Red eye emergencies in primary care.

Severe red eye conditions can be the result of intraocular inflammation, corneal insults or inflammation, and acute glaucoma. These pathologies require the knowledge and assessment tools of an ophthalmologist. This article will discuss red eye emergencies that the NP should promptly recognize and refer to ophthalmology.

The Health Of Patients' Eyes (HOPE) Glaucoma study. The effectiveness of a 'glaucoma personal record' for newly diagnosed glaucoma patients: study protocol for a randomised controlled trial.

BACKGROUND: Glaucoma involves progressive optic nerve fibre loss, subsequently leading to irreversible and disabling visual field defects. In Europe, the prevalence of glaucoma is approximately 2.2 % of all people aged over 40 years; this equates to 12 million people. Glaucoma patients require regular lifelong follow-up, contributing to a large financial and resource burden for the National Health Service (NHS) in the UK. This study aims to determine whether providing newly diagnosed glaucoma patients with a personalised client-held eye health summary ('glaucoma personal record'), improves patients' knowledge of their glaucoma condition. A potential long-term benefit could be improved self-management and henceforth a slower rate of deterioration. METHODS/DESIGN: HOPE Glaucoma is a 3-year, prospective, parallel-group, pragmatic, single-centred, randomised controlled trial. An anticipated 122 adults, newly diagnosed with glaucoma (including ocular hypertension, suspected glaucoma and/or chronic open-angle glaucoma) will be recruited from a nurse-led ophthalmology outpatient clinic at a medium-sized NHS Trust. Participants will be randomly allocated to receive standard clinical care (control arm) or standard care plus a glaucoma personal record, detailing the current state of their condition (interventional arm). Participant assessments are designed to test whether provision of a glaucoma personal record 1) improves patient knowledge of glaucoma and 2) contributes to improvements in clinical outcomes, i.e. delay of visual field loss. The primary outcome measure is better client knowledge of glaucoma at the 9-12 month follow-up visit. Secondary outcome measures include the rate of visual field loss and patient-reported outcome measures on visual function (National Eye Institute VFQ - 25) measured at baseline, 9-12 months, 24 months and 36 months. Estimating a 20 % drop-out rate, the study will have 90 % power to detect a mean two-point difference in glaucoma knowledge score between groups at 5 % significance - based on two-sided Mann-Whitney U test. DISCUSSION: If a glaucoma personal record is found to significantly improve glaucoma patients' knowledge of their condition, this intervention could potentially provide a low-cost, straightforward tool to educate and engage glaucoma patients. Subsequently, this could have the potential to increase patient self-management and therefore allow glaucoma patients to prolong their sight functionality for longer. TRIAL REGISTRATION: ISRCTN41306818 , registered on 22 August 2013.

El examen del anillo neurorretiniano: ¿fenómeno vintage o revolución? / Neuroretinal rim examination: A vintage phenomenon or a revolution?

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Correlación de la relación excavación/papila óptica medida mediante HRT-III, SD-OCT y el dispositivo de colorimetría fotográfica Laguna OnhE / Correlating cup-to-disc ratios measured by HRT-III, SD-OCT and the new color imaging Laguna ON hE procedure

OBJETIVO: Estudiar la correlación existente entre la relación excavación/papila óptica (E/P) medida mediante el nuevo dispositivo de colorimetría fotográfica Laguna ONhE (Optic Nerve Hemoglobin), tomografía de coherencia óptica (OCT) de dominio espectral, tomografía retiniana con láser confocal (HRT) y valoración mediante retinografía. MÉTODOS: Un total de 154 ojos de 154 sujetos (52 controles, 36 hipertensos oculares y 66 con glaucoma primario de ángulo abierto) fueron estudiados de forma prospectiva determinándose el cociente E/P mediante Laguna ONhE, HRT-III (Heidelberg Engineering), OCT Spectralis (Heidelberg Engineering) y el análisis de fotografías de papilas por parte de un observador experto en glaucoma de forma enmascarada. RESULTADOS: Los coeficientes de correlación intraclase (CCI) globales fueron: 0,379 (IC 95%: 0,233-0,508) entre Laguna ONhE y HRT; 0,621 (IC 95%: 0,513-0,709) entre Laguna ONhE y OCT, y 0,558 (IC 95%: 0,398-0,678) entre Laguna ONhE y observador, siendo esta concordancia estadísticamente significativa en todos los casos. El mayor CCI se obtuvo entre OCT y observador: 0,715 (IC 95%: 0,605-0,795). CONCLUSIONES:La medida de E/P estimada por Laguna ONhE presenta buena correlación con la determinada por OCT y la valorada por un especialista en glaucoma. Las mejores correlaciones se encuentran entre OCT y experto. La concordancia fue buena entre Laguna ONhE, OCT y experto, siendo menor con HRT, que presenta una correlación menor con el resto de procedimientos

OBJECTIVE: To examine correlations between cup-to-disc (C/D) ratios determined by the new Laguna ONhE (optic nerve hemoglobin) color imaging procedure, spectral domain optical coherence tomography (OCT), confocal scanning laser tomography using Heidelberg retina tomography (HRT), and examining retinal images. METHODS: C/D ratio measurements were made on 154 eyes of 154 subjects (52 healthy controls, 36 with ocular hypertension and 66 with primary open-angle glaucoma) using the Laguna ONhE, HRT-III (Heidelberg Engineering) and OCT Spectralis (Heidelberg Engineering) instruments and photographs of the optic disc were examined by a blinded observer (experienced glaucoma specialist). RESULTS: Global intraclass correlation coefficients (ICC) were: 0.379 (95% CI: 0.233-0.508) for Laguna ONhE-HRT, 0.621 (95% CI: 0.513-0.709) for Laguna ONhE-OCT, and 0.558 (95% CI: 0.398-0.678) for the Laguna ONhE-observer, indicating significant agreement in each case (P<.001). The highest ICC was recorded for OCT- observer (0.715; 95% CI: 0.605-0.795). CONCLUSIONS: C/D ratios measured using the Laguna ONhE procedure correlated well with OCT measurements and retinography measurements made by an experienced observer. Best correlation was observed for OCT versus observer measurements. Agreement was good between the Laguna ONhE, OCT and observer measurements, and was somewhat lower between HRT and the remaining procedures

Glaucoma and glaucoma medications.

Glaucoma is an insidious "thief of vision" that affects millions of Americans and is a leading cause of blindness worldwide. The signs of the most common form of glaucoma are incremental and are often not noticed until the vision loss is acute. Nurses, in any practice arena, who are aware and knowledgeable about glaucoma can play a vital role in identifying those at risk for glaucoma before irreversible damage is done. In addition, knowledgeable nurses will be able to educate those diagnosed with glaucoma about their disease and the proper use of their glaucoma medications. In the following discussion, a brief explanation of how glaucoma affects vision is presented and selected medications used to treat glaucoma are identified.

Extending a nurse practitioner's role to include the undertaking of advanced procedures.

This article outlines an initiative to develop an ophthalmic nurse practitioner's role to carry out YAG laser peripheral iridotomy. It details the training and competency assessment needed to extend this role, and the results of an initial audit. Advice for trusts planning similar projects is also given.

The impact of a glaucoma nurse specialist role on glaucoma waiting lists.

Over the last two decades there has been an increasing demand on health care services. This has led to increased waiting lists and waiting times to access public hospital services. In ophthalmic practice an aging population and technological advances have been major contributors to this situation. The challenge for health care providers is how to manage waiting lists within the resources provided and targets set by Elective Services, a department of the Ministry of Health (MoH). The Ministerial Taskforce on Nursing (1998) highlighted that nurses are an underutilised resource. Subsequent to the Ministerial Taskforce, the availability of interim funding from Elective Services and a skilled speciality nursing workforce the Ophthalmology Department at a large metropolitan hospital was able to implement an advanced nursing role with respect to glaucoma management. Early diagnosis is important in reducing the risk of permanent visual impairment from primary open angle glaucoma; therefore the length of time to diagnosis can have long term implications for the patient. Patients for the 'nurse-led' glaucoma clinic were recruited from specific categories of glaucoma patients on the waiting list. An audit of the impact on the waiting list was undertaken periodically over a two year period. The audit following the introduction of the clinical nurse specialist clinic shows a marked reduction in waiting list numbers and length of time waiting for first specialist assessment for glaucoma. The implementation of this role proved to be successful and has subsequently become a permanent nurse specialist position in the ophthalmology department.

Understanding the role of the glaucoma specialist nurse.

Primary open angle glaucoma is a life-long condition that is more prevalent in people over 40 years of age. This article explores the available literature on quality of life for patients with glaucoma and considers the role of the glaucoma specialist nurse.

Visual impairment in children.

This article examines the paediatric ophthalmic nurse's role in treating and managing several common ocular conditions.

Guía práctica: glaucoma. Diagnósticos potenciales e intervenciones de enfermería / Glaucoma: potential diagnoses and nursing interventions

El glaucoma es una neuropatía óptica progresiva de etiología multifactorial que afecta a más de 50 millones de personas en el mundo y origina defectos del campo visual, incluso la ceguera.Aunque en general persiste la idea de que la técnica y la medicación son los factores más importantes para la curación, nos hemos servido de la técnica y hemos descrito la evolución perimétrica del glaucoma y las alteraciones visuales que va generando; las/os enfermeras/os, como profesionales expertas/os de los cuidados, tenemos que valorar los patrones de salud que se ven alterados en los pacientes con glaucoma, definiendo los diagnósticos e intervenciones de enfermería adecuados, para situarlos en el contexto del proceso de enfermería que identificará los cuidados que van a necesitar las personas que padecen esta enfermedad progresiva e incapacitante (AU)

Nurse prescribing in glaucoma.

AIMS/PURPOSE: To investigate a nurse-led assessment clinic of new referrals of possible glaucoma. To determine the potential for nurse prescribing. To review the background literature about nurse prescribing. METHODS: Audit of the outcomes of patients attending the nurse-led glaucoma assessment clinic during two defined periods (169 patients). An audit of all patients started on timolol or latanoprost treatment by a nurse following a protocol. RESULTS: A total of 46 patients were commenced on treatment at the clinic, 31 on timolol, 14 on latanoprost, and one on brimonidine. Four of these had the treatment stopped at the review clinic in order to reassess the diagnosis. Four patients in the timolol group developed side effects requiring a change in medication, but these could not have been predicted from their past medical history. Nine patients had treatment changed or added to because the intraocular pressure was felt to be inadequately controlled. During the two 3-month audits, a further 11 patients were commenced on treatment for glaucoma at the review clinic. CONCLUSIONS: Initial data from this clinic suggest that nurses possess the diagnostic skills necessary to prescribe for new glaucoma patients. The legal and administrative frame works are developing for more nurses to be able to prescribe. With the newer prostaglandin treatments for glaucoma being available, nurses may usefully and safely be able to prescribe first-line treatments for glaucoma.