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This article was downloaded by: [Central Michigan University] On: 08 October 2014, At: 08:39 Publisher: Cogent OA Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK South African Family Practice Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/ojfp20 Ophthalmoscopy for general practitioners Solani Mathebula BOptom, MOptom, DPhil a a Department of Optometry, University of Limpopo E-mail: Published online: 15 Aug 2014. To cite this article: Solani Mathebula BOptom, MOptom, DPhil (2011) Ophthalmoscopy for general practitioners, South African Family Practice, 53:5, 501-501, DOI: 10.1080/20786204.2011.10874141 To link to this article: http://dx.doi.org/10.1080/20786204.2011.10874141 PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Versions of published Taylor & Francis and Routledge Open articles and Taylor & Francis and Routledge Open Select articles posted to institutional or subject repositories or any other third-party website are without warranty from Taylor & Francis of any kind, either expressed or implied, including, but not limited to, warranties of merchantability, fitness for a particular purpose, or non-infringement. Any opinions and views expressed in this article are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor & Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions It is essential that you check the license status of any given Open and Open Select article to confirm conditions of access and use.

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Page 1: Ophthalmoscopy for general practitioners

This article was downloaded by: [Central Michigan University]On: 08 October 2014, At: 08:39Publisher: Cogent OAInforma Ltd Registered in England and Wales Registered Number: 1072954 Registered office: MortimerHouse, 37-41 Mortimer Street, London W1T 3JH, UK

South African Family PracticePublication details, including instructions for authors and subscription information:http://www.tandfonline.com/loi/ojfp20

Ophthalmoscopy for general practitionersSolani Mathebula BOptom, MOptom, DPhilaa Department of Optometry, University of Limpopo E-mail:Published online: 15 Aug 2014.

To cite this article: Solani Mathebula BOptom, MOptom, DPhil (2011) Ophthalmoscopy for general practitioners, SouthAfrican Family Practice, 53:5, 501-501, DOI: 10.1080/20786204.2011.10874141

To link to this article: http://dx.doi.org/10.1080/20786204.2011.10874141

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) containedin the publications on our platform. Taylor & Francis, our agents, and our licensors make no representationsor warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content.Versions of published Taylor & Francis and Routledge Open articles and Taylor & Francis and RoutledgeOpen Select articles posted to institutional or subject repositories or any other third-party website arewithout warranty from Taylor & Francis of any kind, either expressed or implied, including, but not limited to,warranties of merchantability, fitness for a particular purpose, or non-infringement. Any opinions and viewsexpressed in this article are the opinions and views of the authors, and are not the views of or endorsed byTaylor & Francis. The accuracy of the Content should not be relied upon and should be independently verifiedwith primary sources of information. Taylor & Francis shall not be liable for any losses, actions, claims,proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever causedarising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Terms & Conditions of accessand use can be found at http://www.tandfonline.com/page/terms-and-conditions It is essential that you check the license status of any given Open and Open Select article toconfirm conditions of access and use.

Page 2: Ophthalmoscopy for general practitioners

Letter to the Editor

501 Vol 53 No 5S Afr Fam Pract 2011

Cardiovascular disease (including ischaemic heart disease and stroke) remains the most common cause of death.1 Traditional risk factors for cardiovascular disease (such as hypertension, hyperlipidaemia and cigarette smoking, among others) allow doctors to identify, monitor and treat high-risk patients.2-7 However, a large proportion of cardiovascular morbidity and mortality is not explained by these risk factors. As a result, there is a possibility of finding additional variables for cardiovascular risk stratification.

Atherosclerosis is a systemic disorder that uniformly affects the vascular system.2,4 However, the clinical manifestations rarely appear simultaneously in different vascular beds in the same patient, as a result of to the different sizes of the arteries supplying different organs. Since it is a systemic disorder, its clinical manifestations would show an ordered progression, such that changes in one organ can predict the next organ most likely to be affected. Knowledge of the order in progression would be important, because if damage to any organ is known, damage to the next may be predicted.

Recent research provides evidence of the role of erectile dysfunction as a common precursor of systemic atherosclerosis.8-11 The results show that erectile dysfunction may play a role in predicting cardiac and systemic vascular disorders. This suggests that there is a possible correlation between penile arterial vascular status, in a patient with erectile dysfunction, and retinal vascular findings, as assessed by ophthalmoscopy. Erectile dysfunction and cardiovascular disease share common risk factors, and the pathological changes in the cavernous tissue of a patient with erectile dysfunction are similar to those in the vascular walls elsewhere in the body of a patient suffering from generalised atherosclerosis.8

Retinal blood vessels are of the most superficial branches of the vascular tree. Pathological changes in these vessels can be easily seen by ophthalmoscopy,12 which affords a unique opportunity for non-invansive assessment of the systemic microcirculation. Retinal arterioles have anatomical and physiological characteristics similar to those of the cerebral and coronary microcirculation.1 Retinal microvascular abnormalities, such as retinal arteriolar narrowing and retinopathy, have been associated with systemic vascular disorders, including hypertension, diabetes mellitus, metabolic syndrome and cardiovascular diseases,2 suggesting that they can be used as a marker of generalised atherosclerosis.

The clinical value of ophthalmoscopy is to reveal the systemic vascular condition of the patient. Examining the fundus has not been important in assessing patients with erectile dysfunction. Now, general practitioners may

use ophthalmoscopy to assess not only atherosclerosis, but also to predict the condition of the penile cavernous arteries. At present, optometrists and ophthalmologists use ophthalmoscopy routinely as a diagnostic tool to examine the retina and ocular media.12 General practitioners can use ophthalmoscopy as a diagnostic tool for generalised atherosclerosis and erectile dysfunction. The retina provides a window of opportunity to study the human circulation.

Although general practitioners are not expected to manage ocular diseases and erectile dysfunction, they have an important role to play as the gatekeepers, by performing ophthalmoscopic examinations. By so doing, they can potentially not only save the sight, but the life, of a patient. The general practitioner can make a difference by making appropriate referrals after performing a basic assessment. Ophthalmoscopy is a valuable tool for general practitioners. It is estimated that 50% of patients presenting at the general medical clinic have clinically important pathology in the ocular fundus.13

Solani Mathebula, BOptom, MOptom, DPhilDepartment of Optometry, University of Limpopo E-mail: [email protected]

References1. Wong TY, Klein R, Klein BEK, et al. Retinal microvascular abnormalities and

their relationship with hypertension, cardiovascular disease, and mortality. Surv Ophthalmol. 2001;46:59-80.

2. Epstein FH. Cardiovascular disease epidemiology; a journey from the past into the future. Circulation 1996;93:1755-1764.

3. Wong TY, Mitchell P. The eye in hypertension. Lancet 2007;369:425-435.

4. Klein R, Sharret AR, Klein BEK, et al. Are retinal arteriolar abnormalities related to atherosclerosis?: The Atherosclerosis Risk in Communities Study. Arterioscler Thromb Vasc Biol. 2000; 20:1644-1650.

5. Wong TY, Klein R, Couper DJ, et al. Retinal microvascular abnormalities and incident of stroke: the Atherosclerosis Risk in Communities Study. Lancet 2001;358:1134-1140.

6. Wong TY, McIntosh R. Systemic association of retinal microvascular signs: a review of recent population-based studies. Ophthalmic Physiol Opt. 2005;25:195-204.

7. Nguyen TT, Wong TY. Retinal vascular manifestations of metabolic disorders. Trends Endocrinol Metab. 2006;17:262-268.

8. Cheitlin MD. Erectile dysfunction: the earliest sign of generalized vascular disease? J Am Coll Cardiol. 2004; 43:185-186.

9. Kawanishi Y, Kimura K, Nakanish R, et al. Retinal vascular findings and penile cavernosal artery blood flow. BJU Int. 2003;92:977-980.

10. Lue TF. Erectile dysfunction. N Engl J Med. 2000;342:1802-1813.

11. Emarah AM, El-Haggar S, Osman IA, Khafagy AWS. Correlation between penile cavernosal artery blood flow and retinal vascular findings in arteriogenic erectile dysfunction. Clin Ophthalmol. 2010;4:1047-1051.

12. Roux P. Ophthalmoscopy for the general practitioner. S Afr Fam Pract. 2004;46:10-14.

13. Wang F, Ford D, Tielsch JM, et al. Undetected eye disease in primary care clinic population. Arch Int Med. 1994;154:1821-1828.

Ophthalmoscopy for general practitioners

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