Dry Eye: More Than an Ocular Condition

HOT TOPIC

Could DED Affect Your Mental Health?

A new study in the American Journal of Ophthalmology found a significant link between individuals with dry eye disease (DED) and an increased risk of a variety of mental health disorders, such as depression, anxiety, bipolar disorder, and disorders on the schizophrenia spectrum. The study, led by researchers at the Perelman School of Medicine at the University of Pennsylvania, analyzed data from the National Institute of Health’s All of Us database, which includes more than 18,000 patients with DED and a matched control group. These patients had a mean age of 64.9 years and were 67% female. The records identified the patients as those with the medical codes of dry eye, meibomian gland dysfunction, and tear film insufficiency.

Their research findings showed that patients with DED were more than three times as likely to have mental health conditions compared with those without DED. These associations were significantly more robust among Black individuals than among White individuals, except for those with bipolar disorder. The authors recommend that “Greater efforts should be undertaken to screen patients with DED (dry eye disease) for mental health conditions, particularly in historically medically underserved populations.”

My Two Cents

This is something I’ve personally suspected for many years. What’s difficult, however, is deciding which came first, the anxiety issues or the dry eye issues? Either way, we must pay attention to our patient’s mental well-being as well as their ocular surface issues. We can use this study to illustrate to our patients with any anxiety or depression that they are not alone, and that perhaps seeking mental health care would be appropriate.

OUTSIDE THE LANE

Study Finds Efficacy of Antiviral Treatment for Ocular Shingles

Other research led by faculty from the Perelman School of Medicine at the University of Pennsylvania and the NYU Grossman School of Medicine has revealed that long-term, low-dose antiviral medication is crucial for treating ocular shingles, also known as herpes zoster ophthalmicus (HZO).

The research, part of the Zoster Eye Disease Study (ZEDS), found that taking the antiviral medication valacyclovir for 1 year significantly reduces the risk of new or worsening eye disease by 26% at 18 months. This treatment also decreases the duration of pain and the need for neuropathic pain medication. HZO affects about 8% of the more than 1 million new shingles cases each year in the United States and can lead to keratitis and iritis, which causes our patients textbook pain, redness, light sensitivity, and decreased vision, among other symptoms. The results of the ZEDS trial were based on patients seen from November 2017 until January 2023, enrolling more than 500 participants whose shingles affected their eyes. Half of the participants took daily doses of valacyclovir for 1 year, while the other half of the study participants received a placebo.

The study’s findings supported extending antiviral treatment beyond 7 to 10 days to improve patient outcomes. It was also recommended to emphasize prevention through zoster vaccine recombinant, adjuvanted (Shingrix, GSK) vaccination, especially for patients older than 50 years of age.

My Two Cents

New research always causes me to reexamine my clinical protocol. Typically, when I see a patient with HZO, I prescribe a treatment of 1,000 mg of valacyclovir three times daily for 10 days. However, this new part of the ZEDS trial shows that extending that treatment for an entire year would be a better clinical idea, albeit with a yearlong treatment of just 1,000 mg daily. This is a discussion I’ll be having with my patients beginning tomorrow.

CAN YOU RELATE

Last week, I took some time out of clinic (and convention) season to visit Jackson Hole, Wyoming, with my dad. He’s always wanted to “go west” and has never seen the Teton Mountains. I had been to the area years ago for a wedding and have been itching to go back and explore it further. The Jackson Hole area is between seasons now, and the wonderful resort we stayed at in Teton Village was nearly empty. The amount of personal attention we received from the staff was incredible, and the few other tourists we encountered during our stay were refreshing. Throughout our visit, the staff repeatedly mentioned how they were gearing up for the snow and how, during the winter and the summer, the area is so thick with tourists you struggle to find personal space.

My mind started thinking about when I was in school; we were often told about “busy seasons” in the eye care world. When I graduated and spent some time in corporate eye care, I experienced this firsthand. Tax refund season and back to school time seemed insane, and the schedule was filled to the brink with patients. I remember walking out of the exam room to call a patient back and seeing people sitting on the floors waiting to be seen and spend that refund check.

When I joined a small private practice, our busy times were back to school and at the end of the calendar year, as patients looked to use their insurance benefits before they expired. Now, at Williamson Eye Center, the entire year seems busy. We’re booked out every day all year. And as a practice that does a plethora of cataract surgeries, those procedures tend to be scheduled most frequently at the end of the year, as patients know their medical deductibles are met and try to squeeze that surgery in before their deductible resets. Just like resorts and vacation destinations, eye care practices can also have their own different busy seasons!