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Catalyst challenges the mainstream.


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National Heart Foundation of Australia. The National Heart Foundation of Australia's summary of the recommendations for cholesterol management. Canberra: NHF, J Am Coll Cardiol ; Australian Government Department of Health. Australian Statistics on Medicines Canberra: Department of Health, A national census of medicines use: a hour snapshot of Australians aged 50 years and older.

Med J Aust ; Cholesterol still important risk factor for heart disease.

ABC of Eyes (4th ed.)

Sydney: NHF, Australian Capital Territory Medicare Local. Statin use survey results. Impact of increasing the re-supply interval on the seasonality of subsidised prescription use in Australia. Time series analysis: forecasting and control. Hoboken, NJ: John Wiley, Corderoy A. Sydney Morning Herald ; 1 Mar. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90, participants in 14 randomised trials of statins.

Lancet ; The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials.

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National Vascular Disease Prevention Alliance. Guidelines for the management of absolute cardiovascular disease risk. Sydney: National Stroke Foundation, Statin use in the secondary prevention of coronary heart disease in primary care: cohort study and comparison of inclusion and outcome with patients in randomised trials.

BMJ ; Efficacy of cholesterol-lowering therapy in 18, people with diabetes in 14 randomised trials of statins: a meta-analysis.

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Canberra: ABC, Adherence to lipid-lowering treatment: the patient perspective. Patient Prefer Adherence ; 6: Impact of adverse news media on prescriptions for osteoporosis: effect on fractures and mortality. Lagarde M. How to do or not to do.. Health Policy Plan ; First Name. Middle Name. Last Name.

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Do you have any competing interests to declare? Yes Competing interests. Email me when people comment on this article. Responses are now closed for this article. Mean weekly dispensings 12 weeks before Catalyst. Weekly change in number of dispensings. Mean weekly number of discontinuers 12 weeks before Catalyst. Peak change in discontinuation. Occasionally they become inflamed or ulcerated. A pterygium is a non-malignant fibrovascular growth that encroaches onto the cornea.

Management—If the pingueculum is ulcerated, antibiotics may be indicated.

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For a pterygium, surgical excision is indicated if it is a cosmetic problem, causes irritation, or is encroaching on the visual axis. Symptomatic relief from the associated tear-film irregularities are often helped by the use of topical artificial tear eye drops.

see url Red eye that does not get better Red eyes are so common that every doctor will be faced with a patient whose red eye does not improve with basic management. It is important to be aware of some of the more common differential diagnoses. Many of the conditions described below will need a detailed ophthalmic assessment to make the diagnosis. Consider early ophthalmic referral when patients present with red eyes and atypical clinical features or fail to improve with basic management. Orbital problems It is easy to miss someone with early thyroid eye disease and patients can present with one or both eyes affected.

Look for associated ocular for example, lid retraction and systemic features of thyroid disease. There are several rare but important orbital causes of chronic red eyes, including carotico- cavernous fistula, orbital inflammatory disease, and lymphoproliferative diseases. Eyelid problems Malpositions of the eyelids such as entropion and ectropion often cause chronic conjunctival injection. Nasolacrimal obstruction presents with a watery eye but there can be chronic ocular injection if the cause is lacrimal canaliculitis or a lacrimal sac abscess.

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A periocular lid malignancy such as basal cell carcinoma or sebaceous meibomian gland carcinoma may rarely present as a unilateral chronic red eye. Conjunctival problems If a patient has a history of an infective conjunctivitis that does not improve, then you should always exclude chlamydial conjunctivitis, particularly if there are also genitourinary Red eye 13 Pterygium Bilaterial thyroid eye disease with exophthalmos and conjunctival oedema chemosis Acute dacrocystitis Extensive subconjunctival haemorrhage Chlamydial conjunctivitis ABC of Eyes 14 symptoms. Giant papillary conjunctivitis may occur in patients with ocular allergic disease or in contact lens wearers.

If someone is on long term topical drug therapy for example, for glaucoma then drug hypersensitivity should be considered, especially if drug instillation causes marked itching or the eyelids have an eczematous appearance. Other causes of chronic red eyes include a subtarsal foreign body, dry eyes, and cicatricial ocular pemphigoid. Fluorescein drops will reveal corneal staining in patients whose red eye syndrome is caused by a corneal problem.

Viral infection Adenoviral keratoconjunctivitis may lead to a red, painful eye for many weeks and patients should be warned of this. Patients with refractory adenoviral keratitis may occasionally need topical steroid therapy. This should only be undertaken with close ophthalmological supervision as it can be hard to wean patients off steroids. Scleral problems Episcleritis and scleritis present with red eyes that do not respond to topical antibiotic therapy. Think of scleritis in any patient presenting with marked ocular pain and injection. Anterior chamber problems Failure to consider uveitis in a patient with a red eye, photophobia, and pain can result in delays that make subsequent management more difficult.

Angle closure glaucoma has a very characteristic clinical presentation that is easy to miss. Subtarsal foreign body Chronic adenovirus infection Drug hypersensitivity Doctors do not often have to deal with this problem because patients usually are prescribed glasses by an optometrist.

In the absence of disease the vision will improve when the pinhole is used—unless the refractive error is extremely large. Disease affecting the cornea for example, keratoconus may cause severe refractive problems. The rays of light from closer objects, such as the printed page, are divergent and have to be brought to a focus on the retina by the process of accommodation.

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The circular ciliary muscle contracts, allowing the naturally elastic lens to assume a more globular shape that has a greater converging power. In young people the lens is very elastic, but with age the lens gradually hardens and even when the ciliary muscle contracts the lens no longer becomes globular. Thus from the age of 40 onwards close work becomes gradually more difficult presbyopia. Convex lenses in the form of reading glasses therefore are needed to converge the light rays from close objects on to the retina.

People who wear glasses to see clearly in the distance may find it convenient to change to bifocal lenses in their glasses when they become presbyopic. In bifocal lenses the reading lens simply is incorporated into the lower part of the lens. Therefore, the person does not have to change his or her glasses to read. However, details at an intermediate distance such as the prices of items on supermarket shelves are not clear.

A third lens segment can be incorporated between that for distance above and that for reading below, creating a trifocal lens. This has led to the introduction of multifocal lenses in which the lens power increases progressively from top to bottom. People may also have problems adapting to this type of lens, as peripheral vision may be distorted. Refractive errors do not get worse if a person reads in bad light or does not wear their glasses. The exceptions are young children, however, who may need a refractive error corrected to prevent amblyopia. Light rays from distant objects are focused on to the retina without the need for accommodation.

Light rays from a close object for example, a book are focused behind the retina. The eye has to accommodate to focus these rays Conical cornea keratoconus indenting lower lid on down gaze Ciliary muscle relaxes No accommodation Accommodation Suspensory ligament taut Lens flat Lens becomes globular Suspensory ligament lax Ciliary muscle contracts Accommodation: adjustment of the lens of the eye for viewing objects at various distances All emmetropic people need reading glasses for close work in later life Myopic or shortsighted eye In the myopic eye, light rays from infinity are brought to a focus in front of the retina because either the eye is too long or the converging power of the cornea and lens is too great.

To achieve clear vision the rays of light must be diverged by a concave lens so that light rays are focused on the retina.