December 2018


Good habits for healthy eyes

Eric Donnenfeld, MD,
chief medical editor

Good habits for healthy eyes are important for all ophthalmologists to know. In this last issue of 2018, we share thoughts on eye health from ophthalmologists on several key issues.
One of the most controversial topics in medicine is the value of oral omega-3 supplementation. Multiple studies document both their value and, occasionally, lack of value. Alice Epitropoulos, MD, and Michael Gross, MD, refer to the Tear Film & Ocular Surface Society Dry Eye WorkShop (DEWS) I and II reports, which state that nutritional therapy is listed as first-line treatment for even mild dry eye disease. Both physicians agree that a critical level of omega-3 supplementation is crucial to achieve the desired effect and that there are significant differences in the quality and therefore efficacy of omega-3 supplementation.
Iatrogenic damage can significantly harm both the eyelid and the eye itself and is surprisingly common, according to Henry Perry, MD. Eye rubbing also plays a major role in allergic eye disease. It inflames the ocular surface, which can make any inflammatory ocular surface disease, such as dry eye, worse, according to Christopher Rapuano, MD. They agree that eye rubbing also plays an important role in the development of keratoconus and floppy eyelid syndrome. Getting patients to stop rubbing their eyes can be difficult but is important to eye health. Good tips include aggressively treating allergic eye disease with topical and sometimes systemic anti-allergy medications, cold compresses, non-preserved tears, and enlisting the help of family members.
One of the most common eye conditions is ocular allergies, and according to Vincent de Luise, MD, they affect up to a third of the population. He noted that there are five different categories of ocular allergy and that therapy is based on making the correct diagnosis: seasonal allergic conjunctivitis, perennial allergic conjunctivitis, atopic keratoconjunctivitis, giant papillary conjunctivitis, and vernal keratoconjunctivitis. The symptom seen in all five allergic conditions is ocular itching. According to Bennie Jeng, MD, atopic keratoconjunctivitis is the most difficult ocular allergy to control, and systemic therapy is often required. Clara Chan, MD, EyeWorld Cornea editor, thinks that in addition to topical antihistamines, ophthalmologists should consider topical corticosteroids and even an immunosuppressive in more severe and chronic ocular allergy.
Contact lens wear is common, and ophthalmologists and optometrists who manage these patients should be aware of the challenges. According to Terrence O’Brien, MD, the majority of contact lens wearers also experience dry eye disease, which is the most common reason patients discontinue contact lens wear. Christopher Starr, MD, agrees that contact lens intolerance is often due to dry eye, but allergy to the contact lens wear also plays an important role. Francis Price Jr., MD, and Marianne Price, PhD, performed an important prospective trial on contact lens wearers and found that 14% of patients discontinue contact lens wear annually mostly due to the development of dry eye. In addition, they found greater patient satisfaction and fewer complications with LASIK than contact lens wear. Francis Mah, MD, also sees ocular allergy and dry eye as common reasons for contact lens discontinuation. On the subject of infections associated with contact lens wear, all of the sources agree that the greatest risk is the use of extended wear contact lenses and that these infections must be treated aggressively to prevent vision loss.

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Ophthalmology News - EyeWorld Magazine
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