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Hypertension Sleep Apnoea June 2018 ADVANCING THERAPEUTIC OPTOMETRY Hypertension Managing hypertensive patients in your practice Sleep apnoea OSA and its relationship to the eyes Accredited CPD points available with every issue of Pharma. Vision Australia. Your partners in the circle of care. When is the best time to refer to us? Diagnosis of a permanent, 1 non-correctible or progressive eye condition. or Visual Acuity is 6/24 or less (BCVA/BEO) or Visual Fields 2 of 30 degrees or less with both eyes open (BEO). or Vision impairment is 3 putting your patient at risk. or Support adjusting to vision 4 impairment is needed. At Vision Australia we work together with optometrists to ensure the best outcomes for people who are blind or have low vision. With 28 locations around Australia, it’s easy to refer to us. Just visit visionaustralia.org or call 1300 84 74 66. VA0030_OO_Press_Ad_A4_05.indd 1 26/4/18 3:34 pm June 2018 Editor JEFF MEGAHAN 02 20 Clinical Editor Cardiovascular Q and A CXO featured article Associate Professor Mark Roth Associate Professor Sheela E Kumaran, Jyoti BSc(Pharmacology) Mark Roth and Associate Khadka, Rod Baker and BAppSc(Optom) PGCertOcTher NEWENCO FAAO OAM Professor Leo Hartley Konrad Pesudovs Publications Manager JESSICA DONALD 04 21 Obstructive sleep apnoea’s Outer retinal tubulations Cover design effect on the eyes Lachlan HESSING Abhishek Sharma Associate Professor Optometry Australia Leo Hartley ABN 17 004 622 431 25 Level 1, 201 Clarendon Street 10 Looking into the future: South Melbourne VIC 3205 the biological contact lens Ph 03 9668 8500 Brain injury assessments bandage Fax 03 9663 7478 Steven Leslie Dr Emily Glover and [email protected] Dr J James Thimons www.optometry.org.au 13 Copyright © 2018 The ocular effects of 27 hypertension Comments made in Pharma are of A new glaucoma treatment a general nature and intended for Paula Katalinic and Professor Leo Semes guidance only. Optometry Australia and Gonzalo Jacome the individual contributors expressly disclaim all liability and responsibility 23 to any person in respect of, and for the consequences of, anything done or 14 Therapeutic News of note omitted to be done in reliance wholly or FEATURE Associate Professor partly on anything in this publication. Mark Roth Pharma is distributed in Australia Chair-side Reference: and New Zealand. All references to Hypertension pharmaceutical preparations in Pharma are applicable within Australia. Michael Yapp / Centre for Eye Health 2 JUNE 2018 Cardiovascular Q and A mounting evidence that, at the very for face-to-face visits when you’re trying least, OSA contributes to faster rates to establish yourself in an area. Visiting of progressive field loss and retinal pharmacists is also very valuable, as ganglion cell loss. Obviously, larger they can refer patients to you and also studies will need to be conducted to feel comfortable calling you when they reveal the mechanism of damage that need advice. may be exacerbating (or even causing) primary open-angle glaucoma (POAG) Phoning the local ophthalmologist and normal tension glaucoma (NTG). when you first refer a patient will help We know that optic nerve dysfunction establish a good rapport. results from hypoxia, acidosis, Associate Professor hypercarbia and airway obstruction, Roth: Hypertension is also a focus of frequently observed in patients with this edition of Pharma, which includes Mark Roth OSA. The mechanism I’ve reported on another excellent chair-side reference in is reperfusion injury as a result of these a series from the Centre for Eye Health. BSc(Pharmacology) factors. As the introductory article from Paula BAppSc(Optom) PGCertOcTher Katalinic and Gonzalo Jacome states: NEWENCO FAAO OAM Roth: I certainly will be including signs ‘hypertension significantly increases and symptoms of OSA in my history the risk of cardiovascular disease.’ What taking. This condition is yet another is the front line General Practitioner example of how optometry can work perspective and main challenges of more closely with medicine. Do you hypertension and cardiovascular health? Associate Professor Mark Roth OAM, think optometrists are under-recognised clinical editor of Pharma interviews with their clinical skills and expertise Hartley: Risk factors for cardio-vascular Associate Professor Leo Hartley, and the part they can play in the health health should be determined. These can one of Australia’s most prominent system? be modifiable and non-modifiable. Risk optometrists who has also completed a calculators have been developed for this medical degree. His dual qualifications Hartley: The increased use of the purpose. and clinical experience provides a ‘doctor’ title by optometrists (in rare insight into the commonality of my opinion, rightly) reflects the The first challenge GPs often have medicine and optometry. increased role that optometrists is getting patients to take care of play as true primary care health themselves (and that means taking Roth: Firstly, congratulations on your professionals. Optometrists have responsibility for their diet, exercise, obstructive sleep apnoea (OSA) article, excellent undergraduate (and in some alcohol intake and of course, smoking). published in this issue of Pharma. It’s cases, postgraduate) training in basic a massive work and it covers the topic sciences, medicinal systemic and eye Brief interventions and referrals to comprehensively. Why do you believe health which form the important STEM allied health professionals (exercise it’s an important topic for optometrists? knowledge needed to stay updated in physiologists, nutritionists) with GP this rapidly-expanding profession. follow-up, can really help to get patients Hartley: It’s my opinion that to change. A healthy diet (with minimal optometrists, as primary care health Roth: What would you suggest to early salt and an emphasis on unprocessed professionals, should be aware of what career optometrists who are interested foods, particularly vegetables and ophthalmic conditions can signal in taking greater responsibilities in some lower-fructose fruits) can go a systemic conditions in our patients. managing their patients? How can they long way to decrease body fat and OSA has emerged as an important risk build bridges with medical practitioners minimise reliance on antihypertensive factor for many systemic associations. and specialists? drugs. Cutting down on established drinking and smoking habits (which Roth: I was surprised to read of the Hartley: Communication is the key. are, effectively, self-medications) takes broad range of ophthalmic associations A routine eye examination report to considerable commitment from patients. of sleep apnoea, such as non-arteritic GPs builds confidence that you know ischaemic optic neuropathy and what you’re talking about. Recognition As you know, depression is a significant central serous chorio-retinopathy. Is by the government that optometrists risk factor for heart disease, so a healthy there sufficient evidence to include can diagnose and expedite referrals diet leading to a healthy gut biome has glaucoma? for diabetic retinopathy has given been shown to decrease reliance on optometry greater credibility in the eyes medication for depression. Hartley: The literature provides of GPs. Of course, there is no substitute JUNE 2018 3 Pharma clinical editor Associate Professor Mark Roth and Associate Professor Leo Hartley discuss the role of optometrists and general practitioners in the management of the cardiovascular system It can be frustrating (albeit essential, Roth: Hypertension is not like a dial in many cases) having to rely on where you can turn pressure up and medications to control patients’ blood down accurately. What drugs are mainly pressure. Also, of course, several studies used and are there new advances in have shown (as with glaucoma) quite medical therapy? poor medication adherence 12 months after initiation. Hartley: Firstly, just as in glaucoma, we want to assess the risk of morbidity Roth: On the positive side, there before commencing treatment. See Table is strong evidence that controlling 1 below for a list of hypertension drugs. hypertension leads to reduced cardiovascular disease-related morbidity Roth: All drugs come with potential Associate Professor and mortality. Is it as simple as that? side-effects. This is why an initial Leo Hartley case history of ALL the drugs a patient Hartley: Obesity, and dietary salt is taking is so vital. Several vascular MBBS DipAppScOptom FACBO intake of course, lead to hypertension, medications come with significant FACO GradCertHltProfEd cardiovascular disease and diabetes. ocular effects. For example: Digoxin for GradCertOcTh These conditions, if left untreated, lead atrial fibrillation can cause xanthopsia, to a cascade of events that include renal or yellowing vision. What are the main disease, stroke and heart attack. CV drugs for optometrists to look out University of Melbourne for? University of Sunshine Coast My emphasis is on the whole patient. That is: encouraging the patient to Hartley: Digoxin is fortunately not work with me to take charge of their used that often these days. Most of the health as a whole and to see me as beta-blockers will have an effect on their health coach (who has a wide IOP and may cause dry eye (so may armamentarium of advice, other health need tear lubricants concomitantly). I Hartley: I believe there is certainly professionals and medications to help usually don’t start a glaucoma patient no harm in checking blood pressure in that process). Just as optometrists on a topical beta-blocker if they’re on a and doing a random blood sugar test. do when helping patients make systemic beta-blocker already. That’s not In some cases where the patient has appropriate lens choices, I try not to to say it won’t have an additive effect, never consulted a GP, it can be a game just prescribe treatments without the because it may. changer. For others, the more times a patient’s involvement in the decision- patient is reminded that they need to making. Although, sometimes in cases Roth: What are your views regarding look after themselves, the better.
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