J Am Soc Hypertens. 2013 Jul-Aug;7(4):305-16.

Assessing the role of optometrists in the control of systemic hypertension in Saudi Arabia.

Osuagwu UL, Ogbuehi KC, Almubrad TM.

Department of Optometry and Vision Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia. drpenny2002@yahoo.com

 

Abstract

The low level of awareness, treatment, and control of systemic hypertension is a global problem, but it is much more serious in Saudi Arabia. This study examines the contribution made by Saudi optometrists in detection and management of patients with systemic hypertension. We surveyed a sample of 250 optometrists practicing in Saudi Arabia to evaluate the level of knowledge and awareness of their role in combating systemic hypertension. A 48.4% response rate was obtained from practicing optometrists. Of those responding, optometrists were very positive towards the use of blood pressure (BP) monitors in optometric practice on a routine basis. Forty-six percent of the optometrists had access to a BP monitor, and about 93% of these respondents actually used the monitors during clinic consultations. Automated monitors were the most common (54%). Fifty-one percent and 49% of the optometrists reported that they did routinely question their patients about high BP and about their current BP medications, respectively. The less frequently asked question concerned the cholesterol level of the patient (21%). The tests most widely used by the optometrists while examining hypertensive patients was direct ophthalmoscopy with red free filter (56%) and the least was binocular indirect ophthalmoscopy (21%). Optometrists were more likely to refer patients suspected of systemic hypertension on the basis of elevated BP (74%) and presence of retinal hemorrhages (72%), but were less likely to refer patients with changes in arteriolar reflex (41%). The opinions were very positive towards the routine monitoring of BP within the Saudi optometry profession, as optometrists indicated that they had time within an eye examination to measure BP, it was financially rewarding (56% of respondents), and patients appreciated it (64% of respondents). Despite half of the optometrists having access to BP monitors (predominantly automated devices), many of the optometrists were unsure if they were trained enough to monitor BP in such patients. There is urgent need to train optometrists on the use of BP devices, interpretation of readings, and use of additional diagnostic tests during such eye examinations.

Copyright © 2013 American Society of Hypertension. Published by Elsevier Inc.

KEYWORDS: Blood pressure, cardiovascular disease (CVD), public health, survey

PMID: 23582875

 

Supplements:

Systemic hypertension remains a significant cause of morbidity and a leading cause of cardiovascular mortality worldwide (1 – 6). In Saudi Arabia, more than 20% of the adult population is affected by the disease, and this prevalence is expected to increase in the coming years (7). Despite isolated examples of good practice, prevention initiatives are thinly spread, detection is patchy and clinical protocols are poorly followed. The measurement of BP is a very significant detection test that can provide a great deal of information for the optometrist. It can be critical in aiding the practitioners’ evaluation of both the patient’s visual health and related systemic condition and in indicating a possible need for referral, which could be life-saving. This study presents a general survey of the optometrists’ view of the benefits of assessing blood pressure in optometric practice. We also tried to evaluate the level of awareness of the optometrists on their roles as primary health providers in combatting this ‘silent killer’ disease –hypertension.

Fig 1
Fig 1. Average opinion of Optometrists on blood pressure measurement. n = 121 optometrists. GPs = general physicians.

Figure 2
Fig 2. Availability of blood pressure monitors in optometric practices in percentages. n = 56.

As shown in Figure 1, on average, optometrists were very positive towards the in-office measurement of BP. The average opinion was that the measurement of BP is necessary in the optometry practice as a routine (62%), especially since it takes up very little chair time; such a practice would advance the profession as it was financially viable (56%) and appreciated by patients (64%). About half of the Optometrists respondents had access to a BP monitor in their practices, with automated devices being preferred (53.6%) as shown in Figure 2. Ninety-three percent (52/56) of these optometrists actually used the devices on different patients (figure 3) especially those with a previous diagnosis of high blood pressure (51.9%) and those suspected of having HBP (30.8%). However, the optometrists also indicated the need for a continuous education in the area of BP measurement if they are to take a pro-active role in combating the increasing prevalence of the disease in the Kingdom; and avoid unnecessary referrals.

Fig 3

Fig 3. Frequency of use of blood pressure monitors in optometric practices. n = 52. HBP = high blood pressure

Figure 4

Fig 4. Additional test procedures performed during the examination of the diagnosed/suspect systemic hypertensive patient in percentages. n = 77. BIO = binocular indirect ophthalmoscopy.

Majority of the Optometrists said they altered their examination routine in patients diagnosed or suspected of having systemic hypertension. Approximately 50% of the techniques listed in Figure 4 were conventionally available in optometric practices in this region, with most of the other techniques requiring the use of diagnostic agents (Dilated ophthalmoscopy, binocular indirect ophthalmoscopy BIO, fundus lens examination) not common practice. Referral of patients to the BP was most often based on elevated BP (52.1%) and the presence of retinal hemorrhages (50.4%) than any other changes (Figure 5). In general, changes in healthcare necessitates that the role of the Optometrist be furthered in to the medical model since Optometrists are the frontline of health care and could play an important role in aiding early diagnosis of systemic diseases like hypertension.

Fig 5

Fig 5. Average opinion on important clinical findings prompting referrals of the systemic hypertensive patient in optometry practice in Saudi Arabia. n = 85. AV = arterio-venous; BP = blood pressure.

In conclusion, whereas it is not common practice to measure BP in optometry practices, Optometrists are willing to measure BP routinely on patients especially those with, positive family history and certain risk factors, such as; being black, overweight, over 40 years of age, and when history taking reveals certain symptoms like headache in the morning or dizziness when stressed. This practice is beneficial to the public and profession. However, to effectively perform this role, there is urgent need to: a) train Optometrists on proper use, recording and interpretation of BP measurements; b) train Optometrists to use additional diagnostic techniques such as dilated funduscopy to aid in improving the screening process for hypertension; c) emphasize on the importance of thorough case history & symptoms recording, and; d) standardize referral guidelines to ensure that appropriate referrals are made and early intervention initiated. Adding BP measurements to routine eye examinations in optometric practice is hoped to reduce the incidence of strokes, myocardial infarction and heart failure.

 

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