Optometric Management

FEB 2017

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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 39 CLINICAL INTERDISCIPLINARY DR. SHECHTMAN is a professor of optometry at Nova Southeastern Uni- versity College of Optom- etry, where she serves as a clinician in the Eye institute. She is also the co- ordinator of the diabetes and macula service and the director of interdisci- plinary education. Dr. Shechtman is a member of ASCO's Inter-professional Education and Collaborative Practice Committee, a fellow of the AAO and the Optometric Retinal Society (ORS). requested medical lab tests. A follow-up visit is scheduled with the patient to discuss the results, if necessary, and any ocular ram- ifications. e PCP manages the underlying disease. FREE TO ORDER Should you be able to write a re- quest for lab tests, use a pre-print- ed order lab form or a transmis- sion through your EHR system. Be sure to document on the form or via the transmission a proper ICD-10 code (this may include systemic condition and/or ocular finding/diagnosis). Providing a "rule-out" diag- nosis is generally not accepted by insurance, but if you suspect a particular condition, you can use that disease code as a dif- ferential diagnosis and order the proper tests. For example, one could write "ACE" to "r/o Sarcoidosis" rather than listing a number of medical lab tests and then state "r/o TB, syphilis, toxo- plasmosis, etc." As is the case when prohibited from ordering tests, contact the patient's PCP about your findings and their possible link to a sys- temic disease. Regardless of which camp you're in, coordinating care with the PCP provides him or her with an understanding of how system- ic disease relates to the eye, again, enabling the order of the proper lab tests, which expedites correct patient care and helps build refer- rals to your practice. In addition, the PCP will ultimately be man- aging the underling disease. MAINTAIN COMMUNICATION Continuous communication with PCPs is critical to patient care. Do so by providing them with information about your ocular management and follow- up. With our scope of practice expanding, ordering proper lab tests, in conjunction with the PCP, helps to re-define our role within health care. OM TABLE 1 COMMON LAB TESTS POSSIBLE OCULAR MANIFESTATIONS Complete blood cell (CBC) count with differentials (diff); (Red blood cell count (RBC), white blood cell count (WBC) with diff, hemoglobin, hemato- crit, RBC indices, platelet count) Manifestations of anemia, leukemia, bacterial, inflammation or bleeding disorders (such as retinal vasculopathy) Lipid profile low-density lipoprotein (LDL)/high-density lipoprotein (HDL)/ triglyceride (TG)/very low-density li- poprotein (VLDL)/cholesterol Cardiovascular disease risk factors, such as retinal emboli, atrial fibril- lation/transient ischemic at tack, retinal artery occlusion, anterior ischemic optic neuropathy, arcus and xanthelasma. Fasting blood sugar (FBS)/HbA1c Diabetes mellitus (i.e. diabetic retinopathy) Inflammatory markers (Erythrocyte sedimentation rate (ESR)/c-reactive protein (CRP) Adjunct to ocular manifestations of giant cell arteritis and ocular manifestations of inflammatory or autoimmune disease (i.e. uveitis) Rheumatoid factor (RF) Arthritic ocular manifestations (i.e dry eyes) Angiotensin-converting enzyme (ACE) Adjunct to ocular manifestations of sarcoidosis Blood clotting tests (Prothrombin time (PT)/partial thromboplastin time (PTT)/ international normalized ratio (INR)) Manifestations of coagulation disor- ders (i.e CRAO) in a young patient) Thyroid testing (Triiodothyronine (T3)/ thyroxine (T4)/thyroid stimulating hor- mone (TSH)) Thyroid-related ocular manifestations (i.e. Grave's disease) Sickle cell testing "SCD" (Sickledex) Ocular manifestations of SCD (i.e. peripheral neovascularization) Antinuclear antibody (ANA) Autoimmune disease screener (i.e. adjunct to lupus) Human leukocyte antigen (HLA) Specific autoimmune disease (i.e. ankylosing spondylitis- related uveitis) HIV-Elisa HIV-related ocular manifestations (i.e. Kaposi sarcoma)

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