Australian Family Physician October - Vision at risk
Vol 38, (10) 753 - 848
The theme for the October issue of AFP is vision at risk. This
month's articles include reducing vision loss in chronic eye disease,
screening recommendations for retinopathy, sudden loss of vision,
coeliac disease, optic neuritis, demystifying abdominal ultrasound,
integration into the Australian health care system – insights from IMGs,
and prescription medication borrowing and sharing.
Is vision really at risk?
Rachel Lee
When I commenced my role as Publications Fellow at
Australian Family Physician I was assigned this ‘Vision at
risk’ issue. Initially I considered very concrete issues for my
editorial, but recent events have me thinking far more
metaphorically about vision.
Let’s talk about the alternatives - Canada vs. Australia
Lawrence Leung
MBBChir, BChinMed, MFM(Clin), FRACGP, FRCGP(UK),
is Assistant Professor, Department of Family Medicine,
Queen’s University, Kingston, Ontario, Canada.
Letters to the editor
The opinions expressed by correspondents in this column are in no way endorsed by either the Editors or The Royal Australian College of General Practitioners.
Glaucoma
Janice Charles, Helena Britt, Salma Fahridin
Between April 2007 and March 2009, glaucoma was managed
by general practitioners at a rate of 1.8 contacts per 1000
encounters in the BEACH (Bettering the Evaluation and Care
of Health) program, extrapolating to about 200 000 times per
year nationally.
Sudden loss of vision - History and examination
Lucy Goold, Shane Durkin, John Crompton
Sudden loss of vision requires careful history and examination to
identify the underlying cause.
Sudden loss of vision - Investigation and management
Lucy Goold, Shane Durkin, John Crompton
Sudden vision loss usually requires urgent ophthalmic
assessment. Diagnosis and management requires the judicious
use of a wide range of serological and imaging investigations to
guide appropriate treatment and referral.
Reducing vision loss in chronic eye disease
Anthony Fong, Graham Lee
Ocular disease in its early stages may be asymptomatic and
insidious. Three of the leading causes of visual loss are cataract,
age related macular degeneration and glaucoma.
Retinopathy – screening recommendations
Geoffrey Spurling, Deborah Askew, Claire Jackson
Type 2 diabetes mellitus is an increasingly prevalent
presentation in Australian general practice, where most patients
receive their preventive care and management.
Coeliac disease
Kim Faulkner-Hogg, Linda Hodge, Anne Swain
This article forms part of a series looking at the relationship between
diet and good health, and the role of the dietitian in the primary
health care team. This article discusses the assessment and dietary
management of coeliac disease, a T-cell mediated reaction to gluten.
Optic neuritis - More than a loss of vision
Edward R Chu, Celia S Chen
Optic neuritis is an acute inflammation of the optic nerve that
results in painful loss of vision. Patients often present to a general
practitioner, and early recognition is important as treatment may
improve the speed of vision recovery.
Multiple sclerosis presenting with homonymous hemianopia
Siew W Law, Andrew W Lee, Celia S Chen
Ophthalmic manifestations are a prominent feature of
multiple sclerosis (MS). Optic neuritis accounts for 18% of
initial MS symptoms and 40–70% of all patients with MS have
at least one episode of optic neuritis during their disease
course.
Demystifying abdominal ultrasound
Tom Sutherland
Abdominal ultrasound is an extremely useful test for evaluation of
patients with right upper quadrant pain or abnormal liver function
tests.
A tile factory worker presenting with breathlessness and dry cough
Rumi Khajotia; Esha Das Gupta
Jenny, a nonsmoker, 54 years of age, presents with 3 years of
dry cough, progressive breathlessness and reducing exercise
tolerance.
A painful red eye
Neil S Sharma; Ju-Lee Ooi; Maria Z Li
A man, 75 years of age, presents with a red, painful, watery right
eye of 1 week duration. He describes photophobia but says his
vision is not reduced or blurry.
Clinical Challenge
Questions for this month's clinical challenge are based on articles in this issue. The style and scope of questions is in keeping with the MCQ of the College Fellowship exam. The quiz is endorsed by the RACGP Quality Assurance and Continuing Professional Development Program and has been allocated 4 CPD points per issue.
AFP in Practice
AFP in Practice questions are designed to get you started in a small group learning (SGL) activity in your practice or with colleagues. Requirements to earn 40 Category 1 CPD points for a SGL activity are: minimum of four and a maximum of 10 people, minimum of 8 hours of discussion in a year, and at least two GPs.
Prescription medication borrowing and sharing - Risk factors and management
Janette Ellis, Judy Mullan
Prescription medication borrowing and sharing is a behaviour
that has been identified in patients of all ages.
Book reviews
Books reviewed this month are The Australian Pregnant Book by Derrick Thompson, General Practice – Clinical Cases Uncovered by Emma Storr, Gail Nicholls, Alison Lea, Martha Leigh, Sheena McMain, Back from the Brink Too Helping your loved one overcome depression by Graeme Cowan and Screening for Good Health The Australian Guide to Health Screening and Immunisation by Martin Bray, Kerry Kirke, Nicola Spurrier.
Feasibility and efficacy of COPD case finding by practice nurses
Jeremy Bunker, Oshana Hermiz, Nicholas Zwar, Sarah M Dennis, Sanjyot Vagholkar, Alan Crockett, Guy Marks
Chronic obstructive pulmonary disease (COPD) is a leading cause
of disability, hospital admission and premature mortality, but is often
undiagnosed.
Improving childhood immunisation coverage rates - Evaluation of a divisional program
Hammad Ali, Nicholas Zwar, Jo Wild
In contrast to generally high childhood immunisation coverage
rates across Australia, general practices in central Sydney (New
South Wales) have a below average coverage rate.
The practice of confidentiality in an Aboriginal medical service - What do GPs need to know?
Jenny James, Sonya Cameron, Tim Usherwood
The medical ethic of confidentiality is usually taught from a western
ethical perspective based on the Hippocratic oath.
Integration into the Australian health care system - Insights from international medical graduates
Pam McGrath, David Henderson, Emma Phillips
International medical graduates (IMGs) now comprise a significant
part of the Australian workforce.