Optometry In the News
This week I looked over the July issue of Contact Lens Spectrum, their annual dry eye issue. We are inundated with dry eye treatment and therapies, so I will not bore you with the mundane. I did however run across a few articles that got me thinking and may add some value to my practice, maybe it will help yours as well.
William Townsend, CURCUMIN: A POTENTIAL THERAPY FOR DRY EYE?
The first article was by William Townsend, CURCUMIN: A POTENTIAL THERAPY FOR DRY EYE?. He went to his PCP and was prescribed turmeric for arthritis and inflammation. He then postulated about the possibility of taking the active ingredient in turmeric and making it a topical agent to be used in the treatment of inflammatory eye conditions such as dry eye. It was an interesting read, and I started thinking about something I have believed since Optometry school. Two keys to longevity are 1. Maintaining flexibility (ain't nothing I am going to do at the office for that) and 2. Controlling inflammation. We can definitely do something about number 2.
Current Options
As clinicians we have steroids, xiidra, and restasis. Steroids are not ideal long term and my personal experiences with restasis have been mixed at best. I have had a little more luck with xiidra; however, cost and chronic lifelong therapy are deterrents. I suppose we could consider doxycycline when treating MGD, but again my patients are more receptive to “natural” remedies vs medications. I assume it has more to do with cost than anything. That being said, omega 3’s, flax seed, and principles/features of the mediterranean diet come to mind.
Thinking Outside the Box (“natural remedies”)
The DREAM study put a damper on omegas 3’s, but like anything in medicine the debate will continue. If you are prescribing or recommending, I’d go with 2000mg/day and make sure you know the difference between esterified vs unesterified. You want esterified and a quick test to find that out is to take the capsule and put it in the freezer for 5 -10 minutes. When you take it out, if it is white, it is worthless and not going to be bioavailable. Now the good stuff is not cheap and balancing cost and benefit is always a huge concern. My wife has horrible MGD and I cannot find a supplement that is worth the cost. She's asymptomatic (for now) and bruder masks are there for a reason right?!? I am no expert on flaxseed and I am going to do some research on the merits and types to recommend. I think it can be mixed with most anything, so that helps in the compliance department. Lastly, a really outside the box idea I had was to highlight the key principles of the mediterranean diet (fish, olive oil, avocados, and herbs and spices for flavor). I thought about putting it on a card or in a brochure to educate my patients and treat the WHOLE person. I do not want to get too far outside my wheelhouse here, less I be mistaken for some of the crazy chiropractors that have cures for everything, but I think these things have substance and patients love “natural” remedies.
ORTHOKERATOLOGY: NOT CUT-AND-DRY by Nick Despotidis
The second article was ORTHOKERATOLOGY: NOT CUT-AND-DRY by Nick Despotidis. Dr. Despotidis listed 5 reasons your patients may be experiencing dryness with their Ortho-K lenses. They included: 1.Epiblepharon 2.MGD 3.Incomplete blinking 4.Lens fit issues 5.Chemical toxicity.
Take Control and Prepare Ahead of Time
When it comes to chemical toxicity, I nip that in the bud by providing all the solutions I want my patients to use. This eliminates any confusion and stops the temptation to buy generic or cheaper options. If there is an issue, I know what they are using and can address it head on. Switching to clear care is the simple solution if the GP lens cleaner is causing issues. Fit issues I am all over, as I am staining the cornea and taking ropographies at every visit. This seems like a no brainer if you are being thorough and switching retainers yearly. The last 3 I need to pay more attention to. When it comes to my consultations and pre-screening of patients, I am more concerned with Rx and topographies vs lids and such. I will be more diligent and address those issues before they become a concern. Epiblepharon is the extra skin fold that is more prominent in patients of asian descent. I do not see too many patients in this demographic, but will be acutely aware of possible issues if such a patient presents.
DRY EYE AND MYOPIA MANAGEMENT by Kate Gifford
The third article I took a nugget from was DRY EYE AND MYOPIA MANAGEMENT by Kate Gifford.
Benefits Outweigh Risks
Dr. Gifford pointed out the need to weigh the cost benefit ratio of myopia management with soft contacts (more than Ortho-k) and possible dry eye issues secondary to systemic medications or allergies. I have not had a great deal of these patients, but I would agree we can manage the dryness and still manage the myopia. The long term benefits of therapy are worth the headaches of dryness.
Overall the issue was pretty straight forward, but these are the articles that had practical application to my office.
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