March 2020


Illuminating intraoperative technologies

by Rosa Braga-Mele, MD Cataract Editor

Rosa Braga-Mele, MD
Cataract Editor

An important consideration for ophthalmologists is the effect of topical and oral medications on the eye and systemically on the rest of the body. However, prescription medications are not the only things to keep in mind. Nutraceuticals play an important role as well, and sometimes these non-prescription supplements are overlooked. Alice Epitropoulos, MD, was the first author on an important paper that looked at omega-3 supplementation on dry eye and found re-esterified omega-3s to have an effect on improving the signs and symptoms of dry eye. A randomized clinical trial known as Dry Eye Assessment and Management (DREAM) found no difference between omega-3 supplementation and olive oil, but John Sheppard, MD, pointed out that both are part of a healthy Mediterranean diet and are good for the eyes. Cynthia Matossian, MD, said that all omega-3 supplements are not the same, with the majority of omega-3s converted to a non-absorbable entity by the purification process, and in recommending omega-3s, there are only a couple of brands that are safe. Henry Perry, MD, agreed that re-esterified omega-3s are important and thinks a lower dose can be effective in some patients.
All cataract surgeons are aware of the effect of alpha-1 blockers on the iris. This class of medications most commonly represented by tamsulosin is prescribed to improve urinary flow. However, according to William Myers, MD, Bryan Lee, MD, and Steven Safran, MD, this class of medication is also responsible for intraoperative floppy iris syndrome (IFIS). The physicians said that IFIS can occur after one dose of an alpha-1 blocker and do not recommend stopping the medication if it is already in use. To combat the effects of IFIS there are a variety of intraoperative medications, viscoelastics, and devices that can be employed to improve iris tone and the safety of cataract surgery.
Dry eye is the most common complaint for patients seeing an eyecare professional, and it is also one of the most common complications of a variety of systemic medications. Elizabeth Yeu, MD, Chasidy Singleton, MD, and William Trattler, MD, provide their insights into systemic medications that may be behind those nagging dry eye symptoms. Dr. Singleton pointed out that diagnosing medication-induced dry eye starts with a good history. The physicians said that high blood pressure, allergies, skin conditions, mental illnesses, incontinence, and more are all conditions that may be associated with the use of medications that can cause dry eye, and alternative medications may help alleviate patient symptoms.
Finally, Christina Weng, MD, Pravin Dugel, MD, and Robert Noecker, MD, highlight some of the medications we may not be thinking about that can affect the retina and optic nerve. The physicians agreed that hydroxychloroquine, commonly employed to treat autoimmune disease, can have a pathologic effect on the outer retina, and patients taking this medication should be followed and screened for retinal toxicity with spectral domain OCT and visual fields. The physicians also discuss ethambutol, pentosan, cancer treatments, and drugs that alter blood flow as risk factors for ocular disease.
I hope you enjoy this issue of EyeWorld and are able to become a better clinician by understanding the risks and benefits of systemic medications and nutraceuticals on ocular health.

Illuminating intraoperative technologies Illuminating intraoperative technologies
Ophthalmology News - EyeWorld Magazine
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