Hydrus Microstent Removal and Repositioning

I. Paul Singh, MD

Eyetube

I. Paul Singh, MD, shares a case of a highly myopic patient in which a previously implanted Hydrus Microstent (Alcon) was not correctly positioned. This video shows how to efficiently and safely grasp and remove the device and place it in a different location. Financial Disclosure: Consultant (Alcon)

Interprofessional Collaboration Pays Off

Working alongside a patient’s primary care physician, the author was able to diagnose Sjögren syndrome and refer her for proper care.

Naureen M. Haroon, OD, MPH, FAAO

Modern Optometry

I was surprised to learn my new 62-year-old patient had been complaining about severe dry mouth to her primary care physician for the past 15 years with no relief. Year after year, she was advised to use mouth moisturizing tablets or a spray, and sent home. But when I heard her complaints of long-standing dry eyes and a dry mouth, I immediately thought of Sjögren syndrome (SS). These two symptoms don’t always indicate SS—especially considering the patient had no other underlying autoimmune conditions, such as systemic erythematous lupus or rheumatoid arthritis, as seen in secondary SS—but it should always be considered and ruled out. THE PATIENT ENCOUNTER While in my examination chair, I noticed the patient had a dry cough. She excused herself to grab a cough drop from her purse, which she explained was a daily occurrence. We discussed possible systemic and environmental factors that could exacerbate her dry eye signs and symptoms, and I started her on lifitegrast ophthalmic solution 5% (Xiidra, Bausch + Lomb) twice daily and fish oil. I also gave her a sample of artificial tears. We talked about punctal plugs, and I advised her to reach out to her primary care physician to request testing for SS. Following up, I sent a simple letter to the patient’s primary care physician, discussing my exam findings and my concern for SS.

Healthy Habits for Glaucoma Patients

Moderation and communication are key.

Valentina Lozano, MD

Glaucoma Today

Glaucoma surgeons often field questions from patients regarding health and lifestyle practices. Examples of inquiries include the following: “Are there vitamins or supplements I can take to prevent glaucoma?” “What kind of exercises can I perform?” “Can stress affect my glaucoma?” and “Does marijuana help with glaucoma?” Patients may receive short answers or generalized guidance such as, “Eat healthy, exercise regularly, and try to relax.” Understandably, they may feel uncertain about these vague instructions and unclear on what is best for their eye health. The challenge for glaucoma specialists is that it can be difficult to answer the questions definitively. We practice evidence-based medicine, meaning that any recommendation we make to patients is supported by substantial data. Research on lifestyle and glaucoma, however, is limited. To make the situation more complex, we still do not fully understand glaucoma. It is not just one eye condition but a group of eye conditions that damage the optic nerve. Some patients have increased IOP, whereas others have normal IOP and abnormal blood flow to the optic nerve. Until we understand glaucoma well enough to make conclusive lifestyle recommendations, some general wellness principles can be adopted by patients looking to optimize their health. Nutritionist and wellness expert Nancy Lin, PhD, separates healthy living into five pillars: (1) physical, (2) nutritional, (3) environmental, (4) mental/emotional, and (5) spiritual.