Eyeworld

EW NEWS & OPINION 28 September 2017 APX 200 Pupil Expander • Fast and easy to insert and remove • No intraocular manipulations • Does not interfere with surgery Visit FCI-Ophthalmics.com to See the APX 200 in Surgery or Call 800-932-4202 to Order ACTUAL SIZE One Small Pupil at a Time Expanding Your Vision by Vanessa Caceres EyeWorld Contributing Writer Regarding cataracts, the only increased risk was in patients with atopic dermatitis who were younger than age 50. There was also increased use of ocular medications among patients with dermatitis. "Whereas 4.5% of control subjects had claimed at least 1 prescription of anti-inflammatory ocular agents, 12% of patients with mild AD and 18.9% of patients with severe AD had done so," the study researchers wrote. Use of anti-infec- tive ocular agents was 31.7% among the general population compared with 49.2% among those with mild AD and 59.2% among those with severe AD. For ocular combination product use, the figures were 3.6%, 4.7%, and 9.1%, respectively. One interesting wrinkle is that the biologic agent dupilumab, pre- scribed for AD, has been associated with high incidences of unspeci- fied conjunctivitis in test groups compared with placebo groups, according to the researchers. "Since dupilumab, an interleukin [IL]-4 re- ceptor inhibitor, has been associated with conjunctivitis, it is important that physicians have access to risk estimates in a population of atopic dermatitis patients without such treatment," Dr. Thyssen said. Some biologics including dupilumab, tralokinumab, and lebrikizumab are associated with raised concentrations of eosinophils, which are pathognomonic for al- lergic eye disease. "Because para- dox immune reactions are possible during biologic therapy and kerato- conjunctivitis in severe cases may result in blindness, future studies are needed to determine the cause and risk of IL-4 and IL-13 inhibition on keratoconjunctivitis in patients with AD," the researchers wrote. The study is the largest one of ocular disorders in adults with AD, according to the study authors. However, a limitation they shared is that they did not have information about the reason for ocular prescriptions, and patients may actually have used the ocular medications for conditions other than keratitis and conjunctivitis. Still, those kinds of medications are commonly prescribed for those kinds of eye diseases. study gives some statistical credence to that information. The study, published in the Jour- nal of the American Academy of Der- matology, focused on the prevalence and risk of select ocular diseases among patients with atopic derma- titis in Denmark. 1 The study was led by Jacob Thyssen, MD, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark. The study began because there are no large-scale epidemiologic data on the prevalence or incidence of conjunctivitis and related comor- bidities among adults with atopic dermatitis, according to the study authors. Study details The study included 5,766 and 4,272 adults with mild and severe atopic dermatitis, respectively. "Patients were classified as having severe [atopic dermatitis] if they received or had received sys- temic therapy consistent with severe disease (methotrexate, azathioprine, mycophenolate mofetil, systemic corticosteroids, psoralen plus ultravi- olet A, or cyclosporine)," according to the study. Patients who did not receive these treatments were classi- fied with mild atopic dermatitis. Study researchers accounted for ICD-10 diagnoses of conjunctivitis, keratitis, keratoconus, cataract, and glaucoma and a claimed prescription for various ocular drugs, including anti-infectives, anti-inflammatory agents, and ocular combination products. Researchers also looked at data from control patients. The mean patient age was 38.3 to 42.8 years among the AD groups; the study in- cluded more female patients. Study authors noted some specific trends linking AD and ocular disease. "Keratitis, conjunctivitis, and keratoconus occurred more fre- quently in patients with AD than in control subjects, whereas cataract and glaucoma did not occur more frequently," Dr. Thyssen and coau- thors reported. The hazard ratio for conjunctivitis was 1.48 for mild AD and 1.95 for severe AD. For keratitis, it was 1.66 for mild AD and 3.17 for severe AD. The hazard ratio was 10.01 for keratoconus in patients with severe atopic dermatitis. T he connection between atopic dermatitis (AD) and certain ocular diseases is well known. However, a new population-based Population-based study finds greater incidence of conjunctivitis, other conditions among AD Delving into the atopic dermatitis and ocular disease link Research highlight continued on page 30

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