Optometric Management

FEB 2017

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38 F E B R U A R Y 2 0 1 7 • O P T O M E T R I C M A N A G E M E N T . C O M CLINICAL INTERDISCIPLINARY O CULAR MANIFESTA- TIONS of systemic disease are frequently encountered in our practices. e proper medical labs are nec- essary to confirm the diagnosis and initiate proper management. (See "Table 1," p.39.) When encountering a particu- lar ocular finding, there may be a plethora of tests considered. A comprehensive eye exam and a detailed history helps nar- row down the differential di- agnoses, aiding in determining which medical blood tests should be ordered. For example, a patient with a recurrent subconjunctival hem- orrhage and no contributing history of risk factors, such as medications or medical history, may have a hematological disor- der. To find out, however, he must undergo a complete blood cell count (CBC) with differential, liver function tests, prothrom- bin time, partial thromboplastin time and international normal- ized ratio (INR) tests, in addition to in-office blood pressure mea- surement and a consultation with his primary care physician (PCP). When the latter occurs depends on your state scope-of-practice laws. Work with the primary care physician and a lab to meet the needs of your patients. PROHIBITED FROM ORDERING If your state scope-of-practice laws and/or the patient's insur- ance prevent you from ordering medical lab tests, contact the pa- tient's PCP to inform him or her of the ocular finding you believe is related to a particular systemic disease. is way, the PCP can order proper medical lab test- ing, enabling you to ensure the patient receives the most appro- priate treatment fast. Specifically, provide a summary report to help the PCP understand the ocular condition; this may include perti- nent data related to the case. For example, the most criti- cal part of managing an older patient who has a central retinal artery occlusion (CRAO) is to order a hypertension panel, dia- betes mellitus and lipid profile, transesophageal or transthoracic echocardiogram, carotid doppler, CBC with differential and eryth- rocyte sedimentation rate (ESR)/ c-reactive protein (CRP) tests. If the PCP is aware of the close correlation between stroke and CRAO, he or she may order an MRI or neurological consult. (Ac- cording to the American Stroke Association and the American Heart Association, there is a high risk of subsequent stroke follow- ing the incidence of a CRAO.) e PCP then shares with you, the optometrist, the results of the FACILITATE LAB TEST ORDERING COORDINATE WITH PRIMARY CARE PHYSICIANS FOR DISEASE MANAGEMENT CONTINUOUS COMMUNICATION WITH PCPS IS CRITICAL TO PATIENT CARE. Depending on scope of practice laws in your state, you may coordinate directly with a lab or with the patient's primary care physician. DIANA L. SHECHTMAN, O.D., F.A.A.O.

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