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Eyes on the Road

11/20/2015

 
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If you are planning to travel for the holidays and you wear glasses or contact lenses, make sure you are prepared.  If  you forget to plan and pack for your visual needs, your trip will be much less enjoyable and possibly more hazardous.  Traveling involves unfamiliar areas and traffic patterns and other unknowns such as weather conditions which make clear vision essential to getting there and back safely.  In addition to blurry vision, other travel-related safety and health issues pertain to improper contact lens wear and UV exposure.           

Eyeglass wearers should make sure their glasses are in good working condition.  Most optical shops will adjust and clean your glasses at no charge, regardless of where they were purchased.  If you feel like your vision isn't as good as it could be, you may need to see your eye doctor and update your prescription so you can order new glasses prior to your trip.  Whether you wear glasses or contacts, remember to pack a spare pair of glasses if you have an extra pair.   

Contact lens wearers should make sure that they have an adequate supply of contacts on hand and pack spare lenses, along with a contact lens case and appropriate lens solution.  If you are planning to fly and you intend to keep contact lens solution in your carry-on bag, remember that the bottle cannot exceed a volume of 3.4 ounces.  Contact lens wearers should avoid transferring their solution from the stock bottle to a smaller non-sterile container thereby risking contamination, serious infections and vision problems.  Many brands are available in sizes that are compatible with T.S.A. carry-on restrictions.

Most contact prescriptions have daily disposable options that can be very convenient for traveling and do not require the wearer to pack solution.  I often write contact prescriptions for patients in their preferred 2-week or 1-month replacement brand but also write a prescription for a daily disposable brand in cases where that type of lens may be more convenient for travel or safer for recreational use - especially if the contacts will be worn for various water sports or other activities where the lens will be exposed to a recreational water source.    
If you will be driving or spending much time outdoors, sunglasses can make your experience more enjoyable and provide protection for your eyes.  Make sure your glasses provide UV protection.  Polarized lenses are superior in many ways but they may not be for everyone.  Whether you already have a favorite pair or are shopping for new sunglasses, your optician or your eye doctor can evaluate them and ensure that you have what you need.     


Lastly, if your eye doctor has prescribed a topical eye drop for a medical condition that affects your eyes, don't forget to pack your medication(s).  For chronic conditions like glaucoma, make sure you have enough medication to last and that refills are available so you can use them according to your doctor's directions.  

Have a fun and safe holiday season.  Remember to take care of your eyes so that they can take care of you - including when you travel.  

Keep Your Peppers out of Your Peepers

11/12/2015

 
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A patient I saw recently reminded me of how spicy food can be bad for contact lens wearers.  This doesn't mean can't enjoy Mexican, Thai or other varieties of spicy food if you wear contacts.  It means that if you are making a spicy dish, you could end up with very irritated eyes if you handle your contacts after working with hot peppers. 

Capsaicin is the main heat-rendering molecule associated with jalapenos, serranos, habaneros and other hot peppers.  Capsaicin and similar molecules found in hot peppers can leave a very persistent residue on your hands, especially if you handle the pithy internal ribbing.  These compounds are not very water soluble so even extensive hand washing may not remove all the residue.  Since even small traces of capsaicinoids on your fingers can cause significant eye irritation if you touch your eyes or contacts while capsaicin is present, the best precaution is to wear gloves while handing hot peppers.  It is also important to avoid spreading the potentially irritating residue to other items or utensils.  Thus, gloves should be disposed of as soon as you are done handling the hot peppers.  Glove options include latex, nitrile and vinyl gloves and each type has different considerations regarding allergenicity, presence of powder, size availability, fit, type of cooking task you are performing and cost.  There are many good online resources regarding the pros and cons of each type of glove as well as other recommendations for food safety.  Whatever type you choose, just remember to protect your hands (and eyes) when handling hot peppers.  


Rheumatoid Arthritis and the Eyes

11/5/2015

 
By Bradley L. Rhinehart, O.D. 

Rheumatoid Arthritis (RA) is an auto-immune disease which causes pain, loss of function and progressive joint damage.  Initially, small joints in the hands and feet are affected but RA can spread to other joints and other parts of the body.  Although RA primarily causes musculoskeletal complications, other considerations include mental health and so-called "extra-articular" complications in the nervous system, heart, lungs, digestive tract, kidneys, skin and eyes.1  While there is still much to learn, it is known that RA affects females more frequently than males, and that risk increases with age and with a family history of RA.2 

Important considerations for RA patients include pain management, maintaining normal function and preserving quality of life.  RA should be diagnosed and treated by physicians who specialize in rheumatology and auto-immune diseases.  Extra-articular complications should be managed by appropriate specialty providers.  For example, since both RA and RA treatment can affect the eyes, ocular complications of the disease and risks associated with treatment should be managed by an eye doctor.  

Moderate to severe dry eye is often associated with RA and such patients often require aggressive dry eye treatment to help maintain healthy eyes and good vision.  When RA is properly managed or is in a period of remission, it is easier to control dry eye symptoms.  In addition to dry eye treatment, a detailed health history may reveal other physical symptoms in patients who have RA but have not yet been diagnosed.  When undiagnosed RA is suspected, referrals should be made to a rheumatologist so patients can receive the additional testing and care they need.  

Another aspect of RA management is the risk of retinopathy and vision loss in patients taking a so-called "high-risk medication" like Plaquenil (hydrxoychloroquine).  This medication can be very effective in managing pain and joint stiffness in RA patients as well as in treating complications of other auto-immune diseases like Lupus.  Retinopathy may be avoided or limited when patients are properly monitored.  Providers and patients need to be vigilant since even though retinal complications are rare, the adverse effects are irreversible and can continue to worsen, even after a patient has discontinued the medication.  Ideally, eye doctors may detect changes in the eyes before patients notice any functionally significant vision loss.

Risk factors for retinal complications with hydroxychloroquine pertain to dosage, height, weight and age as well as impaired liver or kidney function and the presence of preexisting retinal disease.3  Current guidelines established in 2011 by the American Academy of Ophthalmology recommend a complete eye examination, automated central visual field testing and one of several methods to evaluate the integrity of the central retina, (for which I usually recommend non-invasive diagnostic laser imaging of the macula), prior to or shortly after beginning treatment.4

Thereafter, patients should have an eye examination yearly.  Other specialized testing does not need to be repeated within the first 5 years unless a patient has additional risk factors.  After 5 years, both the eye examination and the enhanced retinal testing should be repeated yearly since complications are more likely after 5 years, which is usually around the time patients reach a cumulative dose of 1,000 grams.4

As with all medications, it is all about risk vs. benefit.  Hydroxychloroquine provides significant benefits in terms of decreased pain and joint stiffness and improved dexterity, mobility, mood and overall quality of life to many patients.  RA patients should work closely with their primary care and specialty providers, including their eye doctor, to manage the disease and reduce the risk of  potential complications associated with treatment.  Patients should remember that, while retinal complications are rare, monitoring is important because the risk is different for each person and adverse effects can be permanent.  In cases of retinopathy, the eye doctor should report findings to the managing rheumatologist so an appropriate substitution can be prescribed.  Retinal evaluation should then be repeated every 3 months until the condition is stable.3


1 Cojocaru M, Cojocaru IM, Silosi I, Vrabie CD, Tanasescu R. Extra-articular manifestations in rheumatoid arthritis. Mædica. 2010;5.4:286–291. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3152850. Accessed October 29, 2015. 

2 Mayo Clinic Staff. Diseases and conditions, rheumatoid arthritis. Mayo Clinic Web site. http://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/basics/risk-factors/con-20014868. Accessed October 30, 2015.

3 Hansen MS, Schuman SG, Scott IU, ed., Fekrat S, ed., Marmor MF ed.

Ophthalmic pearls: hydroxychloroquine-induced retinal toxicity.  EyeNet June 2011. http://www.aao.org/eyenet/article/hydroxychloroquine-induced-retinal-toxicity?June-2011. Accessed October 29, 2015.

4 Marmor MF, Kellner U, Lai TY, Lyons JS, Mieler, WF. Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy. Ophthalmology. 2011;118:415–422. http://www.ncbi.nlm.nih.gov/pubmed/21292109. Accessed October 29, 2015.
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    This blog features eye-related items of interest written or posted by Dr. Rhinehart. 

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