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Turn to patient education in the absence of advances in treatment options
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 Michael D. DePaolis |
Patients visit us for a variety of reasons. Many come in when their prescription needs to be refined and to see more clearly. Some schedule appointments for the peace of mind that comes with knowing their eyes are healthy, especially if they have diabetes or a strong family history of an ocular disease. On occasion, patients visit us in hopes that a new technology or treatment might benefit their condition. While most of the time we address these needs quite well, what happens when there is nothing new to offer patients?
In every aspect of eye care, advances in technology seem to ebb and flow. This is no truer than in the realm of ocular allergy management. While 2011 brought us two great new agents – Bepreve (bepotastine besilate ophthalmic solution 1.5%, Ista Pharmaceuticals) and Lastacaft (alcaftadine ophthalmic solution 0.25%, Allergan) – and while it is true certain patients have benefited from ketotifen fumarate going over-the-counter, we fundamentally manage ocular allergies in much the same fashion we did 5 years ago.
Antihistamine/mast-cell stabilizers remain our primary workhorse and, when a particularly recalcitrant case presents, we reach for corticosteroids such as loteprednol etabonate. Furthermore, while interesting new treatment modalities are being developed, it looks like managing allergies in 2012 is going to be very much like it was in 2011. Given this scenario, what should we do differently – if anything – in managing our patients’ allergies this spring?
An essential aspect of clinical care involves providing patients with the sense of value: the feeling that their time and resources were well spent. In the absence of a new contact lens, drug, or surgical procedure, this “value” often comes from patient education and professional guidance.
In the case of an allergy sufferer this might entail a brief discussion of contemporary thoughts involving allergy etiologies, avoidance strategies and nonpharmacologic management. It might also include a review of a patient’s current therapeutic agents and recommendations regarding alternate drugs. Much like the management of glaucoma or dry eye, allergy patients often derive benefit from adding another drug or from switching to another agent, even if it is the same pharmacologic class.
Above all, our educational efforts should be aligned with their systemic allergy management. In short, we want our allergy sufferers to feel that while our therapies are primarily directed toward the eye, we are interested in their overall well-being.
For sure, the concept of intertwining one’s ocular and systemic health has become the norm. Whether it is allergy, diabetes or macular degeneration, we find ourselves increasingly counseling patients above and beyond the ocular therapeutic agents we prescribe. We are talking about environmental issues, diet, lifestyle and, perhaps most importantly, about the choices they make.
In this issue of Primary Care Optometry News, we have amassed an exceptional group of colleagues, providing sage advice in managing a wide variety of conditions ranging from allergy to macular degeneration to obesity. I hope you will find – like I have – value in their clinical pearls. I also hope you will find – like I have – value in sharing these thoughts with your patients.
- Disclosure: Dr. DePaolis has no relevant financial interests to disclose.