Advise Patients About Routine Ophthalmic Health

Routine eye care is essential to maintaining overall health and diminishing or halting various ophthalmic disorders, which can negatively affect vision and overall health-related quality of life.

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Research findings have indicated that the ongoing prolonged use of electronic devices, including cell phones, computers, tablets, and e-readers, contributes to a growing issue affecting many individuals, including pediatric patients, around the globe. The American Optometric Association refers to this issue as digital eye strain (DES), or computer vision syndrome, and data indicate that DES can augment the risk of dry, red, and itchy eyes as well as headaches, blurry vision, foreign body sensation in the eyes, eye irritation, watery eyes, photophobia, eye strain, and strabismus.^1,2

Ocular discomfort due to dry eye disease (DED) is the most common condition for which patients seek OTC ophthalmic products.³ Patients experiencing DED should be encouraged to seek care from their primary health care provider or an ophthalmologist to determine the cause of DED, if feasible, which can aid in determining whether self-management is appropriate and other prescription therapies are warranted.

Examples of other common ophthalmic issues that may be amenable to self-treatment include mild to moderate allergic conjunctivitis, corneal edema, blepharitis, and contact dermatitis of the eyelid. Patients should also be encouraged to seek medical evaluation to determine the cause and appropriate course of action based on individual need.³ When appropriate, individuals may also use various supplements marketed for ophthalmic health, including age-related macular degeneration (AMD).³

Pharmacists are well positioned to ascertain self-care appropriateness and when to direct patients to seek further medical evaluation. Pharmacists can also educate patients about the various OTC products marketed for ophthalmic issues, such as nonmedicated ophthalmic ointments and artificial tear solutions for treating and preventing DED, as well as ophthalmic decongestant, antihistamine, and/or astringent formulations for the treatment and prevention of allergic conjunctivitis. There are also hyperosmotic saline solutions and ointments for treating corneal edema, and eye irrigating kits to treat loose foreign substances in the eye. Patients may also be interested in nutritional supplements formulated with vitamin C, vitamin E, lutein, zeaxanthin, zinc, and copper for AMD, particularly dry AMD.³

The Table⁴ provides vital counseling tips for patients.

News and Clinical Data

Findings from an online survey by the American Academy of Ophthalmology of 3512 adults in the US revealed that 81% of participants felt they were knowledgeable about eye or vision health. However, only 1 in 5 was able to correctly identify the 3 primary causes of blindness, which are glaucoma, AMD, and diabetic eye disease. Furthermore, 67% were unaware that many patients do not experience symptoms before experiencing vision loss.⁵ These findings highlight the need for pharmacists to provide education to patients at risk of these conditions.

Results from a study published in the American Journal of Ophthalmology revealed that COVID-19 vaccines do not appear to augment the risk of ocular adverse events. Ocular adverse events studied included retinal artery occlusion, retinal vein occlusion, noninfectious uveitis, noninfectious scleritis, optic neuritis, ischemic optic neuropathy, and ocular motor cranial nerve palsy. The authors wrote, “This study provides valuable evidence to the expanding body of research on vaccine safety and supports the idea that the overall benefits of COVID-19 vaccination outweigh potential ophthalmic risks.”⁶

Additionally, study findings published in Ophthalmology Glaucoma examined the association between statin use and glaucoma. Results revealed that the use of statins was associated with a higher risk of developing glaucoma when compared with individuals not using statins, especially for adults in their 60s with hyperlipidemia.⁷ The authors concluded that statin use may be an independent risk factor for glaucoma, which may furthermore be affected by lipid profile and age.⁷

Finally, the CDC indicates that many adults are at elevated risk of vision loss, but an estimated 40% did not obtain an annual eye exam the previous year.⁸ Furthermore, among adults who reported needing glasses, about 1 in 11 said they could not afford them, underlining the challenges that high costs cause for patients who need vision care. Many patients may therefore turn to OTC products such as reading glasses, providing opportunities for pharmacists to counsel patients.

Conclusion

Pharmacists can be instrumental in identifying medications or medical conditions that may contribute to or exacerbate common ophthalmic conditions, such as DED, and making clinical recommendations tailored to patient needs when warranted. They can also educate patients about the importance of ophthalmic health and instruct them on the proper administration of ophthalmic medications, including storage and preparation of medication, proper dosage, frequency of administration, and recommended duration of use. A helpful patient education teaching tool on the proper installation of ophthalmic drops is available on the American Academy of Ophthalmology website at aao. org/eye-health/treatments/how-to-put-in-eye-drops.

During counseling, pharmacists should remind patients about the importance of routine eye exams, maintaining a healthy diet, and taking frequent breaks from screen time throughout the day. Encourage patients to seek medical care if they experience any ophthalmic issues. Pharmacists should inform patients that ophthalmic disorders such as cataracts, diabetic retinopathy, glaucoma, and AMD require routine eye care by specialists. Additionally, pharmacists should encourage patients to discuss their risk factors with their primary health care provider to help manage or prevent these serious and often progressive ophthalmic disorders to preserve vision.

REFERENCES

1. Mohta A. A new childhood epidemic: excessive screen time’s link to eye and vision issues. MDLinx. January 25, 2024. Accessed September 13, 2024. https://www.mdlinx.com/article/a-new-childhood-epidemic-excessive-screen-times-link-to-eye-and-vision-issues/3FzB6vYgBoI28q6PkOQigW

2. Hedderson MM, Bekelman TA, Li M, et al; Environmental Influences on Child Health Outcomes Program. Trends in screen time use among children during the COVID-19 pandemic, July 2019 through August 2021. JAMA Netw Open. 2023;6(2):e2256157. doi:10.1001/jamanetworkopen.2022.56157

3. Fiscella R, Jensen MK. Ophthalmic disorders. In: Krinsky DL, Ferreri SP, Hemstreet BA, Hume AL, Rollins CJ, Tietze KJ, eds. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. 20th ed. American Pharmacists Association; 2020.

4. Survey reveals most Americans know a lot less about eye health than they think they do: here’s why that’s a problem. News release. American Academy of Ophthalmology. January 13, 2020. Accessed September 13, 2024. https://www.aao.org/newsroom/news-releases/detail/survey-reveals-most-americans-know-less-eye-health

5. Hwang S, Kang SW, Choi J, et al. COVID-19 vaccination and ocular adverse events: a self-controlled case series study from the entire South Korean population. Am J Ophthalmol. 2024;269:69-77. doi:10.1016/j.ajo.2024.08.015

6. Lee SY, Paul ME, Coleman AL, et al. Associations between statin use and glaucoma in the All of Us Research Program. Ophthalmol Glaucoma. Published online July 31, 2024. doi:10.1016/j.ogla.2024.07.008

7. Fast facts: 4 in 10 adults at high risk for vision loss. CDC. May 15, 2024. Accessed September 12, 2024. https://www.cdc.gov/vision-health/data-research/vision-loss-facts/four-in-10-us-adults-high-risk-vision-loss.html

8. 8 things you can do right now to protect your vision. National Eye Institute. Updated November 1, 2022. Accessed September 13, 2024. https://www.nei.nih.gov/learn-about-eye-health/healthy-vision/8-things-you-can-do-right-now-protect-your-vision