Opias and
Itises and Phobias
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Usually, there is one in every crowd. Someone who marches
to the beat of a different drum – or doesn’t hear the
beat at all. Sometimes he simply likes being contrary. Less
often, he actually has a point. For example, the first time
I presented a version of this article as a continuing
education lecture, a hand popped up three minutes into the
class. “Isn’t this stuff way out of the scope of
Opticianry? We ain’t doctors, after all.” Despite the
grammar…good point.
Most states that license the practice of Opticianry have
very specific restrictions when it comes to exceeding the
scope of practice. Consider the following passage of Florida
Statute 484.013, which specifically addresses this issue:
“It is unlawful for any optician to engage in the
diagnosis of the human eyes, attempt to determine the
refractive powers of the human eyes, or, in any manner,
attempt to prescribe for or treat diseases or ailments of
human beings.” Therefore, in no way is the information
presented herein designed to facilitate circumventing these
types of restrictions. On the other hand, it cannot be
denied that dispensing opticians make up the greatest number
of eye care professionals (ECPs), and that we represent the
front lines of the profession.
Every ECP working today has been asked by a concerned
patient questions like, “Her ophthalmologist told my
mother she has developed wet macular degeneration. What does
that mean?” Similar inquiries regarding a variety of
ocular ailments occur nearly every day. The question is, do
we reply with some version of “that’s not my job?”
Alternatively, do we reply with something like, “technically
that is out of the scope of my practice, but if she was my
mom I would…” and concluding our reply by sending them
to a specific resource (book, Internet site, doctor), or by
strongly recommending they seek further medical attention
with an optometrist, ophthalmologist, or even an emergency
room. As a 30-year veteran of this profession, I prefer the
latter. With that in mind, here are some of the most common
ocular maladies, their causes, signs and symptoms, and usual
treatments.
Age-Related Macular Degeneration (ARMD or AMD) is
probably the most common ailment about which I am asked. Dry
AMD is the early stage of the disease and is caused by the
aging or thinning of the macula. Although there are a few in
clinical trials, no FDA-approved treatment exists for dry
AMD. In about 10-15% of cases, dry AMD progresses to the
more serious wet AMD. It is called wet because new blood
vessels that have grown beneath the retina begin to leak
blood and fluid. No pain and a gradual loss of vision makes
AMD seem almost symptomless. There is no outright cure, but
some treatments may help to slow its progression and even
improve vision. I think our best advice is for patients to
be diligent about keeping appointments, and closely
following doctor’s recommendations. Some researchers
believe that certain nutrients like zinc, lutein, vitamins
A, C and E help to lower the risk or slow down the
advancement of dry macular degeneration.
Sometimes called the silent thief of sight, glaucoma is
something a front-line ECP should be able to discuss with
her clients. I use it as a way to motivate patients to get
an eye exam. Know that there are generally no symptoms of
most forms of glaucoma – no symptoms until it is too late.
During the eye exam, the doctor will measure your client’s
intraocular lens pressure (IOP). If it is too high (doctors
start to become worried if the pressure approaches or
exceeds 30 mmHg, which stands for millimeters of mercury),
treatment will begin. Untreated, this pressure can affect
the optic nerve, eventually causing permanent, irreversible
vision loss. Standard treatment usually involves eye drops.
If that treatment is ineffective, lasers and surgery may be
indicated. Sharing that information is usually enough for a
patient to schedule an exam.
Some medical researchers claim that upwards of 50 percent
of Americans suffer with allergy symptoms. Of those, 75
percent demonstrate problems with eye allergies. The most
common symptoms include red, swollen, or itchy eyes,
sneezing, coughing, headaches, or runny nose. There are as
many causes as there are symptoms. Pet dander, aerobic
allergens, dust, pollen, mold, and reactions to certain
drugs and cosmetics could all be culprits of the disorder.
The most effective “treatment” is avoiding or
eliminating whatever caused the allergy. Stay inside when a
lot of pollen is forecast. Wear large, wraparound eye
protection outside. Many over-the-counter medications help
to alleviate allergy symptoms. Antihistamines relieve many
of the symptoms of airborne allergens, while decongestants
help sink swollen nasal passages for easier breathing.
If your client has some type of unusual growth, or
pimple-like body on or near the eye, he may have developed a
stye, chalazion, pinguecula, or pterygium. A stye (also
known as a sty or hordeolum) resembles a pimple, and grows
on the inside or outside of the lid. The first signs are
redness and pain, swelling and tenderness. A stye is caused
by bacteria, and should never be “popped” like a pimple
– it should be allowed to rupture on its own. Applying hot
compresses for 5 or 10 minutes a few times a day will help
facilitate its disappearance. If styes become recurrent, a
doctor may prescribe an antibiotic ointment to help
discourage their return. Sometimes mistaken for a stye, a
chalazion is a blocked or enlarged oil gland in the eyelid.
Chalazia also usually disappear on their own, though they
may hang around for months. If that is the case, your doctor
may introduce a steroid to shrink it or drain it manually.
A pinguecula is a yellow lesion that has formed on the
sclera (the white of the eye). It is slightly raised, and
since they usually occur within the palpebral fissure (the
opening between the eyelids), exposure to UV is considered
the primary cause. A pterygium is a wedge-shaped, fibrous
tissue with blood vessels usually on the sclera. It is
benign. Large and advanced pterygia may start to grow over
the cornea, causing or increasing astigmatism. While all of
these growths are usually harmless and “run their course,”
it is prudent to advise your clients to have the condition
treated by an optometrist or ophthalmologist.
Diabetic retinopathy is damage caused by the retina due
to complications from diabetes. When the blood sugar gets
too high, permanent vision loss can occur. Floaters or
double vision may be a symptom, and any client complaining
about these symptoms should be referred to a doctor for
evaluation. Usually the inquiries a front-line ECP
encounters come from patients or family members who are
looking for help after the fact. While there are a couple of
drugs that show promise for people in the early stages of
diabetic retinopathy, no treatment exists to reverse its
damage.
After macular degeneration, questions about cataracts are
the next most common thing asked about by patients. A
cataract is simply a clouding of the eye’s lens. The lens
is made of water and protein, and as we age, some of the
protein starts to clump together and begin to cloud the
lens. Cataracts may make sunlight too glaring, as well as
headlights when driving at night. Colors may seem less
vibrant. While no one knows for sure what causes cataracts,
exposure to UV is thought to be a major contributing factor.
Other minor contributing factors may include diets high in
salt, pollution, cigarette smoke, and high alcohol
consumption. As cataracts start to form, changes in the
spectacle and contact lens prescription will help, but
eventually IOL surgery will be indicated. In what is one of
the most common surgeries in the United States, the
ophthalmologist will remove the natural, clouded lens and
replace it with a new one.
Some of the other disorders that I believe ECPs should
familiarize themselves with include, pink eye, ptosis,
Acanthamoeba keratitis, amblyopia, Bell’s palsy,
blepharitis, floaters, detached retinas, nystagmus, ocular
herpes, and strabismus. Next month we will discuss how an
Eye Care Professional can best discuss these conditions on
the front lines of Opticianry.
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