Robert Swinger, DACVO, DVM, founder of Animal Eye Guys clinics in South Florida, noted that 2 types of glaucoma cases typically present for emergency care. "The one that went acutely blind this morning, and it’s painful, and the eye is red, and it was normal 12 hours ago… or the eye that comes in and is twice as big as the other eye and has been blind for weeks,” he said, during his recent lecture on ophthalmic emergencies at the 2024 American Veterinary Medical Association Convention in Austin, Texas. “We’re going to treat those very differently.

“The patient that is painful, has flare, is red, has edema, that maybe has a normal optic nerve – the acute case, we’re going to treat aggressively. We want that pressure to go down within the next 2 hours to try and get vision back. The buphthalmic eye with Haab’s striae, terminal vessels, small optic nerve cupping, that ship has sailed, so our goals for that patient are comfort. We want to get the pressure down so that their headache goes away, so that they feel good,” Swinger continued.

The vast differences in the ways in which glaucoma shows itself, and theway it should be approached by medical professionals, is exemplified by the scenario which Swinger has outlined. To further that same point, Swinger went on to explain that clinical signs can be on a sliding scale and can vary depending on glaucoma stage. That said, associated signs can include episcleral vessel congestion, buphthalmia, corneal edema, epiphora, mid/deep stromal corneal vessels, Haab’s striae, aqueous flare, mydriasis, lens subluxation/luxation, and retinal or optic nerve degeneration.

During his lecture, Swinger shared the importance of determining a cause and identifying which classification of glaucoma any given patient may have, as any following therapy will be dependent on it. Glaucoma should be classified as either primary, congenital, or secondary.

A significant portion of the diagnosis with glaucoma comes down to intraocular pressure (IOP) exceeding 25mmHg, though variables including patient’s age, clinical signs, patient positioning, and the type of tonometry instrument utilized should be considered. IOP tends to ride higher in younger patients. Added pressure to patient’s neck and eyelids should be avoided, tight collars and restraints should be removed, and patient should ideally be in sternal recumbency.

As Swinger explained, there are 2 methods for medical therapy. Firstly, there’s the route of decreasing fluid production through the implementation of carbonic anhydrase inhibitors (topical dorzolamide or oral methazolamide) or beta blockers (timolol). The other option aims to increase fluid outflow through use of prostaglandin analogues or parasympathomimetic drugs.

Introducing treatment options, Swinger explained that the goal moving forward is not to cure patients. “There’s no cure for glaucoma. Once you have it, you generally have it.”

However, treatment goals should be focused on preserving vision, reducing IOP, and providing comfort to the patient. If pressure cannot be managed, next steps can include ciliary body ablation, enucleation, or intrascleral prosthesis, though Swinger noted that intrascleral prosthesis is outdated. “We were really doing those, I think, more for us than the dog,” he said.

As for followups, Swinger recommended rechecking the IOP 1-3 days following the initial exam. From there, if it’s controlled, he recommended rechecking IOP every 1-2 weeks, in 1 month, and then every 2-3 months going forward. If it’s not controlled, however, consider additional glaucoma medications. If the patient retains their vision with primary glaucoma, but it isn’t controlled, consider potential surgery with an ophthalmologist. If the patient cannot see, and their glaucoma isn’t controlled, Swinger recommended a comfort procedure.

Although he noted that it is not directly emergency-related, Swinger included a reminder that primary glaucoma is a bilateral disease. So, when faced with primary glaucoma, it’s essential to start the unaffected eye on prophylactic therapy. Otherwise, the second eye will develop glaucoma as well, “within about 3 months.”

Swinger stressed the importance of starting therapy early for the best results. “With prophylactic therapy we can buy ourselves maybe 2 years before we start to see the problems of glaucoma,” he said.

SwingerR. It’s all fun and games until someone loses an eye: an overview of ophthalmic emergencies. Presented at: American Veterinary Medical Association Convention; Austin, TX: June 20-25, 2024.

Articles

Clinical signs, diagnosis procedures, and management goals for this eye disease were covered during a session at the 2024 AVMA convention

Treating glaucoma in the emergency room

The recent opening of veterinary and pet care facilities nationwide marks an important advancement in animal healthcare. New establishments are designed to enhance accessibility, offering more comprehensive services to meet the diverse needs of pets. As a result, pets are better equipped to receive timely and effective care, leading to improved health and well-being.

Here are 3 recent facilities opening across the United States:

Clearwater Marine Aquarium Manatee Rehabilitation Center in Clearwater, Florida

Clearwater Marine Aquarium (CMA) recently opened a manatee rehabilitation center. The facility is designed to accommodate the increase of manatees in need of care. CMA’s new facility will aid sick, injured, or orphaned manatees, including those affected by habitat loss, boat strike injuries, ingestion of foreign objects, entanglements, and cold stress syndrome.

"The opening of the manatee care center symbolizes a complete journey for us, years in the making. Having already played a vital role in rescue, research, and monitoring of manatees, we now step into the crucial realm of providing direct care for their recovery and survival," James “Buddy” Powell, chief zoological officer at CMA, said in a news release.

 "Global research and hands-on care are intertwined. Through studying manatees both in the wild and within our facility, we gain invaluable insights into their needs and behaviors, empowering us to craft more effective conservation strategies,"

The new center features advanced technology, including ozone treatment and medical habitats with false bottoms. With modern technology, CMA’s Manatee Rehabilitation Center was built to ensure the comfort and well-being of these marine animals, according to the release.

Virginia Veterinary Centers Midlothian. (Photo courtesy of Ethos Veterinary Health and Virginia Veterinary Centers)

In Midlothian, Virginia, a team of veterinary professionals and others celebrated the opening of their new Virginia Veterinary Centers (VVC) emergency and specialty veterinary hospital. VVC Midlothian is a full-service specialty and emergency care animal hospital serving Midlothian and its neighboring areas. The new location, located at 12077 Hull Street Road in Midlothian, Virginia, replaces the VVC’s former location at 2560 Colony Crossing Place in Midlothian.

The new hospital comprises 10,200 sq ft of emergency and specialty care, doubling VVC’s Midlothian’s clinical space and creating the opportunity to expand specialty services, according to a news release.

 This new hospital features modern equipment and advancements, such as a full in-house laboratory with digital cytology analysis, specialized isolation suites for respiratory and gastrointestinal infectious diseases, and an intensive care unit (ICU) for critical patients.

VVC Midlothian is also equipped with an oxygen cage with high-flow oxygen support, and surgical suites equipped with ventilators and ligature. Moreover, the new facility offers a range of services, including emergency care, internal medicine, and ophthalmology.

Animal Care Center in Anderson, Cincinnati

Animal Care Center (ACC) has expanded its pet care services in Cincinnati to Anderson, in addition to its existing locations in Forest Park, Fairfield, and Blue Ash. ACC is committed to providing a full spectrum of veterinary services, and offers a range of veterinary services, from routine check-ups to emergency procedures, according to the organization.

“At Animal Care Center, we understand that pets are more than just animals—they’re family members,” Alyssa Myers, lead veterinarian at ACC, said in a news release.

 “With the opening of our Anderson location, we’re excited to extend our exceptional services to even more pet owners in the Cincinnati area.”

The new facility in Anderson features cutting-edge amenities. Services ACC Anderson offers include routine vaccinations, dental cleanings, and advanced medical treatments. With the latest veterinary technology, the ACC team aims to provide thorough care for dogs and cats, according to a news release.

Clearwater Marine Aquarium’s Manatee Rehabilitation Center is now open. News release. Clearwater Marine Aquarium. August 12, 2024. Accessed August 14, 2024. 

https://prnmedia.prnewswire.com/news-releases/clearwater-marine-aquariums-manatee-rehabilitation-center-is-now-open-302220186.html

Virginia Veterinary Centers Midlothian (VVC) cuts ribbon on 10,200 sq. ft. emergency & specialty veterinary hospital. News release. Ethos Veterinary Health. August 13, 2024.

New Animal Care Center open in Anderson expanding Cincinnati’s premier pet care services. News release. Animal Care Center. May 21, 2024. Accessed August 14, 2024. 

https://www.newswire.com/news/new-animal-care-center-open-in-anderson-expanding-cincinnati-s-premier-22337882

Take a look at these 3 veterinary centers newly opened or coming soon

Clinic center: Latest animal care facilities opening in the US

Dr Clark explains the important role client service representatives have in the veterinary clinic

Video interview with Jill Clark, DVM

When clients enter the veterinary clinic and when they leave—whether the first time, a regular visit, or the last time—a familiar face they will see is the client service representative (CSR). These professionals greet clients, handle scheduling for clients and the team, and answer questions that clients have before leaving the clinic. Because of trust, they have the potential to build relationships with clientele, making them crucial influencers for the practice. 

 interview highlighting some talking points in her upcoming lecture at 

, Jill Clark, DVM, founder and chief visionary officer of IGNITE, shares why she believes CSRs are the most important humans in the veterinary clinic. 

: [Client service representatives are] also becoming client experience gurus, and that's one of the passions I have for both Ignite and NAAVR (North American Association of Veterinary Receptionists)... But they really can have roles that are far above what we typically utilize them for. I mean, they really can impact the client's experience from even how they find out about the practice, to the initial phone call and all the way until followup. That's a role that they can play a big part in. 

And then they're great revenue producers. We don't think of them as that. We think the doctors are, [and] maybe the technicians, but it's really those [CSR] folks that are the ones that get people in the door for the rest of us. And they also think of pretty creative ways to get people back for rechecks and and all the other care options that that clients have for their pets, so [they are] extremely influential when it comes to the client.

Client service representatives are one of the most important people in the veterinary clinic, and here is why

A veterinary clinic's extreme influencer

Veterinary dermatology care can make all the difference in an animal’s quality of life. Knowing how to diagnose, treat, and manage specific ailments affecting the skin can ultimately lead to an animal’s relief and comfort. The 3 following articles offer information and insights for veterinary professionals, from best practices when managing food allergies, to diagnosing and managing anal sac diseases, to the prevalence of allergy-related claims.

Diet trials: The true test of food allergies

: As veterinary dermatology has advanced, there has been a notable increase in the diagnosis of food allergies. At the Fetch dvm360 conference in Nashville, Tennessee, Julia E. Miller, DVM, DACVD, helped attendees better understand their food allergic patients, and the best ways to diagnose them.

Getting to the bottom of anal sac diseases

: Anal sac diseases can cause discomfort in animals while they sit or defecate, causing them to scoot, lick, or bite at the area. Miller stresses that, although not glamorous, these signs are important, and she explains methods for diagnosis and management.

: Trupanion, the pet insurance provider with more than 1 million pets currently enrolled, aimed to evaluate the most common claims submitted by pet owners between 2019 and 2023. At the top of the list are allergies. The company revealed analytical insights into allergen claims, including top geographic regions and dog breeds with the most cases.

Don’t miss these articles highlighting dermatologic cases that include food allergies, anal sac diseases, and allergy-related insurance claims

3 must-reads on dermatology

The FDA recently announced it has released a set of documents in connection with the transition phase after the FDA’s longstanding Memorandum of Understanding (MOU) with the Association of American Feed Control Officials (AAFCO), which is set to expire on October 1, 2024.

According to the release, any ingredient used in animal food, including pet food, is required to be the subject of an FDA-approved animal food additive petition (FAP) or be generally recognized as safe (GRAS) for its intended use within animal food. Despite the MOU expiring with the FDA, the organization considers AAFCO an important partner and will work closely with AAFCO and state regulatory partners to help ensure the safety of the animal food supply.

The released documents include the following

FDA requests comments on its pre-market animal food review process

The FDA is asking for the public asking stakeholders to address particular questions and requests for information regarding the FDA’s Food Additive Petition (FAP) and the GRAS Notification program. The solicited comments will help the FDA make necessary changes, if any, that can be used to better serve public health as well as improve the path to market for new animal food ingredients.

Comments and information submitted to docket FDA-2024-N-2979 will be intended for consideration by the FDA. The comment period began on August 9, 2024, and will no longer take comments on December 9, 2024. Anyone interested in submitting comments can find instructions on the Federal Register NOA.

Draft Guidance for Industry #293 “FDA Enforcement Policy for AAFCO-Defined Animal Feed Ingredients”

Despite the expiration of the MOU, Draft Guidance for Industry (GFI) explains that the FDA does not intend to initiate enforcement action in response to the interstate marketing of animal food ingredients that are not approved additives or GRAS for their intended use. However, if the ingredients are listed in the ingredient definition chapter of the 2024 AAFCO OP, the FDA has no safety questions or concerns. The GFI #293 also states the FDA will not initiate enforcement of action in the case of the use of animal food ingredient names that are uncommon or unusual but are defined within the AAFCO OP unless the names cause the labels to be misleading or false.

Comments will be accepted from now until September 9, 2024. Because this guidance is time-sensitive, the FDA does not plan to extend the 30-day comment period before it starts working on the guidance's final version. Anyone interested can submit an electronic comment for docket FDA-2024-D-2977. Instructions on commenting can be found within the Federal Register Notice of Availability for draft GFI #292.

Draft GFI #294 “Animal Food Ingredients Consultation”

Draft GFI #294 explains an interim Animal Food Ingredient Consultation (AFIC) process for firms to engage with the FDA concerning ingredients that firms may have otherwise utilized in the AAFCO ingredient definition process. The AFIC process would provide another way for firms to consult with the FDA about new animal food ingredients and to review information from developers as well as the public about ingredients and any potential safety concerns, along with the FDA’s AFAP and GRAS Notification program.

 This process will also include the chance for public awareness and input on the ingredients for which the FDA is providing consultation.

The GFI also explains the FDA would generally not intend to take enforcement action against ingredients that are unapproved animal food additives, if the FDA sent AFIC a ‘consultation complete’ letter. According to the FDA,

 provided ingredients that are discussed within the letter and there continue to be no concerns or questions about the ingredient's safety.

The FDA began taking comments on August 9, 2024 and will continue to accept comments until September 9, 2024. At this time, the FDA does not plan to extend the 30-day comment period before working on the final version due to the time-sensitive nature of the guidance. Electronic comments can be submitted to FDA-2024-D-2978 and instructions on commenting can be found on the Federal Register Notice of Availability for draft GFI #294.

Along with the establishment of the RFC docket for accepting written or electronic comments, the FDA plans to host multiple virtual stakeholder listening sessions. The sessions will focus on the FDA’s pre-market animal food review programs and questions laid out in the RFC. Those interested in participating in a listening session should email AnimalFoodIngredientRFC@fda.hhs.gov with their first and last name, email address, phone number, and organization/affiliation by September 1, 2024.

FDA Releases Two Draft Guidances, Seeks Public Comment on Pre-market Animal Food Ingredient Review Programs. News release. The US Food and Drug Administration, August 8, 2024. Accessed August 13, 2024. https://www.fda.gov/animal-veterinary/cvm-updates/fda-releases-two-draft-guidances-seeks-public-comment-pre-market-animal-food-ingredient-review?utm_medium=email&utm_source=govdelivery

The FDA has released new guidance and documents on animal food ingredient approval following the expiration of its MOU with AAFCO


FDA issues draft guidances on animal food ingredient reviews and seeks public feedback

August graduates with Chad Brown, director of Veterinary Nursing Programs, and Kathy Salisbury, interim dean of the College of Veterinary Medicine. (Photo courtesy of Purdue University College of Veterinary Medicine)

The college of Purdue Veterinary Medicine (PVM) from Purdue University in West Lafayette, Indiana, recently celebrated its Summer 2024 graduating class of veterinary technicians during the college’s ceremony. During the event, S. Kathleen Salisbury, interim dean of PVM welcomed the college’s newest veterinary technician graduates and their families at the Summer 2024 Veterinary Nursing Graduation Celebration, which took place in Lynn Hall on August 3, 2024.

The ceremony took place after the university commencement exercises that same morning at the Elliott Hall of Music. The PVM graduation celebration featured individual recognition of each attending graduate, as well as traditional recitation of the Indiana Veterinary Technician Oath of Ethical Conduct, according to a news release.

During the ceremony, Salisbury addressed the graduates and their families in a speech that emphasized the college’s veterinary network and the journey that awaited the new graduates. “In particular, this program gives us the opportunity to continue a long-standing and valued tradition of our college as we conduct our Oath Ceremony,” said Salisbury, according to the release.

“Graduates, as you embark on your careers in the veterinary medical profession, you join an alumni network that reflects the ‘veterinary team.’ Numbering more than 5,000, our college’s alumni include veterinarians, veterinary [technicians], as well as recipients of graduate degrees.”

Graduates stepped forward as Chad Brown, DVM, director of Purdue Veterinary Nursing Programs announced their names. “The College of Veterinary Medicine has 2 separately accredited veterinary technician…programs,” Brown said as he stepped to the podium, according to a news release.

 “One is an entirely remote program which is our distance learning program and the other is our campus residential program. So we have graduates from both here today.”

PVM’s on-campus program offers students 3 degree options: Bachelor of Science in Veterinary Nursing, Associate in Applied Science, and a Bachelor of Science completion program for graduates from AVMA-accredited veterinary nursing programs who wish to earn a Bachelor of Science in Veterinary Nursing.

 Meanwhile, PVM’s distance learning program, the Veterinary Nursing Distance Learning Program, allows students to learn at their own pace. It is modeled after PVM’s in-person program and offers 27 online courses and 18 clinical mentorship experiences. The program also has in-person clinical mentorships with hands-on experiences. Moreover, it gives students the possibility of earning their associates degree in as little as 3 years, according to the university.

This summer, 9 graduates of the Associate in Applied Science degree attended the ceremony. As each graduate came forward, they were presented with the Purdue University Veterinary Nursing pin by Jennifer Smith, RVT, RLAT, by instructional technologist. During the ceremony, Brown also gave special acknowledgement to graduate Stephanie Stewart, who was the recipient of the Eber H. Allen Leadership Award funded by the Northeast Indiana Veterinary Medical Association

“Graduates, your charge is to set the visible standard for what a Purdue University veterinary [technician] is and does. In so doing, you will pave the way for all those graduates who will follow behind you. The future of the veterinary nursing profession is placed into your very capable hands. We trust that you will serve it well,” said Brown to the graduates, according to a release.

The degree recipients were also asked to recite the Indiana Veterinary Technician Oath of Ethical Conduct, marking their official entry into the veterinary technician profession. “The oath signifies our high regard for the ethical standards and legal regulations governing the practice of veterinary [technology], our strong commitment to the highest standards of patient care and service, and our dedication to the animals that we serve,” said Brown, according to a release.

New Purdue veterinary nursing graduates take oath during graduation celebration. News release. Purdue University College of Veterinary Medicine. August 9, 2024. Accessed August 13, 2024. 

https://vet.purdue.edu/news/new-purdue-veterinary-nursing-graduates-take-oath-during-graduation-celebration.php

On-campus curriculum overview. Purdue University College of Veterinary Medicine. Accessed August 13, 2024. 

https://vet.purdue.edu/nursing/on-campus/curriculum-overview.php

Veterinary Nursing Distance Learning Program. Purdue University College of Veterinary Medicine. Accessed August 13, 2024. 

https://vet.purdue.edu/nursing/distance-learning

The college of Purdue Veterinary Medicine held a ceremony for its summer 2024 veterinary technology graduates