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Young Ophthalmologists
Management Outline for Common Ophthalmic Conditions
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Learning the ophthalmic exam while being immediately thrust into a clinic setting is stressful.  Many questions need to be asked and answered. One thing I devised in those first few weeks was this “When should I have them return?” cheat sheet that I shrunk to 8-point font and stuck in my pocket. It helped me memorize some of the details and minimize my questions. I hope you find it helpful. (See the abbreviation key at the end of the article.)

DM

1. No DR — DFE q1yr  

2. Mild NPDR (DBH, HE, MAs 1–2 quads) — DFE q1yr

3. Mod NPDR (mild + CWS, venous beading) — DFE q6mo

4. Severe NPDR: a, b OR c — DFE q4mo

a. 4 quadrants w/MAs, DBHs

b. 2 areas of venous beading

c. 1 IRMA

5.    PDR

a. NVD >1/3 disc area

b. VH w/any NVD

c. VH w/NVE >1/2 disc area

d. Any NVI

1. Get staff approval for PRP

2. PRP

3. RTC 6–8wks after PRP

4. RTC based on regression — if PDR inactive, RTC 6mo

6. CSME

1. RT w/i 500?m of fovea

2. HE's w/i 500?m of fovea if assoc w/adjacent RT

3. RT >1 disc area w/i 1 disc diameter of fovea

Rx: focal or grid argon laser and RTC 3mo

POAG/suspect (non-adv)

TA q4mo for POAG, q6mo for POAG-S, q1yr if stable VF x3

VF q1yr

DFE q1yr

-Monocular — 1/2 of above intervals & safety specs (polycarb)

-Monocular trial needed when initiating new anti-glaucoma gtts; RTC 2wks for response

s/p LPI

PF1% QID x4–5d, RTC 1wk — D/C PF1% if no cell; no taper needed; DFE after

LPI (breaks PS)

s/p YAG

RTC 1wk for MR, TA, SLE to ensure no capsular fragments in visual axis

s/p CE/IOL

POD#1 — VA, TA, SLE; Rx: PF1% q2h to QID, abx QID; NSAID if available

POD#7 — VA, TA, SLE; Rx: continue NSAID x1mo, taper PF1% QID x7d, TID x7d,

BID x7d, QD x7d, then stop; d/c abx

POD#30 — VA, MR, TA, SLE, DFE

AMD

1. VA, Amsler grid, DFE — if all is stable, f/u 6mo

2. If VA decreases, Amsler abnormal or SRF/SRH on DFE, to Retina w/i 1wk

The following are definitions of the above abbreviations in order of appearance in text. Note: Once the definition of an abbreviation has been given, it is not repeated.

DM: Diabetes mellitus
DR: Diabetic retinopathy
DFE: Dilated fundoscopic exam
NPDR: Nonproliferative diabetic retinopathy
DBH: Dot-blot hemorrhage
HE: Hard exudates
MA: Microaneurysm
CWS: Cotton-wool spot
IRMA: Intraretinal microvascular abnormality
PDR: Proliferative diabetic retinopathy
NVD: Neovascularization of the disc
VH: Vitreous hemorrhage
NVE: Neovascularization elsewhere
NVI: Neovascularization of the iris
PRP: Panretinal photocoagulation
RTC: Return to clinic
CSME: Clinically significant macular edema
RT: Retinal thickening
POAG: Primary open-angle glaucoma
TA: Tonometry by applanation
POAG-S: Primary open-angle glaucoma suspect
VF: Visual field
LPI: Laser peripheral iridotomy
PF1%: Pred Forte 1%
PS: Posterior synechiae
YAG: Yttrium aluminum garnet (laser for posterior capsular opacification [PCO])
MR: Manifest refraction
SLE: Slit-lamp exam
CE/IOL: Cataract extraction/intraocular lens implant
POD: Postoperative day
VA: Visual acuity
Rx: Treatment
AMD: Age-related macular degeneration
SRF: Subretinal fluid
SRH: Subretinal heme

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About the author: Natasha L. Herz, MD, is a cataract, corneal and refractive surgeon who works as a solo practitioner at Kensington Eye Center in the Washington, D.C., metropolitan area. She completed her residency and fellowship at the Cullen Eye Institute at Baylor College of Medicine in Houston. Local peers selected her to appear in Washingtonian magazine’s Top Doctors of 2012. She also serves on the Academy’s Young Ophthalmologist Committee and is the chair of the young physician committee for her local medical society. She has served as a member of the YO Info editorial board since 2008 and became the chair in August 2011. Natasha Herz, MD 
 
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