Eyeworld

60 | EYEWORLD |JULY 2019 O UTSIDE THE OR likely to have high cholesterol than the general population." There are also large epidemiological studies indicating that rosacea is associated with hyper- cholesterolemia, he said, adding that this could be impactful when treating young dry eye pa- tients with high cholesterol. Practitioners could check for cholesterol levels and where appropri- ate, put these young patients on oral statins. Another study 5 investigators considered was one that showed an association between high cholesterol and increased risk of AMD. "We know that there's an increased cholesterol content in drusen," Dr. Ooi said. Those with higher HDL cholesterol had greater odds of having larger drusen. The idea is that if you can knock this down somewhat using a statin, the body is more able to cope in terms of resorp- tion and the amount of drusen can be reduced, he noted. Use of topical statins may also be helpful in corneal wound healing, as well as with scarring or closing over of trabeculectomy blebs. "The effect on the ocular surface could be quite far-reaching," he said, adding that there are also implications for a range of dry eye manifestations. For example, some of the inflammatory cytokine profiles are consistent with allergic conjunctivitis or allergic dry eye. There are also applications for post-refractive laser surgery dry eye. Overall, statins show promise in a variety of areas due to their many modes of activity. They are anti-inflammatory, can lower VEGF, and can reduce inflammatory cytokines, Dr. Ooi said. Statins are also matrix metalloprotein- ase inhibitory as well as cholesterol lowering. This leaves possibilities open for statin use. "I think there are a lot both in the front of the eye and at the back of the eye with respect to topi- cal and oral administration," he concluded. continued from page 58 References 1. Ooi KG, et al. Statins in ophthalmology. Surv Ophthalmol. 2019;64:401–432. 2. Ooi KG, et al. Efficacy and safe- ty of topical atorvastatin for the treatment of dry eye associated with blepharitis: a pilot study. Ophthalmic Res. 2015;54:26–33. 3. Ooi KG, et al. HMG-CoA reductase expression in human eyelid tissue and in a human mei- bomian gland epithelial cell line. Graefes Arch Clin Exp Ophthalmol. 2019;257:785–790. 4. Ooi KG, et al. Association of dyslipidaemia and oral statin use, and dry eye disease symptoms in the Blue Mountains Eye Study. Clin Exp Ophthalmol. 2019;47:187–192. 5. Colijn JM, et al. Increased high-density lipoprotein levels associated with age-related mac- ular degeneration: evidence from the EYE-RISK and European Eye Epidemiology Consortia. Ophthal- mology. 2019;126:393–406. Investigators have identified an enzyme, HMG-CoA reductase, that controls cholesterol metabolism. Source: Kenneth Ooi, MD In a recent study, investigators reviewed the literature and found that these drugs, which also have anti-inflammatory properties and vascular effects, may play a role in reducing the burden of ophthalmic conditions, such as dry eye, glaucoma, macular degeneration, diabetic retinopathy, and more.

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