The International Clinical Diabetic Retinopathy (ICDR) Severity Scale was created to refine DR classification in efforts to improve diagnosis and management:

• Mild NPDR: Microaneurysms only → Annual monitoring.
• Moderate NPDR: Intraretinal hemorrhages present → 9- to 12-month follow-up.
• Severe NPDR: Based on the 4-2-1 rule (four quadrants of hemorrhaging, two quadrants of venous beading, one quadrant of IRMA) → Referral to retina specialist recommended.
• PDR: Presence of neovascularization → Urgent referral for anti-VEGF therapy and/or panretinal photocoagulation (PRP).
• DME: Referral recommended for center-involved (CI-DME) cases, particularly those affecting best-corrected visual acuity (BCVA).

During “Current Strategies on Managing Diabetic Eye Disease,” a session at the recent Vision Expo East, Mary Beth Yackey, OD, and Jessica Haynes, OD, presented strategies for managing DR in your practice — tackling patient education, risk assessment, and treatment coordination for your diabetic patients. We’ll touch on just a few of the guidelines shared:

• Type 1 Diabetes: The American Diabetes Association and AOA guidelines recommend a baseline eye exam within five years of diagnosis and annual follow-ups thereafter.
• Type 2 Diabetes: Since undiagnosed diabetes is common, patients should have a comprehensive eye exam at diagnosis, with follow-up intervals based on DR severity.
• For moderate-to-severe NPDR, consider additional OCT, OCT-A, or electroretinography (ERG) to assess progression risk. In cases of rapid disease progression, poor glycemic control, or noncompliance, earlier referral may be warranted.

Recommended resource: Diabetic Eye Disease: A Comprehensive Look at the Optometrist’s Role

The doctors also spoke to new therapeutic treatments that are enhancing DR and diabetic macular edema (DME) management:

• Anti-VEGF injections act as first-line therapy for CI-DME and proliferative diabetic retinopathy (PDR); newer agents like faricimab and high-dose aflibercept offer longer durability.
• Panretinal photocoagulation (PRP) remains the gold standard for high-risk PDR to reduce neovascularization.
• Intravitreal corticosteroid implants may benefit pseudophakic patients or those unresponsive to anti-VEGF treatment.
• Emerging therapies: Fenofibrate (lipid-lowering agent) has shown promise in slowing DR progression, while nutritional supplementation targeting oxidative stress is an evolving area of research.

Patient education points to make

Consider the following information, as outlined in the VEE presentation, when discussing things with your patients:

After 15 years of disease duration, 80% of patients with type 1 DM will have some degree of retinopathy.

Elevated blood glucose levels and HbA1c values (less than or equal to 7%), as well as less glucose time in range assessed by continuous glucose monitoring devices, are also associated with higher rates of retinopathy.

Control of blood pressure, lipids, and management of comorbidities, such as sleep apnea, all reduce risk of progression.

Pregnancy in diabetics places increase risk of progression to severe retinopathy; however this is not the case in those with gestational diabetes.

Glucagon-like peptide-1 (GLP-1) receptor analogs are a newer, highly effective category of medication for diabetes management including semaglutide (Ozempic and Wegovy, both Novo Nordisk), and tirzepatide (Mounjaro, Eli Lilly).

Although improved glycemic control is encouraged for promotion of long-term positive outcomes, a transient worsening of retinopathy may be seen initially. (Likely related to VEGF expression, reactive oxygen species production and breakdown of the blood-retinal barrier.)

Source: “Current Strategies on Managing Diabetic Eye Disease,” presented by Mary Beth Yackey, OD, Jessica Haynes, OD, at Vision Expo East; Feb 19-22, 2025; Orlando.

The post Managing Diabetic Eye Disease: Strategy and Patient Education appeared first on Optometry 411.

Let’s take a moment to reflect on the topics that made headlines and sparked conversations in practices across the country.

Dry Eye Disease Dominates

One condition that dominated discussions this year was dry eye disease (DED). With new studies linking lifestyle factors to increasing dry eye cases, 2024 emphasized the need for proactive patient education and updated treatment strategies.

We learned more about the connection between vaping and dry eye. Research showed that vaping’s impact on tear film stability is more severe than previously thought, especially in younger patients.

Recommended reads:
Implementing Dry Eye Disease In-Office Treatments

Deciphering Dry Eye Disease To Improve Patient Care

AI Transforms the Exam Room and the Back Office

Artificial intelligence continued to make waves in optometry, with a promise of enhancing diagnostics and streamlining workflows. This year, AI-driven retinal imaging tools saw wider adoption, and more practices began to embrace automated systems for detecting early signs of diabetic retinopathy and glaucoma.

The buzz wasn’t just about the technology itself but also how optometrists are navigating the ethical and professional implications of AI. Conversations about maintaining patient trust and ensuring that AI complements, rather than replaces, human expertise were front and center.

Recommended reads:
Navigating AI in Optometry: A Balancing Act of Innovation and Ethics

What Did Experts Say About AI at Vision Expo West 2024?

FTC’s Updated Eyeglass Rule

A big regulatory shift in 2024 was the FTC’s updated Eyeglass Rule, which reinforced the requirement for optometrists to provide patients with their eyeglass prescriptions after an exam.

According to crowdsourcing from Vision Monday, optometrists have adjusted their workflows to meet the new requirements. Folks confirmed the administrative burden is about as expected and underlined the importance of clear communication and documentation in everyday practice to improve patient trust.

Presbyopia Drops: A Game Changer?

The impact of the FDA’s approval of Vuity eye drops in 2021 continued to ripple through 2024. Excitement around the promise of presbyopia drops persists, but, in truth, optometrists shared mixed reviews on these drops throughout the year.

Factors like pupil size, lighting conditions, and the duration of the drop’s effectiveness can influence patient outcomes. Discussions at conferences and online optometry spaces noted the importance of discussing potential side effects like headaches and reduced night vision with patients, to set realistic expectations. ODs are looking forward to new players like Qlosi, Clarity 3, and Ryzumvi.

Recommended read: Consider Pros, Cons of Presbyopia Eye Drops

Video: What’s New in Presbyopia-Correcting Eye Drops (12/18/24)

The Year of Myopia Management

Myopia management was another buzzy topic this year. With myopia rates continuing to rise among children, the spotlight was on evidence-based strategies like orthokeratology, atropine drops, and myopia-control soft lenses.

A major highlight was the growing emphasis on early intervention and parental education. Practices that invested in myopia management programs reported a boost in practice growth and patient loyalty.

Recommended reads:
An Overview of Myopia Management Interventions (from international experts)

Myopia: The Role of AI

Inclusivity

The conversation around making optometry more inclusive took a step forward in 2024. Whether creating more accessible exam rooms or better addressing disparities in eye care access, optometrists across the U.S. engaged in thoughtful discussions on equity and inclusivity.

One key development was the push for cultural competence in practices. Thought leaders shared practical strategies for improving understanding, and ODs began implementing changes to make their offices more equitable.

Recommended read: Eye Exams for Patients With Autism Require Accommodating Sensory Challenges

Looking Ahead

Optometry is evolving, and staying informed is more important than ever. 2024 showed us the importance of adaptability and continuous learning.

What stories caught your attention in 2024? Share your thoughts on our socials, and let’s keep the conversation going as we step into another year of growth and innovation.

The post 2024 in Focus: The Biggest Stories That Shaped Optometry appeared first on Optometry 411.

Research is also providing a clearer understanding of how menopause affects eye health. Sex hormone receptors have been found in various parts of the eye, and while the exact functions of estrogen and androgen receptors in these areas are still being studied, evidence suggests that sex hormones play a role in maintaining equilibrium in the eye — so hormonal changes in menopause are bound to have an impact.

It’s a bit tricky because aging in general causes eyesight to deteriorate. Is a patient’s condition due to menopause or simply natural ocular aging? Staying up to date on the potential effects of menopause is the first step in providing better care to patients in this transitional time.

A proactive approach, with regular eye exams and open communication about symptoms is the best way to go. Here’s a quick rundown of the latest findings and practical protocols for managing menopause-related eye changes.

Tackling Dry Eyes

The hormonal changes during menopause, especially the drop in estrogen, are major drivers of dry eye syndrome, one of the most common eye problems during this time. Recent studies show that menopausal women often struggle with visual discomforts, from eye strain and photophobia to a gritty sensation or unnatural awareness of their eyeballs.

There isn’t one product or strategy that works for everyone, but given the impact on daily life, finding a way to treat DED in your menopausal patients should be a priority.

• Regular use of quality artificial tears can temporarily relieve dryness.
• Prescription eye drops can reduce inflammation and increase tear production.
• Intense pulsed light therapy (IPL) may help.
• Small lifestyle changes, like using humidifiers at home and cutting back on screen time, can go a long way in reducing symptoms.
• Omega-3 supplements can potentially help, although current research actually presents mixed results:
  • The Dry Eye Assessment and Management (DREAM) study, a large-scale, multicenter, double-masked randomized controlled trial, evaluated omega-3 fatty acid supplements for DES. The study found no significant difference in symptom improvement between participants taking omega-3 supplements and those receiving a placebo.
  • But a more recent systematic review and meta-analysis in 2023 analyzed data from randomized clinical trials over the past decade. The analysis concluded that omega-3 fatty acid supplementation does effectively reduce DED symptoms, especially when administered in high doses, over a long duration, and with increased levels of eicosapentaenoic acid.

Navigating Corneal Changes

Menopause doesn’t just bring hot flashes and mood swings — it can subtly reshape the cornea. Changes in eye shape can affect focus, cause eyes to tire more easily, and make contact lenses uncomfortable. Patients might notice their usual lenses feeling off or their vision slightly blurred. Here’s research that suggests a link between menopause and a steepened curvature of the cornea.

• If patients experience discomfort with their current contacts, consider refitting them with a different brand or lenses designed for altered corneal shapes.
• Regular eye exams are key to monitoring corneal changes in order to make appropriate adjustments to any vision correction methods.

Monitoring for Glaucoma

Menopause might be a factor for increased glaucoma risk. New research suggests that women who enter menopause earlier may have a higher chance of developing open-angle glaucoma due to reduced estrogen levels. In fact, this 2023 research article suggests that late menarche (13+y), early menopause (prior to 45y), and delivering 5 or more children are all possible risk factors for OAG.

• Keeping an eye on intraocular pressure and performing optic nerve assessments can help catch changes early.
• Some evidence indicates that HRT might help stabilize IOP, though it’s something to discuss on a case-by-case basis with patients because the relationship between HRT and IOP is complex, and individual responses can vary. (HRT carries a risk of cardiovascular issues, breast cancer, blood clots, and gallbladder disease.)

Cataract Awareness

Hormone fluctuations can trigger or accelerate cataract formation in mid-life. It’s important to note that we aren’t entirely clear on the relationship between estrogen and lens health, only that they are linked. For example, HRT has been shown to increase the risk of cataract surgery in women, but hormonal contraception may be associated with a lower prevalence of cataracts (source).

• Not to be repetitive, but again, scheduling regular exams for menopausal and postmenopausal patients helps catch early signs of cataracts.
• For those with impaired vision, cataract surgery remains an effective solution when symptoms start to interfere with daily life.

Protecting Retinal Health

The retina also takes a hit during menopause, with lower estrogen levels possibly raising the risk for conditions like age-related macular degeneration. Menopausal women, especially those with lifestyle risk factors, can benefit from proactive steps.

• Encourage patients to quit smoking and eat a diet high in leafy greens and omega-rich fish, which have been shown to support retinal health.
• Vitamins C, E, zinc, lutein, and zeaxanthin are also recommended to keep the retina healthy:
  • The Age-Related Eye Disease Study and its follow-up, AREDS2, conducted by the National Eye Institute, have provided substantial evidence supporting the use of specific vitamins and minerals in reducing the progression of AMD.

As with most things, managing menopause-related eye issues benefits from a holistic approach. Healthy eating will support more than just the retina. Addressing DED can help with contact lense comfort. Coordinating with other health professionals will help you stay abreast of things like hormone levels and treatments that might influence a patient’s eye health.

And don’t underestimate the power of informing your patients about how menopause can affect their eyes. Hot flashes, mood swings, and brain fog are essentially common knowledge these days, but many people have no idea that menopause can impact eye health. Empowering your patients to take proactive steps makes a big difference.

The post The Menopause Effect: Latest Insights for ODs appeared first on Optometry 411.

Here’s a handy primer on a variety of colored lenses you might suggest, depending on the health conditions and needs of a patient.

A scattershot of notes before we dive in:

• The effects of tinted lenses are a perpetual subject of study. Sample sizes can vary dramatically, so study findings must be evaluated accordingly.
• The idea that tinted lenses can treat visual processing disorders like Irlen syndrome or reading issues like dyslexia is somewhat controversial and not currently supported by scientific evidence. (Read more: Update on Irlen Lenses)
• The ultimate effect of any lens tint will be patient specific. Relatedly, the tint type and darkness should be tailored to individual patient needs and personal preferences.

Rose/Pink Lenses

A rose-colored lens — FL-41 tint, specifically — enhances contrast, reduces glare, and can soothe eye strain and light sensitivity by blocking out a wide range of blue and green light. These can be worn indoors or outdoors, although indoor wear seems to be more effective.

Recommended for:

• Migraines
• Photophobia (including for patients with DED)
• Post-concussion recovery
• Blepharospasm
• TBI or concussion symptoms
• Visual snow syndrome
• Reducing visual noise for people with sensory processing disorders

Read more:
Dry Eye and Photophobia: The Outlook May Be Rosy

Yellow/Orange Lenses

Yellow lenses improve contrast sensitivity and depth perception, making them ideal in foggy, low-light, or overcast conditions. These have long been favored for both indoor and outdoor sports due to the enhancement of rapid reactions and contrast perception. Studies have also shown that yellow helps people stay focused when completing challenging tasks.

Recommended for:

• AMD, as yellow tint enhances contrast
• Glaucoma, as it helps reduce glare and eye strain
• People with bipolar disorder, as it has been found to minimize blue-light-triggered manic fluctuations
• People working at a screen all day (as an alternative to typical blue-light blockers)
• Activities like hunting that require improved visual acuity
• Indoor sports like basketball and racquetball
• Gamers

Note: The use of yellow/amber lenses for night driving, once posited as beneficial against the glare of modern headlights, is not backed by data:

In reality, when driving at night or dusk in already limited lighting conditions, ANY tint further reduces the amount of light transmitted to the eye and further impairs vision. The problem is compounded as the yellow tint gives the wearer the impression they are seeing better, when in fact the reverse is true. (Source: The Dangers of Yellow Night Driving Glasses)

For current info on night driving, check out: Overnight Glasses Addresses Nighttime Driving Difficulties With Tips for Improving Night Vision.

Gray Lenses

We have to include gray, but you already know the deal: A gray tint preserves true color perception, reducing overall brightness without altering colors. It works well outdoors on cloudy or sunny days and reduces glare, especially on the water. There’s a reason this is the most popular sunglass lens tint.

Recommended for:

• General light sensitivity
• Those working or playing in bright outdoor environments

Green Lenses

Green tint reduces glare, enhances contrast in shadowy areas, and can reduce stress on the eyes. Studies have shown green to be calming and relaxing and to have positive effects on creativity. Green light therapy has gained traction as a way to decrease the intensity and duration of migraines, and this is also reflected in lens technology (i.e., Avulux lenses).

Recommended for:

• Migraine sufferers triggered by light
• Outdoor sports regardless of light conditions
• Golf, baseball, and tennis in particular
• Fibromyalgia

Read more: Green Eyeglasses Reduce Pain-Related Anxiety in Fibromyalgia Patients, Study Shows

One OD has had success with gray-green tinted contact lenses for concussions or migraines, noting:

This is a great opportunity for dual prescribing in a primary eye care practice. For a patient who struggles with chronic migraine — and I guarantee that every practice has patients like this — you can offer a regular lens and a performance-tinted lens, so the patient can start wearing the tinted ones as soon as he or she feels a migraine beginning.

I recommend adding questions about migraine and light sensitivity to your patient history questionnaire. When appropriate, you can prescribe the performance-tinted lenses. This becomes a nice niche for the practice that builds revenue and word-of-mouth referrals — and it also solves a major problem for your patients. (Source: Performance-Tinted Contact Lenses Can Help Control Light Sensitivity)

Purple/Blue Lenses

These are good for enhancing contours while reducing reflective glare, and they work well in foggy or misty weather. Take what we know about blue light — that subjects are better able to concentrate at night when exposed to blue light, compared to white or red light — and consider recommending blue tints, which have been shown to have an activating effect on concentration.

Recommended for:

• Photosensitive epilepsy
• Golfers and tennis players needing sharper contrast on greens
• Snowy day sports and activities

One OD speaks to successful experimentation with therapeutic blue tints for Parkinson’s and autism: Some Lens Tints Have Been Shown to Help Sufferers of Certain Health Disorders

Read more: Opticians Who Use Tinted Lenses for People With Autism

Brown/Amber Lenses

These lenses increase depth perception and block blue light. Brown lenses heighten contrast against green landscapes and blue skies, making it a good sunglass lens tint.

Recommended for:

• People working outdoors (e.g., construction)
• Skiers, pilots, and drivers for better clarity in high-glare environments
• Golf and baseball (for seeing details at a distance)

What’s the big takeaway here? With the exception of migraine study results, the benefits of tinted lenses are fairly hard to pin down with data. But that doesn’t mean there’s no benefits. I like this summation:

Some companies are producing sporting glasses intended to improve an athlete’s abilities by filtering out certain wavelengths of light specific to their sport. For example, a mountain biker might use glasses which allow in more reds and yellows, enhancing their ability to see tree roots and loose soil. It is based on “optic science” and is all about balancing the colors of your environment to your advantage. Some believe that an application of this science can help people suffering from learning problems, dyslexia, ADD, autism, and migraines, among other problems. The idea is to use color-based technology to filter out offensive light waves so that the brain can process visual information more efficiently. This concept is somewhat controversial in that studies have produced varying results, and it seems that one filter color is not best for all people with the same diagnosis. This should not be considered a cure but could be a non-invasive way to offer help to some. (Source: Rose-Colored Glasses)

Additional resources and studies: 

An Index of BPI Therapeutic Lenses and Tints

Therapeutic Effects of Tinting a Lens (Contact or Spectacle)

Impact of Tinted Lenses on Contrast Sensitivity, Color Vision, and Visual Reaction Time in Young Adults

A Systematic Review of Controlled Trials on Visual Stress Using Intuitive Overlays or the Intuitive Colorimeter

The post Color-Tinted Lenses for a Wide Range of Health Issues: Current Info and Resources appeared first on Optometry 411.

You must also make sure you’re prescribing within your scope, as authority varies a bit by state. With that in mind, let’s take a look at the latest information and resources on prescribing oral medications to treat optometric issues.

Before initiating oral meds, a complete ocular and systemic history is crucial. This includes detailed knowledge of any other medications the patient is taking and whether the individual has any relevant drug allergies. Also, it is important to document his or her general health status — particularly liver and kidney function. Remember that proper liver function is critical for the metabolism of oral medications, and kidney function is integral to drug excretion.

A practical pointer: When encountering patients with extensive medication lists and multiple drug allergies, it may be helpful to ask them which agents they’ve used in the past for pain management or certain infections. We have several of these patients in our practice. Over time, many of them have learned which pain medications, for example, they can take without difficulty. (Source: When a Drop Isn’t Enough)

Infection Treatment

Antibiotics are the most commonly prescribed oral medication in optometry and are used when a bacterial infection is severe, widespread, or involves deeper ocular structures. Conditions like blepharitis, dacryocystitis, and preseptal cellulitis often require oral antibiotics:

Some ocular infections should be treated with an oral antibacterial agent as standard of care, including hordeolum, preseptal cellulitis and dacryocystitis. Oral antibacterial agents provide high systemic levels, which results in better penetration of the agent into the lacrimal apparatus and surrounding tissues. (Source: Antibiotics in Eye Care: A Balancing Act)

Read more: The OD’s Guide to Systemic and Topical Antibiotics with Cheat Sheet, Eyes on Eyecare

Inflammation Management

Oral anti-inflammatory medications, including corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs), tend to be used for conditions such as uveitis, scleritis, and other inflammatory disorders that may not respond fully to topical treatments.

Read more: Know the Ins and Outs of Oral Steroids, Review of Optometry

Glaucoma Treatment

Certain oral medications, such as carbonic anhydrase inhibitors (CAIs), help lower IOP in acute glaucoma attacks or act as adjuncts to topical medications when eye pressure is not well-controlled.

Systemic medications for intraocular pressure control are typically reserved for cases in which a significant temporary drop in IOP is required that cannot be achieved by any other means.

Oral preparations are most commonly used in cases of acute angle-closure glaucoma or surrounding intraocular surgery, in which substantial pressure spikes may arise. (Source: Everything You Need to Know About Oral Glaucoma Medications)

A Note About Cannabis

While not a mainstream treatment — and needing significant further research — cannabis has been explored in glaucoma treatment primarily due to its effect on IOP. THC, the psychoactive compound in cannabis, is responsible for this pressure-lowering effect. But the effect is short-lived (typically 3 – 4 hours), making it impractical for treatment compared to conventional medications like prostaglandin analogs or beta-blockers, which can control IOP for longer periods with fewer doses.

Essentially, to maintain purported benefits, cannabis would need to be used frequently, which could lead to impaired cognition, dizziness, etc. Not exactly practical or safe.

Allergy Relief

For severe allergic reactions that affect the eyes, oral antihistamines or systemic steroids may reduce symptoms like swelling, redness, and itchiness. Of course, it’s important to consider that oral antihistamines can effectively dry up mucous membranes and cause patients to experience more redness, itchiness, or dry eyes. Decreased tear production from dry eyes means allergens can concentrate in the eye, causing further irritation.

Read more: The Allergic Eye: Recommendations About Pharmacotherapy and Recent Therapeutic Agents, Allergy and Clinical Immunology

Dry Eye Management

In some cases, oral meds such as tetracycline-based antibiotics, are used to manage chronic dry eye by improving tear film stability or reducing inflammation in the meibomian glands.

Read more:
Dry Eye Disease (Keratoconjunctivitis Sicca) Medication, Medscape

How — And Why — to Choose Dry Eye Drugs, Review of Optometry

Inversely, here’s a handy primer on oral medications that can cause dry eye in your patients. Save it as a reference when inquiring about patient history during exams.

Herpes Simplex and Zoster Infections

Oral antivirals like acyclovir or valacyclovir are used to manage viral infections like herpes simplex keratitis or herpes zoster ophthalmicus. Oral antiviral medications can help decrease both the incidence and severity of ocular complications and are generally well tolerated by patients.

Systemic Conditions Affecting the Eyes

Oral medications can also be used to treat systemic diseases with ocular manifestations, such as diabetes (which can lead to diabetic retinopathy) or autoimmune diseases that cause inflammation in the eyes.

Read more: APX3330 “Promising” Oral Treatment Option for Slowing Progression of Diabetic Retinopathy

Controlled Substances

Take a look at this map — Optometrist Prescription of Controlled Substances by State — to see optometrist authority to prescribe certain classifications of controlled substances by state or territory.

Note: As of June 2023, the DEA requires a new one-time training requirement for all DEA-registered practitioners on the treatment and management of patients with opioid or other substance use disorders. (Source: DEA Numbers and Optometry)

Best Practices

As mentioned up top, it’s important to set yourself up for success during the initial exam:

One key to successfully prescribing oral medications to your patients is to obtain a comprehensive medical history, detailed medication review (including supplements and vitamins), allergy history (including reaction) and review of systems … A drug interaction check program or app is also an important step to confirm that the proposed medication will not introduce a potentially harmful effect due to interaction with any current medications or supplements. (Source: Prescribe Oral Meds Like a Pro)

You should also consider effects on pregnancy and lactation, birth control, fertility, etc.

This article was compiled using information from the sources linked above and the following comprehensive resources for prescribing oral medications:
Safe and Savvy Prescribing of Oral Pharmaceuticals, Review of Optometry 

Pharmaceutical Management with Ophthalmic Orals, ODReference

The Dos and Don’ts of Oral Medication, Review Education Group

The Role of Oral Medications in Optometry, Woo University

The post Resources for Prescribing Oral Pharmaceuticals in Optometric Practice appeared first on Optometry 411.

It’s important to stay abreast of the diagnostic developments in this area, of course. You can also use this unique facet of optometry to attract and retain patients. The invaluable benefit of regular eye exams on total health is not common knowledge, and you’d be well served making patients aware.

Messaging should always emphasize that regular eye exams are essential not only for maintaining good vision but also for monitoring one’s overall health. Optometry 411 has compiled a primer on the ways optometrists contribute to the early detection and subsequent management of systemic diseases, plus current related reads to help you with detection:

1. Diabetes

In the past, diabetes was identified in eye clinics only after visible signs of diabetic retinopathy. Recent research has identified subclinical and clinical changes that occur in the anterior segment of the eye with metabolic disease that allows for detection of diabetic eye disease at an early stage. ODs can also be on the lookout for early signs of diabetic retinopathy like microaneurysms, hemorrhages, and exudates in the retina.

Related reads:
Recognizing the Early Signs of Diabetic Eye Disease

Advancements in the Treatment of Diabetic Retinopathy: A Glimpse into Cutting-Edge Therapies

OU Researcher Developing Potential New Treatment for Diabetic Retinopathy That Could Address the Problem Much Earlier

2. Hypertension

Signs of hypertensive retinopathy include narrowing of blood vessels, retinal hemorrhages, and optic disc swelling. Noticing these signs can allow you to promptly refer for an evaluation to initiate hypertension management and reduce the risk of stroke or heart attack.

Related read: Don’t Let the Pressure Get to You — or Your Patients: 3 Questions ODs Should Be Asking Themselves

3. Autoimmune Diseases

Conditions like lupus and rheumatoid arthritis can present with eye symptoms like dry eye, uveitis, or scleritis that you can identify during routine exams. The first symptoms of myasthenia gravis often involve drooping eyelids in one or both eyes and/or double vision, and dry eyes are a key feature of Sjögren’s syndrome. While not technically categorized as an autoimmune disease, the inflammatory disease sarcoidosis causes iritis and severe light sensitivity.

Related reads:
Autoimmune Disease and the Eye

Understanding Ocular Findings and Manifestations of Systemic Lupus Erythematosus: Update Review of the Literature

Purtscher-Like Retinopathy: A Warning Sign of Lupus

4. Thyroid Disease

Piggybacking off autoimmune disease detection, ODs can spot thyroid eye disease, which causes symptoms like proptosis, dry eyes, and double vision. Detecting thyroid-related eye symptoms early means you can refer patients to an endocrinologist, oculoplastic surgeon, etc. for thyroid management and prevention of more severe complications.

Related reads:
Identifying the Constellation of Signs and Symptoms in TED

Thyroid Eye Disease In Your Exam Lane

Thyroid-Associated Ophthalmopathy: The Role of Oxidative Stress

5. Multiple Sclerosis

Optic neuritis is often one of the first symptoms of MS and can be identified through symptoms like sudden vision loss or pain with eye movement. Once you’ve detected optic neuritis in an eye exam, you can refer to a neurologist for diagnosis and management.

Related reads:
Optometry’s Role in Multiple Sclerosis

Vision Problems Associated With Multiple Sclerosis

6. Cardiovascular Diseases

Changes in the retinal blood vessels, such as arteriovenous nicking or cotton wool spots, can indicate underlying cardiovascular issues. ODs can detect these signs during a dilated eye exam. Once again, speedy referral to a cardiologist for further assessment can help prevent serious outcomes.

Related read: Ocular Manifestations of Common Cardiovascular Diseases

7. Cancer

Cancers like ocular melanoma, primary intraocular lymphoma (PIOL), or metastatic tumors, can present with eye symptoms and unusual growths or lesions in the eye. No one needs to be reminded of the benefits to early detection when it comes to improving the prognosis.

Related reads:
Understanding Ocular Metastatic Tumors and Simulating Lesions

How to Manage a Patient with Ocular Metastases?

Primary Intraocular Lymphoma: StatPearls

Effect of UV Radiation on Ocular Melanoma Differs Between Parts of the Eye

8. Infectious Diseases

Infections like HIV/AIDS or tuberculosis can have ocular manifestations like retinitis or uveitis. Syphilis, herpes, chlamydia, gonorrhea, genital warts, and pubic lice can also all affect layers of the eye.

Related reads:
Ocular Manifestations of HIV

HIV Retinopathy: StatPearls

Ocular Manifestations and Diagnosis of Tuberculosis Involving the Uvea: A Case Series

If you want to shore up on your early detection skills even further, check out 20 Surprising Health Problems an Eye Exam Can Catch from the American Academy of Ophthalmology that includes additional conditions like giant cell arteritis, high cholesterol, sickle cell disease, and more. There’s a lot to look for during a routine eye exam, but with your help, patients can benefit from potentially life-saving early detection.

The post The Role of Optometrists in Detecting Systemic Diseases  appeared first on Optometry 411.

It’s hard to keep up with the massive beauty industry, particularly if you aren’t into makeup and beauty trends yourself. Let’s run down current problematic beauty trends and techniques so you’ll know what to look for, and what to ask about when seeing patients.

Tightlining

You see it all the time, but you may not know the term: Tightlining is a makeup technique where eyeliner is applied directly to the waterline, the skin between the base of the lashline and the cornea. It is likely the most common/popular practice on this list. Potential problems include:

• Blocking meibomian glands, causing MGD
• Increasing the amount of cosmetic that enters the tear film and contacts the surface of the eyes
• Exposure to bacteria from unclean or shared products
• Product transfer onto contact lenses causing vision disruption, irritation, and infection

Many people don’t know to be cautious of tightlining because its complications aren’t common knowledge. Beauty magazines have promoted using eyeliner on the waterline for decades, and even if you do show the risks — as Dr. Brittani Carver did on TikTok in 2021, showing a longtime tightliner’s gnarly case of MGD — many viewers still replied that they would not be deterred. As I said, it’s an extremely popular technique.

Eyeliner Tattoos

This is a permanent makeup trend with an important caveat: None of the pigments used for eyelid tattoos are approved for use by the FDA. Eyeliner tattooing involves multiple application treatments, any one of which can cause an adverse reaction:

The process can cause physical damage to the meibomian glands due to dye obstructing the duct, chronic lid margin inflammation, allergic reactions, and potential severe reactions like full thickness lid margin penetration, infections, and eyelid scarring. Eyeliner tattoos may affect the eyes with individuals that have undergone the procedure showing increased corneal staining, shorter tear break up time, and greater amount of meibomian gland dropout.  (Source: Through the Lens of Beauty: Navigating Cosmetic Trends and Their Ocular Effects)

Glitter Eyeshadow

You’ve probably seen glitter in a tear duct or two under your slit lamp, no? Needless to say, anything stuck in a tear duct can cause problems. Glitter can also penetrate the tear film and create corneal abrasions. If people use craft glitter on their face, as opposed to a cosmetic glitter, the risks go up.

In the interest of providing safer solutions to harmful products, you could recommend a cream shadow instead of a glitter powder — it’s less likely to get … everywhere. As with tightlining, having glittery eyelids is a beauty trend that’s not going anywhere, so it’s best to properly advise patients and provide safer alternatives when possible.

Lash Serum

Problems with lash serums are well documented at this point. Serums can cause burning and irritation, iris darkening, conjunctival hyperemia, periorbitopathy due to orbital fat loss, upper eyelid ptosis, and chronic dry eye. Safety information on the packaging is often insufficient and serums are categorized as cosmetics when many actually contain prostaglandin analogues. The good news is that most of these side effects are dose-dependent and may be reversible with treatment discontinuation. (Source: Real Talk About Eyelash Enhancements)

Key lash serum takeaways:

• There is still only one lash serum currently approved by the FDA: bimatoprost 0.3% (Latisse).
• Lash growth serums should not be used while wearing contact lenses.
• Providing visual evidence of potential complications makes patients more likely to consider alternatives.
• Nonprostaglandin analog products like castor oil-based conditioners are not scientifically proven to help lashes grow, but can be a generally safer option for many. Still, there is insufficient research evaluating many of these serums and their safety and efficacy.

Lash Extensions

Lash extensions have exploded in popularity in recent years, despite their regular maintenance requiring two-hour-plus appointments every two to four weeks. Potential complications are numerous:

• Lagophthalmos
• Short-term increases in tear meniscus height and corneal staining
• Risk of chalazia/hordeola
• Keratoconjunctivitis, allergic blepharitis, and conjunctival erosion from the glue used in the application process
• Itching, redness, pain, watery eyes, heavy eyelids, foreign body sensation, and burning
• Hygiene issues from extensions being worn for weeks at a time

Safer practices for extensions include using glues that do not contain cyanoacrylate, latex, or ammonia and removers that are oil-based. You could recommend OTC hypochlorous acid as a cleaning option that will not dissolve the glues. (Source: Lashing Out: Dangerous Beauty Trends)

The DED Factor

We’ve gotten through all this with only one dry eye mention. Let’s remedy that. Current research shows that eye makeup in general is having an impact. In this month’s issue of Contact Lens Update, the Centre for Ocular Research & Education (CORE) highlighted a study that indicates a link between frequent use of eye cosmetics and dry eye symptoms. CORE lists several recommendations you can share with patients:

• Remove contact lenses and all traces of makeup, especially before going to sleep.
• Patients prone to symptoms of DED should consider the following options to mitigate exacerbation of their dry eye symptoms:
  • Applying cosmetics further away from the ocular surface
  • Limiting eyeliner to the external lids only
  • Avoiding eyeshadows that may contain larger shimmery particles
  • Avoiding false eyelashes (and lash extensions)
• All cosmetic users should be reminded to discard and replace their eye cosmetics on a regular basis and to ensure applicators are regularly cleaned. (Source: Article Review: Prevalence of Dry Eye Disease and Its Association with the Frequent Usage of Eye Cosmetics Among Women)

I recommend visiting all the sources linked in this article for deeper dives on the treatment of complications resulting from cosmetics and eye-related beauty trends, plus additional ways to educate patients about healthier practices and alternatives. Through the Lens of Beauty: Navigating Cosmetic Trends and Their Ocular Effects is particularly informative.

Keep in mind that you are the trusted authority in a sea of beauty influencers and positive product reviews that do not take eye health into account.

The post Problematic Cosmetic Trends: Latest Insights and Recommendations appeared first on Optometry 411.

Key takeaways for eyecare professionals: 

• Effective axial length control: RLRL therapy significantly reduced axial elongation, a key factor in myopia progression, compared to controls. Over half of the treated group experienced axial shortening. 

• Slows refractive error progression: While not reversing myopia, the intervention group showed a marked improvement in spherical equivalent refraction compared to controls whose vision worsened. 

• Favorable safety profile: The study reported only one case of mild conjunctivitis in the treatment group, suggesting a safe profile for RLRL therapy. 

This study adds to the growing body of evidence supporting RLRL therapy as a viable tool for managing high myopia in children. While the long-term effects and optimal treatment protocols need further investigation, the initial findings are encouraging. 

Here’s how this translates to your practice: 

• Early intervention is crucial: The study participants had a median age of 11, highlighting the importance of early detection and intervention for high myopia. 

• RLRL as a complementary therapy: Consider RLRL as a potential adjunct to traditional myopia management strategies like eyeglasses and contact lenses. 

• Stay informed on evolving therapies: Myopia management is a rapidly evolving field. Keeping abreast of novel approaches like RLRL allows you to offer the best possible care to your young patients. 

Limitations of the study to consider: 

• The study defines high myopia with a -4D cutoff, lower than some commonly used standards. 

• Longer follow-up periods are needed to assess long-term efficacy. 

• Potential bias due to participant awareness of their assigned treatment group exists. 

Overall, RLRL therapy presents an exciting prospect for managing high myopia in children. Further research will solidify its role in the optometrist’s toolkit for treating this growing public health concern. 

The post New Tool for High Myopia in Children Shows Promise  appeared first on Optometry 411.

Here’s a breakdown of what the Navigator offers: 

• The 3 Ms of Myopia Management: The Navigator focuses on three key pillars: mitigation, measurement, and management. Each section offers educational content, practical advice, and resources to enhance your knowledge and clinical skills. 

• “Myopia Moments” and Webinars: Deepen your understanding with real-world case studies and expert webinars, all conveniently accessible within the Navigator. 

• Patient Education Resources: The Navigator equips you with tools to effectively discuss myopia management with patients and families. 

The Myopia Management Navigator is a free, comprehensive resource to elevate your myopia management skills. This user-friendly platform caters to both experienced practitioners and those new to myopia management, empowering you and your staff to provide informed care and better patient outcomes. 

The Myopia Management Navigator represents a significant step towards making myopia management a standard of care. Explore this valuable resource and take your practice to the next level in addressing this prevalent condition. 

The post Myopia Management Navigator: A Free Resource for Eye Care Pros  appeared first on Optometry 411.

1. Corneal Abrasions: Corneal abrasions are among the most frequent eye injuries, often resulting from foreign objects like dust or contact lenses. Patients typically present with severe pain, tearing, and photophobia. Immediate action includes thorough irrigation to remove any foreign material, followed by fluorescein staining to confirm the diagnosis. Prescribing antibiotic eye drops can prevent infection, and recommending lubricating drops can enhance comfort during the healing process.

2. Acute Glaucoma: Acute angle-closure glaucoma is a sight-threatening emergency. Patients often report sudden onset of severe eye pain, headache, nausea, and halos around lights, accompanied by decreased vision. It’s vital to measure intraocular pressure (IOP) promptly; elevated IOP confirms the diagnosis. Initial treatment includes medications like oral acetazolamide and topical beta-blockers to lower IOP. Immediate referral to an ophthalmologist for further management, possibly including laser therapy, is critical.

3. Retinal Detachment: Retinal detachment can lead to permanent vision loss if not treated swiftly. Symptoms often include sudden flashes of light, a dramatic increase in floaters, or a shadow over the visual field. Approximately 1 in 10,000 people are affected by retinal detachment annually. Prompt dilated fundoscopy is critical for diagnosis. If detachment is suspected, urgent referral to a retina specialist is necessary for potential surgical intervention.

Bonus Tips for Optometric Emergencies

• Preparedness: Keep a well-stocked emergency kit with fluorescein strips, topical anesthetics, antibiotics, and cycloplegic drops.
• Training: Regularly update your skills through continuing education courses focused on emergency eye care.
• Patient Education: Inform patients about the importance of seeking immediate care for sudden vision changes, pain, or trauma.
• Network: Build a strong referral network with local ophthalmologists and emergency departments to ensure swift collaboration when necessary.

By following these tips and building your confidence in handling urgent eye care situations, you can become a valuable resource for your patients and a key player in safeguarding their vision.

SOURCES: AAO

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