Eyeworld

41 EW CORNEA November 2015 3. Validate the patient's experi- ences and feelings, Dr. Rosenberg recommended. Let them know that what they are experiencing can be difficult. "A little compassion and empathy will go a long way," Ms. Petris said. 4. Give patients ways to man- age their symptoms. "Don't say 'There's nothing else,'" Ms. Petris said. "Artificial tears, plugs, steroids, and Restasis [cyclosporine, Allergan, Dublin, Ireland] are just scraping the surface, so when they don't solve things, assure your patient that you will work with them to continue trying new avenues. Hope is the most precious commodity to the dry eye patient." 5. Encourage patients to connect with others in a similar situation. For example, Ms. Petris has a free online forum, Dry Eye Talk (www. dryeyezone.com/talk) where people can share their dry eye experience and seek out support. There are also support groups for depression and other chronic illnesses online. EW References 1. Hallak JA, Tibrewal S, Jain S. Depressive symptoms in patients with dry eye disease: a case-control study using the Beck Depression Inventory. Cornea. 2015 Sept. 30 [Epub ahead of print]. 2. Na KS, Han K, Park YG, Na C, Joo CK. Depression, stress, quality of life, and dry eye disease in Korean women: a population-based study. Cornea. 2015; 34:733–738. 3. van der Vaart R, Weaver MA, Lefebvre C, Davis RM. The association between dry eye disease and depression and anxiety in a large population-based study. Am J Ophthalmol. 2015;159:470–474. 4. Galor A, Feuer W, Lee DJ, et al. Depression, post-traumatic stress disorder, and dry eye syndrome: a study utilizing the national United States Veterans Affairs administrative data- base. Am J Ophthalmol. 2012;154:340–346. 5. Koçer E, Koçer A, et al. Dry eye related to commonly used new antidepressants. J Clin Psychopharmacol. 2015;35:411–413. 6. Vehof J, et al. Shared genetic factors underlie chronic pain syndromes. Pain. 2014 Aug;155(8):1562-8. Editors' note: The physicians have no financial interests related to this article. Contact information Galor: agalor@med.miami.edu Petris: rebecca@dryeyezone.com Rosenberg: drfrosenberg@morrispsych.com leading to a decrease in medication compliance. That can make the patient feel worse. A third possibility is that shared susceptibility factors, both genetic and environmental, underlie dry eye and depression. It is well described that certain individuals are more susceptible than others to develop- ing chronic pain states, with one study specifically focusing on shared genetic factors underlying both dry eye and other chronic pain syn- dromes. 6 The link between depression and dry eye isn't always clear cut, Dr. Galor said. Her research found that mental health diagnoses (post-traumatic stress disorder and depression) and their treatments (antidepressants and anxiolytics) remained significantly associated with an increased risk of dry eye. 4 "Like any other chronic disease, dry eye is a heterogeneous and com- plex condition, and it is likely that both mental health disorders and their treatments are involved in the pathophysiology of disease," she said. 5 ways to help patients who are depressed So what should ophthalmologists do if they see a patient with dry eye who does not yet have help from a mental professional? Here are some suggestions: 1. Refer the patient to a psychol- ogist or qualified mental health professional as soon as there are concerns about a mood disorder, Dr. Rosenberg advised. "The best results often come from a combina- tion of psychotherapy and medica- tion," she said. When speaking with patients, be aware of quality of life concerns they may mention, such as social withdrawal, fatigue, and decreased concentration, which can all be symptoms of depression, she said. 2. Don't assume only one kind of patient gets depressed over chronic disease. "A dry eye crisis is just as likely to emotionally level the most competent, confident people as anyone else," Ms. Petris said. Her anecdotal experience speaking with dry eye patients has found that con- fident, health-conscious types with no other medical problems may get blindsided the most, as they have always taken care of their health. Uniform epithelium removal in only 5 - 7 seconds Corneal Xlinking, PRK Advanced Surface Ablation Improved clinical outcomes of CXL and PRK with Amoils Epithelial Scrubber Minimize total procedure time Avoid alcohol damage to surrounding tissue No need for subsequent scraping T. 800.461.1200 www.innovativexcimer.com nt scraping om order online www.innovativexcimer.com www.innovativexcimer.com order online www.innovativexcimer.com AMOILS

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