Eyeworld

18 EW NEWS & OPINION June 2018 Research highlight by Liz Hillman EyeWorld Senior Staff Writer "Patients may not associate their psoriasis with any eye issues. They may have bouts of eye pain and red eye and chalk it up to conjunctivitis, but it could be something a bit more sinister, like uveitis, which untreated could cause more major issues like scarring, cataracts, and glaucoma. It is important for patients not to be dismissive of eye issues in the setting of systemic disease; they should be diligent about being examined," Dr. Habash said. Jimmy Lee, MD, director of cornea and refractive surgery, De- partment of Ophthalmology and Visual Sciences, Montefiore Health System, Bronx, New York, said while psoriasis is not on his medical history questionnaire, he is consid- ering adding it. Dr. Lee said he is at a large academic center with a robust rheumatology service where he sees a lot of patients with psoriasis and associated ocular surface disease. In terms of the ocular surface issues she sees in her patients with psoriasis, Dr. Ozerov said it varies based on how well the patient's psoriasis is controlled. "A lot of patients with psoriasis present with standard dry eye and ocular inflammation. Others may have different but related manifes- tations of the disease that I closely review. For example, I have a patient who has psoriasis that affects the skin, especially the eye lids. For her, I don't just treat for dry eye; I also have to treat the skin concerns with topical or other medications. It is a spectrum; the condition of the ocu- lar surface depends on the severity of the disease," she said. Dr. Ozerov said she might be a bit more aggressive with steroid use in patients with psoriasis and ocular surface issues, but that's the only difference in her treatment plan, she said. "I'm aggressive with my treat- ment of dry eye to begin with since that's my clinical specialty. Often, I will start patients on immunomod- ulators, like Restasis [cyclosporine, Allergan, Dublin, Ireland]. But in someone who has psoriasis, I am more inclined to use steroids and oral medications during their treat- ment," Dr. Ozerov said. Dr. Hammersmith said her threshold for getting a patient with a rash on their arm or their hands and say, 'What about this psoriasis?' … I think patients minimize psori- asis to some degree," Dr. Hammer- smith said, stressing the importance of being on the lookout for other inflammatory disease that could be associated with dry eye conditions. Inna Ozerov, MD, a Florida- based ophthalmologist, cornea and anterior segment specialist, said most patients with psoriasis in her practice have ocular surface issues. "In my practice, we don't ask [about psoriasis] specifically, but people often either include it in their general past medical history or I know to ask them about it based on the medications they list," Dr. Ozerov said. "It is also on my radar because psoriatic arthritis is often as- sociated with ocular surface inflam- mation and intraocular conditions like uveitis. This is something that I make sure to discuss with patients so they are aware and know what symptoms to look for, including blurred vision, pain, redness, and light sensitivity. People with psori- asis need to understand that it can affect not just the front but also the back of the eye." Ranya Habash, MD, Bascom Palmer Eye Institute, Miami, ex- pressed a similar sentiment. Compared to healthy subjects, patients with psoriasis showed "sig- nificant deterioration of the ocular surface tests," according to the in- vestigators. There was no difference in the condition of the patients' ocular surface when patients with psoriasis were divided based on status of arthritis, another symptom often associated with psoriasis. Ara- gona et al. also noted that patients who took biological drugs seemed to have improved corneal staining and meibomian gland function. "Our findings suggest that the ocular surface involvement in patients with psoriasis indicates the need of periodic ophthalmological examinations to diagnose the con- dition and allow a proper treatment, so contributing to the amelioration of patients' quality of life," Aragona et al. wrote. Kristin Hammersmith, MD, director of the corneal fellowship, Wills Eye Hospital, Philadelphia, said this study reminds ophthalmol- ogists of the association psoriasis can have with ocular surface disease, even if their patients are not com- plaining about symptomatology. "It's interesting because a lot of times when I ask patients about any other medical problems, they don't say anything. Then I'll see they have Physicians discuss ocular issues they frequently see with patients who have this autoimmune disorder M ost commonly known as an autoimmune disorder that manifests itself frequently as patches of scaly skin, psoriasis can impact the eye as well, although published research de- scribes its ocular association as not well understood. 1 A study published in the British Journal of Ophthalmology sought to better understand the ocular symp- toms and ocular surface changes in patients with psoriasis. 2 This research by Aragona et al. included a population of 66 patients with psori- asis whose clinical evaluations were compared with 28 healthy subjects. Clinical testing included the Ocular Surface Disease Index (OSDI) ques- tionnaire, Tearscope (SBM Sistemi, Orbassano, Italy) exam, meibometry, tear film breakup time, corneal and conjunctival fluorescence staining, Schirmer I testing, corneal aesthesi- ometry, assessment for meibomian gland dysfunction, and conjunctival impression cytology. Ocular surface disease in patients with psoriasis

• Cover