Last updated on 26 Jan 2016 at 3:07 PM (Oph07)

Gradual deterioration in visual acuity over time
A 75 year old, otherwise healthy Indian woman, who drives and reads avidly, notices increasing difficulty seeing road signs and reading the newspaper over six months. Five years previously she had cataract surgery to both eyes which greatly improved her vision. After the cataract operations she noted 'I could see like I was 20 years younger'. Current visual acuity is 6/12 right and 6/24 left with spectacles.

 

Applied Science for Medicine
Anatomy of the eye with focus on the choroid and retina
Physiology of vision: alignment and function of photoreceptors
Effect of ischaemia and vascular growth factors on vascular function; effect of ultra-violet light on the eye; effect of oxidative damage to tissue
Pathogenesis of glaucoma
Effects on the eye of commonly used eye drops
Pharmacology of anti-VEGF (vascular endothelial growth factor) therapy - vascular endothelial growth factor inhibitors

Clinical and Communication Skills
Elicit a relevant history of gradual vision loss
Measure visual acuity for distance and near, and record accurately
Assess macular function (e.g. use of Amsler grid)
Assess visual fields to confrontation
Ophthalmoscopy to identify any media opacities (e.g. cataract) and assess fundus
Distinguish acute from chronic vision loss; distinguish between retinal causes and other common, slowly advancing, age related causes of vision loss (e.g. cataract, glaucoma)
Driving standards for vision, return to work capabilities, occupational standards for vision (monocular and binocular)
Patient education: appropriate recommendations, advice regarding risks and appropriate referral for significant vision loss, patient self-monitoring, appropriate use of dietary supplements, cessation of smoking, treatment options

Personal and Professional Skills
Team work: understanding the role of other ophthalmic and non-ophthalmic health professionals (e.g. optometrists) in identification, monitoring and referral
Clinical reasoning: using key signs and symptoms to establish most likely diagnosis

Hauora Māori
Consideration of access to cultural / spiritual support for patient and whānau

Population Health
Epidemiology of common age-related eye diseases that may profoundly affect vision: age-related macular degeneration, chronic open angle glaucoma, cataract, and diabetic retinopathy
Cost to individual and community of blindness and severe visual impairment
Cost to health boards of universal treatment for age-related macular degeneration

 

Conditions to be considered relating to this scenario

Common

age-related macular degeneration, senile cataract

Less common but 'important not to miss'

advanced chronic open angle glaucoma, diabetic retinopathy (maculopathy)