ZOA Newsletter May 2014

Dear friends and Colleagues,

We are well into 2014 and definitely time to take some fresh action to do work that pushes you to your ends and wows a patient. ZOA website construction has begun and we are in the process of gathering and putting together information to be put up on the site. Membership fees are $200 with seniors (60+) $100 and student optometrist $50.

Message from the President’s Desk

Since the AGM in March, it has pretty much been all systems go! Hardly a few days go by without some ZOA work needing to be tackled. The new executive team had its first meeting on the 30th March and we set out to put in place plans for the year 2014 – 2015. I will say that although the amount of work that we would like to do is somewhat overwhelming, it is good that the team is made up of both seasoned and new members – a healthy mix of new ideas and a wealth of experience!

As you will have read from the e-mail I sent to you, we met with CIMAS to obtain clarification on the issue of the requirement for submission of prescriptions with the quotation. I hope that you all read the e-mail and are satisfied with the explanation given by CIMAS.

I am excited to report that our membership of AFCO and of WCO has resulted in an invitation by WCO to train two Optometrists from the ZOA in the area of advocacy.

“One of the main objectives of the World Council of Optometry (WCO) is to ensure that

Optometry is recognised as a key primary health profession, that it is properly regulated and is able to maintain high standards of education and practice. This will ultimately benefit the population and help in the prevention of blindness from avoidable causes.

WCO as the only optometric body in official relations with the World Health Organisation

(WHO) is able to influence decision-makers at the global level on the importance of the profession.

For this reason, WCO has developed an advocacy strategy for the period 2014-2017. WCO is eager to strengthen the capacities of its members to influence and generate policy change effectively. “

Richard Maveneka and I will be attending the training.

As the new President of the ZOA, I am excited at the prospects for growth of our body. It is my hope that as we strengthen the association, Optometrists in Zimbabwe will have more of a presence and influence in the medical fraternity and in the eyes of the public. There currently, is too low an understanding of who we are and what we do as a profession and I would like to be able to close the door at the end of my year in February 2015, with the knowledge that we have educated our medical colleagues and the profession at large and given them a better understanding of the importance of Optometrists as primary eye care practitioners. Within the association itself, it is my hope that by the end of this year, we will have vastly improved the communication from the executive committee to the members, we will have an active website that will be useful to all, all committees will have performed their mandate for the year, we will have clearly documented the history of the ZOA and will also have created a proper institutional memory so that the teams that take over after us will find the association easy to run. ZOA would like to know if any of its members have anyone that may assist us with legal services.

I look forward to a great year. Please feel free to get in touch anytime with comments and / or suggestions.

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We have a report from Alastair Heyes outlining what his role as part of the PCZ practice control committee involves and where the ZOA assistance is required.

Practice Control Committee of the Pharmacists Council

As the optometrist member of the Practice Control Committee I think it would be useful to give a brief explanation of the areas of optometry practice commonly covered by this committee:

Assessing of applications from persons wishing to be put on the register of Optometrists and Dispensing Opticians.

This involves a check on their professional qualifications and at times contacting the institution that issued the degree certificate for confirmation. Interviews of applicants are also carried out when further clarification is required.

Due to the difficulty in assessing some applicants the PCZ would like to introduce professional qualifying exams (already in place for pharmacists). They have asked the ZOA to produce appropriate examination papers.

Assessing of applications to open a new optometric company or to open an additional practice of an existing registered company. This involves checking the shareholding status of the company directors to ensure that the majority shareholder is a registered optometrist or dispensing optician as required by the Health Act.  Also to ensure that the premises inspection has been carried out by the local council and the Health Professions Authority.

Assessment of inspection reports issued by the HPA that highlight deficiencies in aspects of the inspected premises. Issues encountered include practices operating without current HPA registration and inadequate aspects of hygiene.

It is worth remembering that it is the responsibility of each practitioner (whether you are an owner, an employee or a locum) to ensure that any practice that you work in is correctly registered with both the PCZ and the HPA in terms of the Health Act.  Disciplinary action is taken against all practitioners who work in practices that do not meet the requirements of the Health Act.

Assessment of requests for advertising. Although advertising is still not permitted by the Health Act some limited information can be given out informing of details of a new practice / opening hours etc. All applications have to be approved before being used by the practice.

The PCZ often requests input from the ZOA on issues concerning regulation and development of the profession. It is important that we engage fully with them and respond promptly to their requests so that decisions are not made without our input.

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Clinical Optometry: How Hypertension affects the eye

In clinical practice, we encounter a couple of health conditions with such regularity that we may not even think twice when we see the ocular manifestations of them. It’s well known that hypertension (HTN) can lead to many different morbidities, including myocardial infarction, stroke and damage to various systemic organs (most notably the kidneys). This condition strains the cardiovascular system, which can cause vascular changes that we see frequently in the eye care setting. (Bear in mind that other conditions, namely diabetes mellitus, can have similar retinal changes and should be considered as a differential.) Fortunately, we can often observe “warning signs” in and around the eyes.

Effects on the Cardio System
To understand the effect of HTN in the eyes, we need to understand how these conditions affect the traditional blood flow through the cardiovascular system. Hypertension causes the blood to be forced through the vessels at a greater pressure. It is recommended that blood pressure should be performed on all patients over the age of 20 at every routine medical exam and every two years regardless of any previous hypertension diagnosis. Two or more measurements of high blood pressure indicate a diagnosis of HTN. The exception is when malignant hypertension (hypertensive emergency) is present, which is considered a medical emergency and occurs when the systolic reading exceeds 180mm Hg and/or the diastolic number exceeds 110mm Hg.
HTN is a major factor in cardiovascular disease because it puts added strain on the heart and vasculature. It also is linked to myocardial infarctions (MI) and cerebrovascular accidents (CVA), or strokes. Further, the stress caused by HTN on the various organs can result in significant damage and even failure. Renal failure is a serious consequence of high blood pressure––especially in the hypertensive emergency phase.

Hypertension and the Eye
We know that hypertensive changes can affect the retina, but let’s first discuss how it impacts the choroid. Because the choroidal vasculature does not have the same autoregulation as the retinal vessels, the increase in blood pressure can cause ischemia. This is due to the arterioles in the choroid constricting, resulting in damage to choriocapillaris and the retinal pigment epithelium (RPE), which appear as white areas on the retina (usually in the posterior pole). This causes the release of exudates into the subretinal space, leading to RPE detachment. In these situations, fluorescein shows areas of non-perfusion. In cases of chronic hypertensive damage, Elschnig’s spots may appear as RPE hypertrophy with surrounding atrophy.
On the retina, HTN begins with a generalized narrowing of the retinal arterioles due to vasoconstriction. If the blood pressure remains high, the retinal arterioles exhibit an increased light reflex that appears like silver or copper wiring.  Over time, the arteriole and venule interface is changed whereby the arteriole impinges on the venule and causes compression at that point, leading to what is often called arteriovenous (A/V) nicking.

If there is continued hypertensive strain on the vasculature, there can be an eventual loss of autoregulation, resulting in damage to the arteriole endothelial cells and the leakage of plasma and blood contents from the vessels––including exudates. This is the point in which flame-shaped hemorrhages and ischemia are noted on funduscopy. Eventually, optic nerve and retinal nerve fiber layer damage can occur. (This can occur with an acute increase in blood pressure, as in malignant hypertension, or continued chronic HTN.) In the malignant hypertensive state, nerve edema and macular exudates in a stellate pattern may be present.

The concern with retinal changes from hypertension is that the strain may result in vessel damage. This is observable in a pending vein occlusion where it can be seen that the arteriole/venous interface causes the flow of the venous blood to be impeded, resulting in a rupture of the vessel and, depending on the location, may result in a branch or central vein occlusion.
The issue with these occlusions is the potential for an ischemic event, yielding the release of vascular endothelial growth factor (VEGF). If left untreated, VEGF may precipitate neovascularization that can cause other vision-threatening conditions, such as macular edema, neovascular glaucoma and fibrosis leading to retinal detachments. When patients present with retinopathy, be sure to refer them to their primary care providers, as they may be at risk for a cardiovascular event.
Hypertensive patients often present with no visual or ocular symptoms. However, some patients do present to eye care providers with vague complaints of headaches, vertigo, lightheadedness, fatigue, intermittent vision changes or blurred vision.
(Extract taken from Review of Optometry)

Upcoming events

20 May CPD lecture

16-18 June WCO/AFCO/University of Lurio conference Maputo

July ZOA conference

13-15 August SAOA conference Cape Town

23 September CPD lecture

9 October World Sight day Chipinge

8 November ZOA social Harare

18 November CPD lecture

Wishing you all success and epic performance

What was the lens’s excuse to the policeman?

-I’ve been framed officer