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Emergency, Acute And Rapid Access Ophthalmology...


There are two parts to the book; the first section makes up the bulk to the textbook and covers clinical aspects of emergency ophthalmology, and the second discusses the management and organisation of an emergency and rapid access service.




Emergency, Acute and Rapid Access Ophthalmology...



Acute retinal arterial ischemia, including vascular transient monocular vision loss (TMVL) and branch (BRAO) and central retinal arterial occlusions (CRAO), are ocular and systemic emergencies requiring immediate diagnosis and treatment. Guidelines recommend the combination of urgent brain magnetic resonance imaging with diffusion-weighted imaging, vascular imaging, and clinical assessment to identify TMVL, BRAO, and CRAO patients at highest risk for recurrent stroke, facilitating early preventive treatments to reduce the risk of subsequent stroke and cardiovascular events. Because the risk of stroke is maximum within the first few days after the onset of visual loss, prompt diagnosis and triage are mandatory. Eye care professionals must make a rapid and accurate diagnosis and recognize the need for timely expert intervention by immediately referring patients with acute retinal arterial ischemia to specialized stroke centers without attempting to perform any further testing themselves. The development of local networks prompting collaboration among optometrists, ophthalmologists, and stroke neurologists should facilitate such evaluations, whether in a rapid-access transient ischemic attack clinic, in an emergency department-observation unit, or with hospitalization, depending on local resources.


Grades II to IV. For more severe burns, the control of inflammation in the acute phase, particularly the first week after injury, is of utmost importance. Hourly application of topical prednisolone acetate 1 percent is recommended while the patient is awake for the first seven to 10 days. This should be rapidly tapered between days 10 and 14 to minimize the risk of corneal melting.


The Clinica London Ophthalmic Consultants are available for Urgent Eye Care conditions and treatments. You can request rapid access for urgent and emergency eye care by e-mailing contact@clinicalondon.co.ukor calling our Reception on 020 7935 7990.


If you have any of the above or if you or, as a professional medical person think you have, then you require an urgent eyelid and eye assessment. All of the above conditions are regularly treated by all of the ophthalmic consultants at Clinica London. We prioritise rapid access for treatment of the above conditions.


The early recognition and assessment of urgent and emergency eye problems and the provision of urgent and emergency eye care at Clinica London can help save you vision and life. Do not hesitate to contact our Reception to arrange a rapid access appointment with one of our award-winning team of eye surgeons for your urgent eye diagnosis and prompt treatment.


Figure 9-4. Laser Peripheral Iridotomy. The definitive treatment for acute angle closure glaucoma is laser peripheral iridotomy. A. Normal flow of aqueous humr in an eye with an open drainage angle. B. In acute angle closure glaucoma aqueous humor cannot pass through the pupil (pupillary block). Fluid collects behind the iris causing it to bow forward and close the drainage angle. The obstruction of aqueous humor drainage causes a rapid rise in intraocular pressure. C. The treatment for acute angle closure glaucoma using the laser to produce a hole in the iris (laser iridotomy). D. Aqueous humor can bypass the pupil and make its way to the trabecular meshwork and out of the eye. Bypass of the pupillary block reduces bowing of the iris and opens the drainage angle.


To gain further insight into the impact of COVID-19 on urgent wet ARMD services across the UK, we conducted a self-administered QualtricsXM survey among retinal consultants. Individual survey links were sent to 53 consultants at 46 institutions. We received 18 responses (34% response rate) from hospitals with rapid access wet ARMD services across England and Northern Ireland (Fig. 1). No responses were received from units in Wales or Scotland. Eight units (44.4%) performed optical coherence tomography imaging on fellow eyes during the lockdown period (Fig. 2).


To facilitate the safe continuation of rapid access wet ARMD services, some units cancelled routine monitoring clinics, moved to peripheral sites, put in place physical distancing or one-stop virtual clinics. However, some respondents noted that the need for physical distancing has reduced their capacity, while others reported that some patients declined to attend due to anxiety, shielding or the lack of transport options.


The time of diagnosis of OCS is not the time to be first learning the procedure, the necessary equipment, its indications and contraindications, and complications. A survey study suggested that over 90% of EPs felt inadequately trained in LCIC5. There are plenty of online resources that teach how to perform the procedure. Prepare yourself for the procedure by practicing on cadavers,6 animals,7 or low-fidelity simulation models.8 It can also be beneficial to create a kit with the necessary equipment for rapid access to the appropriate tools.


These include services that can be accessed with or without a referral, such as 24/7 emergency and acute care, general and internal medicine, cardiac care, obstetrics, general surgery and certain surgical subspecialties, inpatient and outpatient care.


Some private insurance is offered by employers, but individuals can also purchase policies. Private insurance offers more rapid access to care, choice of specialists, and better amenities, especially for elective hospital procedures; however, most policies exclude mental health, maternity services, emergency care, and general practice.10 According to a 2014 investigation, four insurers account for 87.5 percent of the private insurance market, with small companies making up the rest.11


We offer an emergency eye service and rapid access eye service to appropriately referred/triaged patients. Our community Adult Eye clinics are held at Cheshunt Community Hospital. Our Orthoptist led Community pediatric services are held at Tynemouth Road clinic, Stuart Crescent Health Centre, Hornsey Central Clinic and Waltham Cross Health Centre.


Clinically it can be difficult to diagnose, because the symptoms can be insidious [15, 16]. Evidence suggests that increasing numbers of patients are being investigated for suspected GCA [17]. Across Europe, rheumatology centres have set up rapid access investigation pathways, resulting in improved outcomes for patients [18]. Advancing imaging techniques have demonstrated a larger portion of patients with large vessel involvement both with auxiliary ultrasound [19] and formal large vessel imaging studies [20]. In management of the disease, we now acknowledge that many patients with GCA are exposed to high cumulative doses of glucocorticoids (GC), resulting in significant increasing long-term [21]. The first ever therapy, Tocilizumab, that is specifically licensed for GCA and may be used as a GC-sparing agent, was given regulatory approval in 2017. GCA is moving from a condition managed by many specialists to a disease requiring expertise in both the diagnosis and long-term management of the condition.


To reduce diagnostic delay, improve likelihood for securing diagnosis and improve patient outcomes, patients with suspected GCA should be referred to a rapid access specialist GCA service where available. 041b061a72


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