This article is more than 5 years old. Information may no longer be current.
PCON Symposium topics cover systemic disease, uveitis, vitamin use
Click Here to Manage Email Alerts
PHILADELPHIA – Lecturers here at the Primary Care Optometry News Symposium mirrored the topic range of the publication in their talks on primary care issues.
Systemic concerns: Stroke, Coumadin use
PCON Editorial Board member Bruce E. Onofrey, OD, RPh, FAAO, teamed up with PCON columnist Leonid Skorin Jr., OD, DO, FAAO, to offer advice on systemic-related conditions such as stroke.
Ninety percent of those who have had ischemic stroke have some sort of disability, according to Dr. Skorin. “Evidence-based medicine shows that if we can modify the risk factors, we can prevent or ameliorate the damage that could or does occur,” he said. “There’s no consistent systematic management of stroke risk factors.”
He added that 30% of stroke victims will have another stroke in 5 years.
Mayo Clinic is conducting a trial to analyze long-term morbidity and mortality of stroke victims, said Dr. Skorin, including looking at modifiable risk factors and lifestyle issues for lessening the likelihood of a second stroke. Factors such as hypertension, cholesterol and smoking must be controlled to reduce risk, he said.
Dr. Onofrey advised attendees to question age-related macular degeneration patients about Coumadin (warfarin sodium, DuPont) use. “Often, AMD patients are advised to eat green, leafy vegetables,” he said. “This is a contraindication for Coumadin because it can cause increased bleeding.”
Nutritional supplements
In his talk on nutritional supplements, Dr. Skorin urged practitioners to watch for hypervitaminosis A, a condition that can cause pseudotumor cerebri. Dr. Skorin said the recommended daily allowance of vitamin A is 5,000 IU, with the vitamin being toxic at levels greater than 10,000 IU.
Dr. Skorin pointed out that PreserVision (Bausch & Lomb) contains 14,000 IU of vitamin A, “but this is not completely absorbed,” he said.
He cautioned practitioners to watch for patients taking ginkgo biloba, Coumadin and aspirin. “This is a bad combination,” he said.
History may explain young patient’s bilateral uveitis
 |
 |
|
| Systemic concerns: Leonid Skorin Jr., OD, DO, FAAO (left), and Bruce E. Onofrey, OD, RPh, FAAO, teamed up to share their experience with systemic conditions and nutritional supplements. Images: Hemphill N, PCON | ||
PCON columnist Marlane J. Brown, OD, FAAO, of Minnesota Eye Consultants, presented the case of an 11-year-old soft contact lens wearer who may have developed bilateral uveitis from an unlikely source.
The girl, a 5-D myope, complained of blinking and squinting for about a month. “The child described incredible light sensitivity,” Dr. Brown said. “She couldn’t look straight at people.”
The girl’s anterior chamber showed “2+ cells and flare. Her conjunctiva was white and quiet,” Dr. Brown continued.
Her history included contact lens overwear and a spate of recent vaccinations.
Dr. Brown diagnosed the girl with bilateral uveitis and asked the audience what their next step might be. “Had she been worked up for rheumatoid arthritis?” asked Michael D. DePaolis, OD, FAAO, course director, PCON editor and Dr. Brown’s co-lecturer.
Dr. Brown said she called the girl’s pediatrician to confer, and they both agreed the patient should be tested for juvenile inflammatory arthritis, among other conditions. A complete blood work-up was ordered.
“On examination, you really do need to narrow down the differential diagnosis,” Dr. Brown told the audience. “Optimize your laboratory testing. Direct your appropriate referrals and do a complete examination of the eye and adnexa.”
With juvenile inflammatory arthritis, if uveitis occurs, it is about 2 years after onset of those symptoms, Dr. Brown explained. “This patient was otherwise healthy when she first came in to see me,” she said.
The patient returned a week later for a follow-up. With treatment, the uveitis had cleared up, but her blood work did not provide a clear-cut reason for it. “Her workup was negative, with no signs of rheumatoid and no signs of juvenile inflammatory arthritis,” Dr. Brown said.
Upon further questioning, the girl’s mother said she had complained of wrist and ankle pain after receiving DPT (diphtheria, pertussis and tetanus) and pneumococcal vaccines. Dr. Brown said upon further research she found there may be a link between the vaccines and the patient developing bilateral uveitis. “The pediatrician tried to dismiss it, but I believe that could have been the cause,” she said.
A note from the editors:
These meeting highlights appeared first at PCONSuperSite.com. See next month’s issue of Primary Care Optometry News for further symposium coverage.