Eyeworld

Contact Name: alpha-1 blocker and do not recommend stopping the medication if it is already in use. To combat the effects of IFIS there are a variety of intraoperative medications, viscoelastics, and devices that can be employed to improve iris tone and the safety of cataract surgery. Dry eye is the most common complaint for patients seeing an eye- care professional, and it is also one of the most common complications of a variety of systemic medications. Eliza- beth Yeu, MD, Chasidy Singleton, MD, and William Trattler, MD, provide their insights into systemic medications that may be behind those nagging dry eye symptoms. Dr. Singleton pointed out that diagnosing medication-induced dry eye starts with a good history. The physicians said that high blood pres- sure, allergies, skin conditions, mental illnesses, incontinence, and more are all conditions that may be associated with the use of medications that can cause dry eye, and alternative medications may help alleviate patient symptoms. Finally, Christina Weng, MD, Pravin Dugel, MD, and Robert Noecker, MD, highlight some of the medications we may not be thinking about that can affect the retina and optic nerve. The physicians agreed that hydroxychlo- roquine, commonly employed to treat autoimmune disease, can have a patho- logic effect on the outer retina, and patients taking this medication should be followed and screened for retinal toxicity with spectral domain OCT and visual fields. The physicians also discuss ethambutol, pentosan, cancer treat- ments, and drugs that alter blood flow as risk factors for ocular disease. I hope you enjoy this issue of EyeWorld and are able to become a bet- ter clinician by understanding the risks and benefits of systemic medications and nutraceuticals on ocular health. A n important consider- ation for ophthalmol- ogists is the effect of topical and oral medications on the eye and systemically on the rest of the body. However, prescrip- tion medications are not the only things to keep in mind. Nutraceuticals play an important role as well, and sometimes these non-prescription supplements are overlooked. Alice Epitropoulos, MD, was the first author on an important pa- per that looked at omega-3 supplemen- tation on dry eye and found re-esterified omega-3s to have an effect on improv- ing the signs and symptoms of dry eye. A randomized clinical trial known as Dry Eye Assessment and Management (DREAM) found no difference between omega-3 supplementation and olive oil, but John Sheppard, MD, pointed out that both are part of a healthy Mediter- ranean diet and are good for the eyes. Cynthia Matossian, MD, said that all omega-3 supplements are not the same, with the majority of omega-3s convert- ed to a non-absorbable entity by the purification process, and in recommend- ing omega-3s, there are only a couple of brands that are safe. Henry Perry, MD, agreed that re-esterified omega-3s are important and thinks a lower dose can be effective in some patients. All cataract surgeons are aware of the effect of alpha-1 blockers on the iris. This class of medications most commonly represented by tamsulosin is prescribed to improve urinary flow. However, according to William Myers, MD, Bryan Lee, MD, and Steven Safran, MD, this class of medication is also responsible for intraoperative floppy iris syndrome (IFIS). The physicians said that IFIS can occur after one dose of an JANUARY/FEBRUARY 2020 | EYEWORLD | 3 What your patient is taking and its effect on the eye CENTURION ® VISION SYSTEM IMPORTANT PRODUCT INFORMATION CAUTION: Federal (USA) law restricts this device to sale by, or on the order of, a physician. As part of a properly maintained surgical environment, it is recommended that a backup IOL injector be made available in the event the AutoSert ® IOL Injector Handpiece does not perform as expected. INDICATION: The CENTURION ® Vision System is indicated for emulsification, separation, irrigation, and aspiration of cataracts, residual cortical material and lens epithelial cells, vitreous aspiration and cutting associated with anterior vitrectomy, bipolar coagulation, and intraocular lens injection. The AutoSert ® IOL Injector Handpiece is intended to deliver qualified AcrySof ® intraocular lenses into the eye following cataract removal. The AutoSert ® IOL Injector Handpiece achieves the functionality of injection of intraocular lenses. The AutoSert ® IOL Injector Handpiece is indicated for use with the AcrySof ® lenses SN6OWF, SN6AD1, SN6AT3 through SN6AT9, as well as approved AcrySof ® lenses that are specifically indicated for use with this inserter, as indicated in the approved labeling of those lenses. WARNINGS: Appropriate use of CENTURION ® Vision System parameters and accessories is important for successful procedures. Use of low vacuum limits, low flow rates, low bottle heights, high power settings, extended power usage, power usage during occlusion conditions (beeping tones), failure to sufficiently aspirate viscoelastic prior to using power, excessively tight incisions, and combinations of the above actions may result in significant temperature increases at incision site and inside the eye, and lead to severe thermal eye tissue damage. Good clinical practice dictates the testing for adequate irrigation and aspiration flow prior to entering the eye. Ensure that tubings are not occluded or pinched during any phase of operation. The consumables used in conjunction with ALCON ® instrument products constitute a complete surgical system. Use of consumables and handpieces other than those manufactured by Alcon may affect system performance and create potential hazards. AEs/COMPLICATIONS: Inadvertent actuation of Prime or Tune while a handpiece is in the eye can create a hazardous condition that may result in patient injury. During any ultrasonic procedure, metal particles may result from inadvertent touching of the ultrasonic tip with a second instrument. Another potential source of metal particles resulting from any ultrasonic handpiece may be the result of ultrasonic energy causing micro abrasion of the ultrasonic tip. ATTENTION: Refer to the Directions for Use and Operator's Manual for a complete listing of indications, warnings, cautions and notes. © 2019 Alcon Inc. 4/19 US-CNT-19-E-0216 by Eric Donnenfeld, MD Chief Medical Editor

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