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  • Management Outline for Common Ophthalmic Conditions

    Written By:

    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

    * * *

    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.