Eyeworld

22 EW NEWS & OPINION With the effects these conditions can have on someone's ability to drive, live independently, and see clearly, it's especially important to address related depression, Dr. Riba said. She also has patients who com- bine an anti-anxiety agent or antide- pressant with psychotherapy. It's rare for ophthalmologists to need to speak directly with a prescribing psychiatrist as ocular ef- fects usually are managed easily, Dr. Wang said. The one exception is if there is a severe reaction such as an- gle closure glaucoma. "In that case, communication with the prescribing doctor could be needed to come up with alternative treatments," he said. EW References 1. Gomes JAP, et al. TFOS DEWS II iatrogenic report. Ocul Surf. 2017;15:511–538. 2. Tiskaoglu NS, et al. Dry eye disease in patients with newly diagnosed depressive disorder. Curr Eye Res. 2017;42:672–676. 3. Galor A, et al. Depression, post-traumatic stress disorder, and dry eye syndrome: a study utilizing the national United States Veterans Affairs administrative database. Am J Ophthal- mol. 2012;154:340–346. 4. Becker C, et al. Selective serotonin reuptake inhibitors and cataract risk: a case-control analysis. Ophthalmology. 2017;124:1635– 1639. Editors' note: The physicians have no financial interests related to their comments. Contact information Riba: mriba@umich.edu Tittler: michele.conway@advicemedia.com Wang: drwang@wangvisioninstitute.com For the most part, a thorough annual eye exam is enough to help detect and treat vision symptoms. "If any eye symptoms occur such as blurred vision, red eye, eye pain, fo- cusing difficulty, and double vision, the patient should have an eye exam sooner," Dr. Wang said. Annual eye exams should already be part of the care for concurrent health problems some patients with anxiety or clini- cal depression may commonly have, such as diabetes. Physicians sometimes observe medication compliance issues if a patient is clinically depressed or has anxiety. In addition to the condition itself, this could be from memory or inattention issues caused by certain medications, Dr. Tittler said. These could theoretically worsen medica- tion adherence, but there are practi- cal ways to help patients with this, such as phone alarms or reminders. "In patients with these psychiat- ric conditions, I am more concerned about compliance if they stop their medications without the approval of their prescribing physician," Dr. Tittler said. Sometimes a psychotropic med- ication may have to be changed to help counter the ocular side effects, Dr. Riba said. Alternatively, it may be decided to stop an antidepressant or anti-anxiety agent altogether solely due to ocular side effects and switch to a different medication. The risks/benefits must be addressed, in consultation with the patient and ophthalmologist. This is especially important with chronic conditions like glaucoma, AMD, Alzheimer's disease, and diabetes, Dr. Riba said. Monitor continued from page 21 " In patients with these psychiatric conditions, I am more concerned about compliance if they stop their medications without the approval of their prescribing physician. " —Ethan Tittler, MD 800.354.7848 TOLL FREE IN THE USA | +1.859.259.4924 WORLD WIDE | stephensinst.com S9-2070 S9-2060 S9-2065 As we celebrate 40 years of service to the ophthalmic community, we recognize those doctors who have grown along with us. Just like our instruments, our reputation for value, service and reliability has been crafted to last a lifetime. "I have used Stephens ophthalmic instruments since I went into practice—forty years ago. When I need new microsurgical instruments, I look to Stephens first." JOHN E. DOWNING, MD Bowling Green, Kentucky © 2018 Stephens Instruments. All rights reserved. For more information visit us at ASCRS booth #2410 February 2018

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