Seen & Heard

Glaucoma Today

AGS Annual Meeting Highlights Catch video updates from the 2024 AGS Annual Meeting, featuring April Maa, MD (left), on implementing telehealth; Sahar Bedrood, MD, PhD (middle), on optimizing refractive outcomes in phaco-MIGS patients; and Cara Capitena-Young, MD (right), on managing an accidentally cut tube during insertion. View these videos and more AGS coverage on Eyetube. Helping Patients With Low Vision Administer Eye Drops On Clinical Minute, host Neda Shamie, MD, invites Robert M. Kinast, MD, to discuss a repeated-measures case series that evaluated the administration of eye drops by patients with low vision and tested whether a nose-pivoted drop delivery device could improve their success. Ahmed Glaucoma Valve to Mitigate Post-Injection IOP Elevation On Glaucoma Case Files, Joseph F. Panarelli, MD; Manjool Shah, MD; and Arsham Sheybani, MD, recap a case of a patient with pseudoexfoliative glaucoma who was receiving anti-VEGF injections to treat wet age-related macular degeneration. Dr. Panarelli describes his rationale for Ahmed Glaucoma Valve (New World Medical) implantation. He notes that anti-VEGF injections could have caused IOP elevations and acute damage to the optic nerve. The surgeons also discuss the pros and cons of alternative surgical interventions.

Autoimmune Disease and the Eye

Many affected patients will present with ocular signs and symptoms.

Anthony DeWilde, OD, FAAO

Modern Optometry

Autoimmune diseases are a complex set of conditions, in which the immune system mistakenly targets healthy cells instead of foreign cells. This can lead to significant morbidity and mortality. Autoimmune disease is the second highest cause of chronic illness in the United States. All in all, there are more than 80 types of autoimmune diseases.1 Diagnosing autoimmune diseases can be difficult, often due to lack of access to health care, testing options that are expensive and difficult to obtain, lack of specificity with testing modalities, and vague symptoms. From initial symptoms to final diagnosis, the process typically takes an average of 4.5 years and involves up to four doctors.2 ODs are in a unique position to help patients with autoimmune disease, as many of these conditions manifest with ocular signs and symptoms. By understanding the association between autoimmune disease and the eye, we can detect early signs and symptoms, allowing earlier referral and treatment. The number of autoimmune diseases that can affect the eye is vast. As such, this article will focus on the three main conditions that I’ve encountered over the course of my career: myasthenia gravis (MG), thyroid eye disease (TED), and giant cell arteritis (GCA). MYASTHENIA GRAVIS MG is a chronic autoimmune disease where autoantibodies bind to the neuromuscular junction, blocking its ability to receive normal signals from acetylcholine. This manifests as muscle weakness and fatigue.

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.