Transcript

Lee Tetreault:

Welcome to frequently ask questions from the session Common Eye Problems Seen In Primary Care. We are joined by Dr. Yvonne Chu. Before we begin, with these questions doctor, would you be able to reiterate a few key pointers from today's session to our audience?

Dr. Chu:  

Great, thank you so much. I want to remind all of our audience members to use their RSVP cards when determining whether a patient should be referred for urgent ophthalmology evaluation. RSVP, standing for redness, sensitivity to light, vision loss, and pain. If your patient is expressing symptomatology that checks off each of those, it is time to pick up the phone and get the patient urgently seen by an eye care specialist. Another thing I want to remind our audience is to screen their diabetic patients at least annually for diabetic retinopathy. If you're finding that you're having difficulty with compliance and getting patients to an eye professional to be screened, one, consider looking into teleretinal platforms in which there could be photos taken of the retina and to have those evaluated by eye care professionals to help screen for patients who may be at imminent risk for severe vision loss, so that they could be urgently sent to an eye care specialist to intervene for patients with severe diabetic retinopathy.

And third, I want to encourage all primary care providers to think about risk factors that you see in your patients that may be related to primary open angle glaucoma. And those risk factors are: Increasing age, those over the age of 60, race, those of African-American descent, especially those of Caribbean descent. Three, a positive family history for glaucoma in a first degree relative, and those that may have attended a screening session, or those that may have relayed personal history of increased intraocular eye pressure. Those are the four risk factors that you could see in your clinics where those patients may be at increased risk for primary open angle glaucoma.

Lee Tetreault:

Thank you, Doc. Let's start with the frequently asked questions. First, what eye vitamins do you recommend?

Dr. Chu:  

I think for the general public, there's nothing specific that I would recommend in terms of eye vitamins. Of course, taking a multi-vitamin and including, with a good balanced diet never hurts anyone. But there's been no significant literature that would suggest that taking an eye vitamin for the general public is helpful or to prevent any other ocular conditions. However, for patients who may experience dry eyes or tear film deficiencies, those patients sometimes will benefit for Omega 3, dietary supplements such as fish oil, a flaxseed oil to help balance out their tear film.

And those patients with moderate or intermediate age-related macular degeneration maybe benefit from multi-vitamins that have the Areds 2 formulation that would be marked on the box, and these are all available over the counter, to help with reducing the risk for progression to advanced age-related macular degeneration.

Lee Tetreault:

Is there a recommended way to screen for melanoma of the eye?

Dr. Chu:  

Unfortunately, there's not currently a standard, a protocol for screening of ocular melanoma. And most of these intraocular tumors are typically found during a routine dilated eye exam, as most of these intraocular tumors are not causing any sight threatening compromise during the early phase as well as causing any discomfort or pain. So, unfortunately, intraocular tumors are sometimes detected at a routine eye exam that requires dilation so that the eye care provider can look into the peripheral retina. According to the 2015 comprehensive adult medical eye evaluation preferred practice pattern that's recommended by the American Academy of Ophthalmology, a full dilated eye exam is recommended for those under the age of 40 every five to 10 years, and for those that are between 40 and 54 every two to four years, and those that are 55 to 64 every one to three years. In any patient greater than 65, it's recommended to receive an annual eye exam every one to two years and this would be for patients who have no other significant co-morbidity or risk factors that require an exam such as diabetes.

Lee Tetreault:

How significant is a blocked tear duct to long-term eye health?

Dr. Chu:  

Well, the good news to that is that it will not affect the health of the eye itself long term. Typically, patients who have a blocked tear duct will experience excessive tearing also called epiphora, which is really more of a nuisance than it is a damage to the eye ball itself or the eye's health. So typically the blocked eye duct can be corrected... Excuse me. The blocked tear duct can be corrected through a procedure that's typically performed by an ocular specialist where they re-route the tear duct with a silicone tubing to allow for proper flow.

Lee Tetreault:

Does the data support use of AREDS 2 eye vitamins in diabetic patients for prevention of complications?

Dr. Chu:  

Well, that's a very interesting question. Although there are a lot of similarities in the molecular pathogenesis for diabetic retinopathy and such that there is a retinal damage from oxidative forces, there's been some laboratory studies that show that the AREDS 2 formulation has been helpful in diabetic rats and they have shown some positive results. However, unfortunately, up-to-date for now we don't have any conclusive data in human studies, and I think the jury is still out.

Lee Tetreault:

Great, thank you so much for your time, Dr. Chu.

Dr. Chu:  

Thank you.




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