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• Primary open angle glaucoma OCT enables the optometrist to capture micrometer‐ • Secondary glaucomas. resoluon, three‐dimensional images of the renal layer and macula. Vitreo‐renal disorders: • Flashes and floaters GPs can also explain and discuss driving regulaons and opons for people with visual problems. • Vitreous detachment • Vitreous haemorrhage GPs are well placed to facilitate parents’ access to sources of social support for the visually impaired child • Renal detachment. such as Parents of Vision Impaired (N.Z.) Incorporated Disorders of the opc disc and visual pathways: (hp://www.pvi.org.nz); and also help people to access • Swollen opc disc: recognion and differenal Ministry of Social Development (MSD) and Health and diagnosis Disability support for visually impaired adults. • Atrophic opc disc: recognion and differenal Informaon on the Children’s Glasses Subsidy could be diagnosis useful and providing contacts for Equipment and • Pathological cupping of the opc disc Modificaon Services will be helpful if a person is having difficulty doing everyday tasks because of their • Migraine disability. The best way for people to find out if they • Transient ischaemic aacks (TIAs). can get some equipment and/or modificaon to their Eye movement disorders and problems of amblyopic home or vehicle to help them manage with reduced binocularity vision is to contact: • Diplopia • Accessable (Auckland or Northland) 0508 001 002 or • Non‐paralyc and paralyc strabismus. visit www.accessable.co.nz Emergency care: • Enable New Zealand (For the rest of New Zealand) Recognising and instung primary management of 0800 171 981 or visit ww.disabilityfunding.co.nz ophthalmic emergencies and refer appropriately: • Superficial ocular trauma, including assessment of GPs can also let people know about the Royal NZ foreign bodies, abrasions and minor lid laceraons Foundaon of the Blind which can provide praccal support and has a library of talking‐books. There are • Arc eye optometrists specialising in low vision services in most • Severe blunt injury, including hyphaema communies and some regions have low vision clinics • Severe orbital injury, including blow‐out fracture within or associated with the DHB. • Penetrang ocular injury and ssue prolapse Eye health teamwork in primary care • Retained intra‐ocular foreign body Primary care is an ideal seng for learning about eye • Sudden painless loss of vision problems both in the day to day paent care and in • Severe intra‐ocular infecon optometry pracces. In Counes Manukau and Capital • Acute angle closure glaucoma. and Coast DHBs diabec eye services are provided in Risk factors local optometry pracces and elsewhere the PHOs may conduct eye screening clinics. Both opons provide This will involve the following risk factors: excellent opportunies for examining the eye and • Genecs – family history discussing risk factors and co‐morbidies. Optometrists • Co‐morbidies especially diabetes and hypertension. are key members of the primary healthcare team and (List sourced from Royal College Of General Praconers are becoming increasingly involved in working in Curriculum Statement 15.5) partnership with GPs. An optometry pracce can provide an ideal learning environment for the specialty Supporng people with vision impairment general pracce registrar as every paent is an eye General Praconers can facilitate referrals to the paent and optometrists are experts at examining the community optometrist and request an eye exam eye by direct ophthalmoscopy, use of the slit lamp and report where appropriate. All optometrists will be able by using other equipment for tesng visual fields and to complete a slit lamp examinaon, use binocular intra‐ocular pressure. Most will have fundus cameras indirect ophthalmoscopy and gonioscopy, and provide and many also have advanced imaging equipment such an inial screen of visual fields. Most will also have as OCT . It is an excellent environment for discussing advanced fields analysers and renal cameras, and the impact of chronic eye problems and issues of pracces with opcal coherence tomography (OCT) are screening and prevenon. rapidly become more common.

Some common disorders of the body that may have ocular findings

EXAMINATION OF THE CONJUCTIVA EXAMINATION OF THE VITREOUS Connective Tissue Disorders (eg Infections (eg chlamydia, gonorrhoea) Collagen Vascular Disease (eg amyloidosis) pseudoxanthoma elasticum) Allergies (eg asthma, hayfever) Infections (eg septicaemia) Infections (eg AIDS, syphilis, tuberculosis) Blood Disorders (eg haemophilia) Diabetes Blood Disorders (eg sickle cell anaemia) Tumors (eg leukaemia, Kaposi's sarcoma, Lymphoma Drug Side Effects (eg tamoxifen) melanoma) Addison's Disease EXAMINATION OF THE CHOROID EXAMINATION OF THE MACULA Vitamin Deficiencies Collagen Vascular Disease (eg sarcoidosis, Congenital Disease (eg toxoplasmosis) Collagen Vascular Disease (eg systemic Reiter's syndrome) Drug Side Effects (eg chloroquine, lupus) Infections (eg syphilis, mononucleosis) phenothiazines) Sarcoidosis Gastrointestinal Disease (eg polyposis coli) EXAMINATION OF THE OPTIC DISC Melanoma EXAMINATION OF THE SCLERA Secondary Tumours Drug Side Effects (eg steroids, tetracycline) Liver Disease (eg jaundice) Parasites (eg toxocara) Neurological Disorders (eg brain tumours, Metabolic Disorders (eg gout) intracranial hypertension) Collagen Vascular Disease (eg rheumatoid EXAMINATION OF THE RETINA Compression (eg disc oedema) arthritis) Diabetes Mellitus Autoimmune Disease (eg giant cell arteritis) Osteogenesis Imperfecta Vascular Disease (eg high blood pressure,

high cholesterol, carotid disease) EXAMINATION OF THE OPTIC NERVE Inflammation (eg meningitis) Neurological Disorders (eg multiple sclerosis)

EXAMINATION OF THE ORBIT Thyroid Disease (eg Graves' disease) Tumours Sinus Disease Leukaemia

EXAMINATION OF THE EYELIDS & LACRIMAL GLANDS Skin Disorders (eg acne rosacea, psoriasis) Allergies (eg hives, dermatitis, eczema) Tumours (eg basal cell carcinoma) Neurological (eg myasthenia gravis, Horner's syndrome) Collagen Vascular Disease (eg rheumatoid arthritis)

EXAMINATION OF THE LENS Genetic Disease (eg Marfan's syndrome) Cataract (eg galactosaemia, rubella) Renal Disease (eg Alport's syndrome) Drug Side Effects (eg steroids, arthritis medication)

EXAMINATION OF THE PUPIL EXAMINATION OF THE IRIS & ANTERIOR CHAMBER Neurological Disorders (eg multiple sclerosis, syphilis) Melanoma Head Injury (eg trauma, stroke) Neurofibromatosis Drug Side Effects Gastrointestinal Disease (eg Crohn's disease, ulcerative colitis) Collagen Vascular Disease (eg Ankylosing spondylitis) EXAMINATION OF THE CORNEA Diabetes Mellitus Genetic Disease (eg Down's syndrome, Turner's syndrome) Infections (eg syphilis) Infections (eg herpes simplex, herpes zoster) Sarcoidosis Metabolic Disorders (eg Wilson's disease) Cardiovascular Disease EXAMINATION OF THE CILIARY BODY Collagen Vascular Disease (eg scleroderma, Sjögren's Melanoma syndrome)

PRIMARY EYE CARE

NZ Association of Optometrists PO Box 1978 WELLINGTON