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A lifetime of optometric care
Michael Tanzer
Optometrists are the main primary healthcare providers of visual correction and, like pharmacists, cover all ages. By understanding patients’ visual needs, pharmacists can also assist them to achieve vision outcomes.

Optometrists are the main primary healthcare providers of visual correction and, like pharmacists, cover all ages. By understanding patients’ visual needs, pharmacists can also assist them to achieve vision outcomes.

Optometrists will normally first see children in early primary school, although preschool screening programs detect visual issues at younger ages, often based on congenital or family history, which can involve earlier optometric care. Children tend to fall into three categories of care:

  • Visual correction, often through spectacles or myopia control measures (see below).
  • Disease detection and management, mainly conjunctivitis that is commonly viral or allergy-related, but can be bacterial in infants. Some serious conditions can occur that can be related to rare genetic disorders, cataracts, neurology or tumours of the retina.
  • Functional impairment management for amblyopia (‘lazy eyes’) or eye movement deficiencies. It is more problematic if these patients are treated after school age when the ability to mitigate amblyopia is reduced.

Adolescence and maturity

As teenagers progress to young adults, myopia or 'shortsightedness' – blurred distance vision generally due
to slightly enlarged eyeball – can become a major issue.
In Australia, the incidence of myopia has increased by 50% over the past decade and prevalence is now more than 30% of the population under the age of 17. Many optometrists use myopic control techniques that involve contact lenses, specialised spectacle prescription and medicated drops in an attempt to arrest its advance. Other functional issues with eye movement and tracking, especially in coping with increased computing and near work-to-distance refocus tasks (classroom) are also reviewed. 
The major health issues again revolve around infection and congenital issues, although keratoconus (a thin steep cornea) caused through eye rubbing also requires a more holistic approach to allergy management.

In this age group, extra consideration is given to sport and recreation, work safety considerations, occupation requirements and chronic disease prevention. Sun protection including sunglasses, occupational spectacles, safety work spectacles, contact lenses and lubricants are all key considerations. Background conditions such as diabetes also require close monitoring with treatment of the underlying condition, in which the optometrist is part of a larger team.

Background conditions such as diabetes also require close monitoring with treatment of the underlying condition, in which the optometrist is part of a larger team.

Adulthood

Visual correction and some serious eye diseases are more stable in the adult years, up to age 40 or so. Over 40, glaucoma, cataract, diabetic retinopathy and macular degeneration significantly rise as risk factors and in prevalence.

Presbyopia – near-vision blurring due to lens hardening –
is also apparent in nearly 99% of cases, with onset between 40 and 50 years. Hence, as we age optometric care becomes significant, mainly from prescribing readers, computing and other lifestyle corrections.

Some background corrective issues (astigmatism and hyperopia long-sightedness) can also present as more of an issue if not previously corrected when the more flexible, younger lens may have masked it.

In this age group, greater prevalence of tear dysfunction can occur, although these may be present earlier due to work environmental concerns (computers, air-conditioning, lighting, etc). Other systemic conditions involving arthritis, thyroid problems and auto-immune conditions, will aggravate tear dysfunction.

Old age

Past the age of 60, the incidence of glaucoma, macular degeneration and cataracts in particular increases greatly. Coupled with systemic conditions such as diabetes, hyperlipidaemia and hypertension, these problems can affect the retina specifically, meaning optometric care is very focused on disease management.

Ocular lubricants become a major daily proposition, along with managed ophthalmological care and ensuring visual correction stays optimal. Optometrists have specialised equipment that can accurately measure functional and anatomical changes at cellular level in the retina for early diagnosis. These tests are especially useful with glaucoma, macular degeneration, and retinopathy from diabetes and hypertension.

Pharmacy and 'the vision thing'

Common issues that pharmacy may face include:

  • Contact lenses - patients will have a recommended regime from their optometrist and will generally involve a daily
rub (cleaner or multi-purpose solution) and a disinfectant (hydrogen peroxide with a neutraliser or multi-purpose solution). However, hard or rigid gas permeable lenses require a different set of solutions.
     
  • Drops (tear supplements) – if patients don't blink enough (especially when using a computer), are in heavy air- conditioning, sit in front of a fan or have a background condition affecting the tear layer, they may form a dysfunction that will present as stinging, burning and or marked watery response. Tear supplements may help in about 70% of cases. The other 30% may be due to a problem in the lipid layer that helps bind the tears together and to the ocular surface, for which lipid-preserving drop works best. As a rule for all drops, an unpreserved unit dose is best because preservatives can cause irritation.
     
  • Conjunctivitis therapy – most commonly viral or allergy in origin. Itching, rubbing and localisation is key to treatment. Allergy-related conjunctivitis requires a mast cell inhibitor drop, or an antihistamine if seasonal. Bacterial conjunctivitis is usually more mucous-related and requires an antibiotic. 
If the condition is mild, treatment can be initiated but if there is pain, blurred vision, photosensitivity or any other unusual symptom, then referral is best.
     
  • Sun protection – wraparound sunglasses are considered much better for cataract prevention then the standard, more fashionable types.

Working together

Pharmacists and optometrists are encouraged to work together to get better health outcomes for their patients. Knowing your local optometrist and understanding their experience and the services that they provide will help you deliver better health services for your patients. As a general rule, pain and blurred vision symptoms do require referral for investigation.

It is also good to ensure patients are having a regular eye assessment (every two years).