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CATARACT

Population

  • – Adults with cataracts.

Recommendations

AAO 2018

  • – Obtain initial history of symptoms, ocular history, systemic history, assessment of visual functional status, and medications currently used.

  • – Include the following elements in the initial physical exam: The visual acuity with current correction, external examination, ocular alignment and motility, pupil reactivity and function, measurement of intraocular pressure, slit-lamp exam, and dilated examination with ophthalmology.

  • – Remove cataracts when visual function no longer meets the patient’s needs and cataract surgery provides a reasonable likelihood of quality-of-life improvement.

  • – Remove cataracts when there is evidence of lens-induced disease or when it is necessary to visualize the fundus in an eye that has the potential for sight.

  • – Avoid surgery under the following circumstances:

    • Tolerable refractive correction provides vision that meets the patient’s needs and desires; surgery is not expected to improve visual function, and no other indication for lens removal exists.

    • The patient cannot safely undergo surgery because of coexisting medical or ocular conditions.

    • Appropriate postoperative care cannot be arranged.

    • Patient or patient’s surrogate decision-maker is unable to give informed consent for nonemergent surgery.

Comments

  1. Routine preoperative medical testing does not appear to measurably increase the safety of the surgery.

Sources

  • American Academy of Ophthalmology Preferred Practice Pattern: Cataract/Anterior Segment Summary Benchmark. 2018. http://www.aao.org

  • – American Optometric Association Consensus Panel on Care of the Adult Patient with Cataract. Optometric Clinical Practice Guideline: Care of the Adult Patient with Cataract. 2004. http://www.aoa.org

CATARACT IN ADULTS: EVALUATION AND MANAGEMENT ALGORITHM

CERUMEN IMPACTION

Population

  • – Children and adults.

Recommendations

AAO-HNS 2017

  • – Treat cerumen impaction when symptomatic or prevents a needed clinical examination.

  • – Treat with an appropriate intervention:

    • Cerumenolytic agents (water or saline, Cerumenex, addax, Debrox, or dilute solutions of acetic acid, hydrogen peroxide, or sodium bicarbonate).

    • Irrigation.

    • Manual removal.

Source

Comments

  1. Ear candling is not recommended for treatment or prevention of cerumen impaction and has caused harm to patients.

  2. Removal of cerumen is not necessary if the patient is asymptomatic and adequate clinical exam is possible.

HEADACHE

Population

  • – Adults

Recommendations

ACR 2019

  • – No imaging:

    • Uncomplicated headaches.

    • New primary migraine or tension-type headache, with normal neurologic examination.

    • In the initial assessment of chronic headache, without new features or neurologic deficit.

  • – Urgent red ...

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