Residency Programs
West Los Angeles VA Health Care Center
Demographic Information
A review of the demographics of a group of “general” optometry patients seen recently (2015) at the main eye clinic in bldg. 304 yielded the following: Age range: 33-75
Average age: 62 92% male; 8% female
Range of number of pharmaceuticals/medications per patient: 2-33 Average number of pharmaceuticals/medications listed per patient: 11 Range of number of systemic problems listed per patient: 2-33
Average number of systemic problems listed per patient: 17
A review of the systemic problem lists of these optometry clinic patients yielded the following common diagnoses:
80% had dyslipidemia/hyperlipidemia/high cholesterol 64% had hypertension
40% were cigarette smokers 36% had COPD or asthma
36% suffered from post-traumatic stress disorder 32% were diabetic
24% suffered from alcohol abuse or dependance 24% were obese
20% had coronary artery disease
16% were diagnosed with obstructive sleep apnea
16% had cerebrovascular disease (stroke, carotid occlusion, etc) 16% were anemic
Common ocular diagnoses among this group of patients were as follows: 58% had nuclear sclerosis
40% had dry eyes
22% were glaucoma suspects
21% had glaucoma (all types and levels of sevrity included) 14% had cortical cataracts
13% had vascular retinopathy (hypertensive, diabetic, anemia/thrombocytopenia, etc.)
9% had hypertensive or diabetic retinopathy 7% had macular degeneration
6% had peripheral vitreo-retinal disease
Other interesting ocular diagnoses in this group: Bell’s palsy
Conjunctivochalasis
Endothelial corneal dystrophy Entropion
Essential blepharospasm Hollenhorst plaque
Homonymous hemianopsia Keratoconus
Myopic retinal degeneration Optic atrophy
S/P Penetrating keratoplasty
Photosensitivity from traumatic brain injury Ptosis
Rosacea
A review of the demographics of patients seen by residents at the GRECC Inpatient ward recently (2014-2015) demonstrated the following:
Age range: 65-98 Average age: 78 96% male; 4% female
Range of number of pharmaceuticals/medications per patient: 3-30 Average number of pharmaceuticals/medications listed per patient: 16 Range of number of systemic problems listed per patient: 5-34
Average number of systemic problems listed per patient: 16
The following was found on review of GRECC inpatient medical problem lists: 64% had hypertension
44% had dyslipidemia
40% had cancer of organs other than the skin (prostate, lung, colon, esophagus, leukemia, etc)
36% had renal disease
32% had cardiac dysrhythmia (atrial fibrillation, atrial flutter, etc) 28% had a history of falls or abnormality of gait
28% were diabetic
28% had COPD, chronic bronchitis, or related respiratory disease 28% had cerebrovascular disease such as stroke or TIA
24% were anemic
24% had thyroid abnormalities 20% had congestive heart failure 20% were cigarette smokers
20% suffered from alcohol dependance or abuse
16% were diagnosed with vitamin D deficiency or vitamin B deficiency 12% had metastatic cancer
The following are the common ocular problems among this group of patients: 76% had cataracts
24% were pseudophakic
20% had macular degeneration, 40% of these encounters had “wet” AMD
20% had a diagnosis of glaucoma, and 60% of these were patients with advanced glaucoma
20% had peripheral vitreo-retinal degenerative conditions (lattice, pavingstone, hole)
12% were glaucoma suspects 12% were legally blind
12% had diabetic retinopathy
Other interesting ocular diagnoses among this group of patients: Amiodarone keratopathy
Anophthalmic socket S/P enucleation
Vascular retinopathy secondary to systemic anticoagulant therapy Cortical blindness
Macular hole
Myopic staphyloma
Ocular ischemic syndrome Optic atrophy
Scleral buckle S/P retinal detachment S/P CRAO
Vitreous hemorrhage
A review of the demographics of a group of patients seen recently (2015) by optometry residents at CLC (nursing homes) yielded the following:
Age range: 56 - 94 Average age: 83 96 % male; 4% female
Range of number of pharmaceuticals/medications per patient: 5-29 Average number of pharmaceuticals/medications listed per patient: 18 Range of number of systemic problems listed per patient: 8-39
A review of the systemic problem lists of these nursing home patients yielded the following common diagnoses:
96% had hypertension 84% had dyslipidemia 60% were diabetic 44% had dementia
40% had congestive heart failure and/or cardiomyopathy 36% had atrial fibrillation or atrial flutter
28% were cigarette smokers
24% had cancer other than skin cancer 24% had coronary artery disease
24% had deep vein thrombosis, peripheral vascular disease, or venous insufficiency 20% had cerebrovascular disease
20% had thyroid dysfunction 20% had COPD or asthma 16% were anemic
12% had seizure disorder
Common ocular diagnoses among this group of patients were as follows: 96% had cataracts in one or both eyes
32% had conjunctivochalasis
24% had age-related macular degeneration 24% were glaucoma suspects
16% were pseudophakic in one or both eyes
16% had glaucoma or were being treated for ocular hypertension 12% had diabetic retinopathy
12% had hypertensive retinopathy 8% were legally bind
Other interesting ocular diagnoses in this group: Acute anterior uveitis
Amiodarone keratopathy Apocrine hydrocystoma Bell’s palsy
Chorioretinal scarring seconary to ocular trauma Epiretinal membrane
Floppy eyelid syndrome
Herpes simplex stromal keratitis
Homonymous quadranopsia S/P stroke
Optic atrophy, legal blindness secondary to anoxic brain injury Optic disc collaterals
Recurrent MRSA conjunctivitis Severe optic nerve hypoplasia S/P penetrating keratoplasty
Ocular toxoplasmosis
Toxic optic neuropathy secondary to ethambutol treatment for MAC infection Traumatic optic atrophy
Vascular retinopathy secondary to acute exacerbation of congestive heart failure A review of the demographics of a group of patients seen recently (2015) by optometry residents while on the low vision rotation yielded the following: Age range: 36-97
Average age: 75 100% male
Range of number of pharmaceuticals/medications per patient: 0-24 Average number of pharmaceuticals/medications listed per patient: 10 Range of number of systemic problems listed per patient: 5-56
Average number of systemic problems listed per patient: 15
Pathologies contributing to the patient’s visual impairment (more than one may apply per patient) included the following:
36% had endstage or advanced glaucoma 32% had wet age-related macular degeneration
12% had diabetic eye disease (extensive PRP, DME, or extensive FML for DME) Other contributors to vision loss included:
Rhegmatogenous retinal detachment Cone macular dystrophy
Vitelliform macular dystrophy Cataract
Aphakia
Intractable diplopia Amblyopia
Central retinal vein occlusion
Nonarteritic anterior ischemic optic neuropathy Homonymous hemianopsia s/p parietal lobe stroke Non-AMD macular scar
Retrobulbar hemorrage secondary to head/orbital trauma Dry/geographic age-related macular degeneration
Cystoid macular edema secondary to branch retinal vein occlusion
A review of the demographics of patients seen in the therapeutic contact lens clinic recently (2015) demonstrated the following:
Age range: 31-76 Average age: 56
Soft contact lens visits: 40%
Corneal (small diameter) RGP visits: 20% Scleral (large diameter) RGP visits: 40% Reasons for therapeutic contact lens wear: Aphakia
High anisometropia Extreme hyperopia Extreme myopia
Epithelial basement membrane dystrophy
Cosmetic for opacified cornea (artificial iris-pupil soft lens) Corneal scarring S/P LASIK and astigmatic keratotomy (AK) Keratoconus
Keratoglobus
Pellucid marginal degeneration Post-LASIK ectasia
S/P penetrating keratoplasty (h/o corneal scarring from HSV keratitis) S/P Deep Anterior Lamellar Keratoplasty (DALK) (h/o post-LASIK ectasia) S/P penetrating keratoplasty (s/p radial keratotomy, astigmatic keratotomy) S/P radial keratotomy
post-LASIK scarring
Residents also provide care to patients living on campus in our “Domiciliaries” and who are participating in drug & alcohol and homelessness rehabilitation programs. This subset of patients tends to be younger and healthier than our typical patients. A review of a group of Domiciliary patients seen by residents in 2015 demonstrated the following:
Age range: 22-70 Average age: 48 96% male; 4% female
Average number of systemic pharmaceuticals/medications listed per patient: 7 Range of number of systemic pharmaceuticals/medications per patient: 0-22 Average number of systemic problems listed per patient: 12
Range of number of systemic problems listed per patient: 1-28
The following was found on review of the same group of Domiciliary patient medical problem lists:
60% were homeless
52% had alcohol dependence or abuse 62% suffered from depression
48% were cigarette smokers
28% had hypertension 24% suffered from PTSD 20% had dyslipidemia 12% were migraineurs 12% had hepatitis C 8% were diabetic
8% had cancer (other than skin cancer)
Common ocular conditions included the following: 50% had nuclear sclerotic cataract
25% were glaucoma suspects and/or had ocular hypertension 24% had cortical cataract
20% had dry eyes
12% had peripheral vitreoretinal disease (holes, lattice, pavingstone, etc.) 7% had hypertensive retinopathy
4% had diabetic retinopathy 3% had macular degeneration
Other interesting ocular diagnoses in this group: Radiation-induced eyelid dermatitis
Endothelial corneal dystrophy (Fuch’s) Solar retinopathy
Accommodative paresis secondary to anti-seizure medication Pupillary mydriasis secondary to anti-parkinsonism medication Eyelid myokymia
Floppy eyelid syndrome secondary to obstructive sleep apnea Cranial nerve VI palsy
Photosensitivity secondary to traumatic brain injury Optic nerve melanocytoma
Chronic CSR
Chronic angle closure glaucoma
