Range of number of pharmaceuticals/medications per patient: 2-33 Average number of pharmaceuticals/medications listed per patient: 11

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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.)

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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

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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

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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

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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

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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

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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

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References