerve head (e.g., giant-cell arteritis, hypertension, diabetes, etc.). However, cases of blood loss to the optic nerve, secondary to traumatic injuries or surgeries, have also been shown to result in ischemic optic neuropathy, regardless of age. It seems that in these cases, the resulting anemia and hypotension play contributing roles in the development of ischemic optic neuropathy. ⋯ Patients who experience large amounts of blood loss due to trauma, surgery, internal bleeding, etc. and report vision loss should be screened for possible optic nerve ischemia. As eye care providers, when we are presented with patients who have optic nerve head atrophy, we should inquire about events that may have precipitated blood loss, potentially triggering ischemic optic neuropathy.