Finding Room to Grow

By sticking to science and practicing with confidence, ODs can deliver for their patients and grow as a profession. 

In the second installment of their “Eye Care Update” lecture, optometry’s dynamic duo—Randall Thomas, OD, and Ron Melton, OD—ran through selected hot topics revealed in both recent research and their very own offices.

“Our goal is to spend the year looking at the literature, filtering through it, incorporating the important concepts into our clinical practice, trying them, making sure they work, and then bringing them to you so you too can take the pearls back to your practice early next week,” said Dr. Melton in the opening of their second Wednesday course.

The discussion focused on four take-home messages: (1) be prepared and confident for anything that may walk through the office door, (2) rely less on antibiotics and referring out for non-surgical procedures, (3) pay attention to inflammation because it’s telling you something and, (4) when in doubt, use steroids.

Saved by Shingrix

The pair started by addressing the big hitters of these long winter months: herpes simplex virus, herpes zoster ophthalmicus and herpes simplex keratitis. They touched on Shingrix (GlaxoSmithKline), the new talk of the town in anti-shingle vaccinations. While Drs. Melton and Thomas playfully disagreed on whether the vaccine will truly replace Zostavax (Merck), they warned the audience that “shingles is going to become more and more common for about 20 to 30 more years, until finally it will fade away. That’s just the epidemiological reality,” said Dr. Thomas, so ODs “should be prepared.”

Science, Not Habit

Building on their earlier morning discussions around the importance of using oral and topical steroids to treat inflammation, Drs. Melton and Thomas called on new findings from the Antibiotic Resistance Monitoring in Ocular Microorganisms study. As resistance to commonly prescribed antibiotics is an ever-growing concern, the doctors announced in no uncertain terms that ODs should be consciously prescribing on a case-by-case basis, rather than by habit.

“Every time you think about prescribing an antibiotic, even topical ones,” said Dr. Thomas, “we would beg of you to stop because the chances are, you’re wrong.” The epidemiology of acute red eye, he explained, “is one of inflammation, so antibiotics will have very little utility here.” Let science guide your care. “Do not do things out of habit; follow the literature and make scientifically sound prescribing decisions.”

These sentiments resurfaced as the doctors confronted the next leg of their discussion: differentiating between corneal ulcers and infiltrates. As infiltrates are more common and represent an underlying inflammatory condition, ocular steroids, often combined with an antibiotic, have become the preferred treatment approach. The fast action of the steroid, Dr. Melton advised, will aid in preventing a secondary infection or the much less desirable corneal ulcer.

The Ungrateful DED

Threading the theme of prioritizing inflammation into the second half of their discussion, Drs. Melton and Thomas proposed new ways to target dry eye disease (DED), which has become more widely accepted as an inflammatory condition.

Dr. Thomas suggested that everyone find themselves a copy of a comprehensive supplement to the November 2017 Ophthamology, which highlights new global perspectives on treating DED. Both agree that the supplement is one of the most innovative pieces of this year’s literature. “Inflammation is one of the major targets in treating DED,” read Dr. Thomas, “and breaking the cycle of inflammation is crucial in improving symptoms.” Both doctors continued to cite key publications and case studies released over the last year that list various holistic methods (blinking exercises, warm compresses, fish oils, artificial tears) that patients can use to better address inflammation and actively treat DED.

The lecturers concluded the session by reminding all ODs—new to the field and veterans alike—of the great role and responsibility each takes on in their practice. Take a step back from the knee-jerk reaction to refer out, they said. You don’t have to be a genius to do this stuff, “you just have to have the courage to do what you know is right,” urged Dr. Thomas. “Tell your patients, ‘I am your eye doctor; if you ever have a problem, call me first.’ So, now we’re growing instead of referring, and that’s how we grow as a profession.”