Beruflich Dokumente
Kultur Dokumente
11
Conversely,correctingachildsmyopiawithnegativelensesmayresultincompensatoryaberranteye
growthandthedevelopmentofmyopia.10Animalexperimentshaveshownthatcompensatorychanges
intheaxiallengthofaneyemayoccurinresponsetoerrorsignalsfromlensinduceddefocus.10,12Ina
nonrandomisedclinicaltrialevaluatingparttimedistancespectaclewearintheUnitedStates,43
myopeswerecategorisedintofourtreatmentgroups:(a)fulltimespectaclewear,(b)wearfordistance
viewingandthenaswitchtofulltimewear,(c)wearfordistanceviewingonly,and(d)nonwear.Over
aperiodof3years,therewerenosignificantdifferencesinrefractiveshiftsasmeasuredbynon
cycloplegicdistance
Myopiaisclassifiedinasimplemanneras
i)simple
ii)pathological
SimpleMyopiaisnotprogresivebeyondtheamountincludedwithinnormaldevelopment;isassociated
withgoodvisionandrequiresnotreatmentexceptopticalcorrection.
PathologicalMyopiaontheotherhandisadegenerativemyopiaaccompaniedbychangesinthe
posteriorsegmentoftheeyeballwithlengtheningofAPaxisoftheglobe.Besides,theaxial
pathologicalmyopia,thereareothertypesofmyopiaduetodefectsinthecurvatureofcorneaandlens
andduetodrauma.Today,IwillconfinemyremarksonlytopathologicalaxialMyopia.
Thepathologicalmyopiashowsdegenerativechangesintheposteriorpole.Thusitcanbenamedas
degenerativemyopia(DukeElder).Itmayoccurasanindependentdevelopmental(congenital)
conditionorinassociationwithotherocculardiseasesorgeneraldisease.
VonJeagerfirstdescribedcongenitalmyopiain1855.Sincethenanumberofcaseshavebeen
reported.Majorityofcongenitalmyuopiasremainstationary.Someprogressfurtherleadingto
detachmentoftheretina.Visionisgoodinsomecases,whileinothersitissubnormal.
beinducedareformdeprivationandopticaldefocus.Formdeprivationmyopiacanbeinducedbythe
applicationoftranslucentoccludersovertheanimalseyes.Localretinaleffectsmayoccurandthe
resultantscleralgrowthmodulatedbychemicalssuchasdopamine,growthfactors,andmuscarinic
antagonists.79Negativespectaclelensesinchicksinducecompensatoryaxialelongationandmyopia.10
Suitabletherapeuticmodalitiessuchaspharmacologicalinterventionsandopticalcorrectivedevices
thatmayretardtheprogressionofmyopiainmyopicindividualshavebeenreported.The
overwhelmingmajorityofthesereportshavebeencitedinoptometryandnotophthalmologyjournals.
Theopticalcorrectionofmyopiaandoptimalstrategiestopreventtheprogressionofmyopiahavebeen
developedandprescribedlargelybyoptometrists.Ontheotherhand,issuesregardingthecausesand
preventionofmyopiahaveonlygainedinterestamongophthalmologistsintherecentdecade.The
objectiveofthis
Myopiahasbeenknownformorethan2000yearsandwasfirstdescribedbytheancientGreeks.1,2
However,despitetherecordeduseofconvexlensesforpresbyopiainthelate13thcenturyinFlorence,
Italy,thecorrectionofmyopicrefractiveerrorhadtoawaitthedevelopmentofconcavelensesinthe
mid16thcentury.
Myopiamaybeclassifiedasschoolmyopiaoradultonsetmyopia.3Schoolmyopiadevelops
duringtheschoolageandstabilisesaround1517yearsofage,whileadultonsetmyopiadevelopsin
youngadults.Theaetiology,pathogenesis,andtreatmentofmyopiahavebeenhotlydebatedinthe
ophthalmiccommunityfordecades.4Thereareseveraltheoriesonthemechanismofdevelopmentof
myopiaarisingfromdisruptionoftheemmetropisationprocess.Emmetropisationisachievedwhenthe
opticalpoweroftheeyematchestheaxiallength,resultinginafocusedimageofadistantobjectonthe
retinawithoutaccommodativeeffort.5Ithasbeenproposedthatoveractingintraocularmusclesmay
resultinexcessiveaccommodationandinfluenceemmetropisation.6Thetwobasicmechanismsby
whichanimalmyopiamay
INTRODUCTION
Optometrists, through their clinical education, training, experience,
and broad geographic distribution, have the means to provide
effective primary eye and visison care for a significant portion of the
American public and are often the first health care practitioners to
diagnose patients with myopia.
This Optometric Clinical Practice Guideline for the Care of the
Patient with Myopia describes appropriate examination and
treatment procedures for myopia and contains recommendations for
diagnosis and management of myopia. This Guideline will assist
optometrists in achieving the following goals:
1.
2.
3.
Tellyourdoctorrightawayifanyoftheseunlikelybutserioussideeffectsoccur:signsofinfection
(e.g.,fever,persistentsorethroat),troublebreathing,unusualtiredness,swellingankles/feet,
burning/painful/frequenturination,decreasedsexualinterest/ability,hairloss,musclecramps/pain,See
alsoWarningsection.
Beforetakingitraconazole,tellyourdoctororpharmacistifyouareallergictoit;ortootherazole
antifungals(e.g.,ketoconazole);orifyouhaveanyotherallergies.Thisproductmaycontaininactive
ingredients,whichcancauseallergicreactionsorotherproblems.Talktoyourpharmacistformore
details.
Beforeusingthismedication,tellyourdoctororpharmacistyourmedicalhistory,especiallyof:liver
disease(orhistoryofliverdiseasewithotherdrugs),kidneydisease,heartdisease(e.g.,coronaryartery
disease,heartvalvedisease,congestiveheartfailure),severelungdisease(e.g.,chronicobstructive
pulmonarydisease
s
Tunikavaskularis(lapisuvea)merupakanlapisantengahbolamataterdiri
ataskhoroid,badansiliarisdaniris.
Tunikaneuralis(lapisretina)merupakanlapisandalambolamataterdiriatasretina.
Howtouseitraconazole
ReadthePatientInformationLeafletprovidedbyyourpharmacistbeforeyoustart
takingitraconazoleandeachtimeyougetarefill.Ifyouhaveanyquestions,consult
yourdoctororpharmacist.
Takethismedicationbymouthwithafullmeal,usuallyonceortwicedailyoras
directedbyyourdoctor.Thecapsulesmustbeswallowedwhole.
Thedosageisbasedonyourmedicalcondition,responsetotreatment,andother
medicationsyoumaybetaking.Besuretotellyourdoctorandpharmacistaboutall
Nooneeversaidthatacareerinmedicinewasgoingtobeeasy.Althoughclinicians
canandshouldshareinthejoysandthesorrowsoftheirpatientsandpracticeina
mannerthatplacesapremiumonpatientcenteredcare,itcanbedifficulttomaintain
equanimityandempathy.Everyonewhohasworkedinhealthcareforanymeaningful
lengthoftimehasexperiencedanabusivepatient.
Verbalabusefrompatientscertainlyoccursmorefrequentlyinspecifichealthcare
settings,includingthepsychiatricinpatientunit.StewartandBowersevaluatedthe
phenomenonofverbalabuseinpsychiatricunitsinastudypublishedintheApril
2013issueoftheJournalofPsychiatricandMentalHealthNursing.[1]Theresearch
focusedon522inpatientsfrom84centers.Amongthesepatients,1398incidentsof
aggressivebehaviorwerereportedduringthefirst2weeksofadmission.Halfofthe
studysamplewasverballyaggressiveatsomepointduringthisperiod.
Themostcommontypesofverballyaggressivebehavior,indescendingorderof
frequency,wereabusivelanguage,shouting,threats,expressionsofanger,andracist
comments.However,alargenumberofchartentriesdidnotspecifythetypeofverbal
aggression.Mostofthecommentsweredirectedathospitalstaffasopposedto
clinicians.Ahistoryofviolentbehaviorandsubstanceabusewerepatientvariables
mostassociatedwithverbalaggression.
Althoughnotthemostcommoncategoryofverbalaggressioninthisstudy,thedata
stillshowthatracistcommentsfrompatientsoccurwithsomeregularity.Therearea
numberofethicalandlegalissuesintreatingracistpatients,andthisisalsoacritical
areaforjobsatisfactionandburnoutamonghealthcareproviders.
SynopsisandPerspective
Itisarareminorityphysicianwhohasnotatleastonceencounteredapatientwho
refusesthephysician'scareoutofbigotry.Infact,itisoneof"medicine'sopen
secrets,"KimaniPaulEmile,JD,PhD,anassociateprofessoroflawandfaculty
codirectoroftheSteinCenterforLaw&Ethics,FordhamLawSchool,NewYork
City,toldMedscapeMedicalNews.
"Somanyphysiciansofcolorcanrecallatleastonetimeintheircareerwhenthis
cameup,"shesaid,"andtherearen'tmeaningfulguidelinesforhowtobalancethe
interestsatstakewhentheseissuesarrive."
DrPaulEmilewroteanarticlefortheUCLALawReviewaboutthisissuefromthe
legalperspectiveseveralyearsago.[2]Severalphysicianssincethenhaveaskedherto
addressitinamedicaljournal,sosheand3othersnowpresentaframeworkforhow
toconsiderthesesituationsinaperspectivepiecepublishedintheFebruary25issue
oftheNewEnglandJournalofMedicine.[3]
"Apatient'srefusalofcarebasedonthetreatingphysician'sraceorethnicbackground
canraisethornyethical,legal,andclinicalissuesandcanbepainful,confusing,and
scarringforthephysiciansinvolved,"DrPaulEmileandcolleagueswrite.
Evenifsuchasituationdoesnotoccuroften,"itcausesalotofheartachewhenit
does,"coauthorAliciaFernndez,MD,fromtheDivisionofGeneralInternal
MedicineattheUniversityofCalifornia,SanFrancisco,toldMedscapeMedical
News.DrFernndezherselfexperiencedsuchasituationasaresident.
Nooneeversaidthatacareerinmedicinewasgoingtobeeasy.Althoughclinicians
canandshouldshareinthejoysandthesorrowsoftheirpatientsandpracticeina
mannerthatplacesapremiumonpatientcenteredcare,itcanbedifficulttomaintain
equanimityandempathy.Everyonewhohasworkedinhealthcareforanymeaningful
lengthoftimehasexperiencedanabusivepatient.
Verbalabusefrompatientscertainlyoccursmorefrequentlyinspecifichealthcare
settings,includingthepsychiatricinpatientunit.StewartandBowersevaluatedthe
phenomenonofverbalabuseinpsychiatricunitsinastudypublishedintheApril