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.

Knowing what patients (and prospective patients) are worried about can only help you improve quality of care, guide marketing strategy, and inform your CE decisions, allowing you to shore up your knowledge base in relevant areas.

The post What Are Top Patient Concerns Regarding Eye Health Right Now? appeared first on Optometry 411.

The expansion underscores ECR’s dedication to providing networking opportunities, professional growth, and access to state-of-the-art resources for its members. 

“We hope that ODs will begin to see their accounting effort as a source of business growth opportunities,” said Michael Pote, Partner, at Ratio Accounting, Inc. “Tax management is a given. Business growth requires deep knowledge of the optometric practice and that is what we are bringing to the equation.”  

ECR will be announcing additional partnerships soon.

In today’s fast-paced world, where technology, patient needs, and business practices are constantly evolving, Eyecare Republic supports independent optometrists in staying ahead of the curve. By providing access to vital business resources, ongoing education, and a strong network of peers, ECR makes it easier for members to adapt and continue delivering exceptional care. For more information about membership with ECR and its new partners, please visit https://eyecarerepublic.com or contact Dr. Justin Weigel (jweigel@eyecarerepublic.com) for membership questions or Aaron Allen (aallen@eyecarerepublic.com or 855-859-8792). 

About Eyecare Republic (ECR) 

Eyecare Republic is a nationwide community of independent optometrists focused on improving patient care through collaboration, innovation, and shared resources. Members benefit from collective bargaining, business solutions, and continuous education, helping them to grow and enhance their practices. 

About the New Partner 

Ratio Accounting – U.S. headquarters in San Francisco, CA 

Ratio Accounting specializes in providing tailored financial solutions to optometry practices. With a focus on translating financial data into actionable insights, Ratio Accounting helps members with cash flow forecasting, financial reporting, and tax preparation. Their technology-driven approach, using real-time data access through QuickBooks Online, ensures that ECR members receive up-to-date information for sound business decisions. Ratio Accounting’s consultancy services guide practices through strategic planning, helping them maximize growth and profitability. 

For more information, visit www.ratioaccounting.com. 

The post Eyecare Republic Expands Its Reach: New Partnership Powers Up Optometry Support  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. We’ve 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. Optometrists 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 lead to a prompt referral 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, optometrists can spot thyroid eye disease, which causes symptoms like proptosis, dry eyes, and double vision. Detecting thyroid-related eye symptoms early enables referral 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. 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. Early detection leads to referral for oncology evaluation and treatment and can potentially improve 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 such as retinitis or uveitis. Syphilis, herpes, chlamydia, gonorrhea, genital warts, and pubic lice can also all affect layers of the eye. Identification can prompt crucial further testing and treatment of the underlying infection.

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.