For most of us, our vision is something that we don’t appreciate until we have a problem with it. When I see my patients with diabetes, I always make sure that I have documented their eye exam, along with their foot exam and microalbumin and hemoglobin A1C levels. It often feels like I am just checking the boxes.
Recently I saw a patient with diabetes who was new to me. She has had diabetes for more than 10 years and her blood glucose levels generally have been well-controlled. She had no visual problems but was past due for her eye exam, so I referred her to a local optometrist. The exam found significant retinopathy. She was diagnosed and is being treated. Making sure that we “checked the box” has made a significant difference in her life by preventing vision loss.
Though many of our patients have optometrists or ophthalmologists, most of us see patients for eye problems almost every week. Eye conditions account for 2% to 3% of primary care and emergency department visits.1 Many of these conditions are self-limited or can be managed easily with conservative measures or topical treatments. However, patients occasionally present with vision-threatening ocular conditions for which prompt recognition and appropriate referral are critical to prevent permanent vision loss.
Section One discusses common eye conditions that generally can be managed in the family medicine setting, including hordeolum and chalazion, conjunctivitis, and corneal abrasion and corneal foreign body. This section focuses on risk factors for and diagnosis and management of these conditions. Section Two reviews primary open-angle glaucoma and cataract, and discusses risk factors and presentations as well as when to refer patients to an ophthalmologist. Section Three covers diseases that affect the retina, diabetic retinopathy, and age-related macular degeneration. Section Four discusses initial management of ophthalmic emergencies related to acute angle-closure glaucoma, retinal detachment, and mechanical eye trauma.
The information in this edition will help you confidently and effectively treat patients with eye conditions that frequently are seen in our family medicine practices.
Ryan D. Kauffman, MD, FAAFP, Associate Medical Editor
Founder, Hickory Medical Direct Primary Care
Bellefontaine, Ohio
