Understanding The Root Causes Of Ocular Allergies
Confirmation of results can help to determine an effective strategy for treatment.
The etiology of ocular allergies is complex. However, ophthalmologists can look for allergens by performing skin tests at the point of care using an in-office diagnostic system such as Bausch and Lomb’s Doctor’s Allergy Formula Diagnostic System.
Results are available within 15 minutes of administration of this 3 minute long, noninvasive test. Sixty allergens are used in the test that are specific to the area in which the practice of the ophthalmologist is located.
The Chief Executive and Founder of Jaconsoneye in Lake Villa, IL, is Mitchell A. Jackson, MD. He states that ocular surface disease is often caused by allergies, which can affect the decisions made for the treatment of LASIK, cataract, and other ocular surgeries.
Ocular surface disease is quite complicated. It involves sources from the surrounding environment, osmolarity, and inflammation as well as other risk factors, including contact lens wear, prior eyelid surgery, computer vision syndrome, Sjogren’s syndrome, lupus, thyroid disease, diabetes, autoimmune disease, poor refractory surgery, postmenopausal status, and asage.
Dr. Jackson also includes common medications such as antidepressants, beta blockers, antimuscarinics, and antihistamines as risk factors. Each of these must be individually evaluated prior to treatment.
However, in ocular surface disease, one of the most variable and common elements affecting the disease is allergies. In addition, comorbidity makes a major contribution.
Ocular surface disease may also be exacerbated by the treatments used for symptoms of allergies. For example, the tear film is dried out by antihistamines.
In order to determine if the treatments patients are using are necessary, it is important to figure out if the patient actually has a true allergy. It is possible to find quick answers in the office by doing the skin tests.
It’s possible to determine if the allergies are perennial, which seasons the allergies are the worst, and what the patient is allergic to. The answers to these questions make treatment decisions more accurate when trying to determine if ocular surgery is required or if you are looking at a case of dry eye.
Over-the-counter antihistamines are taken year round by patients with seasonal allergies. During the specific allergy season, the antihistamines are providing needed relief. But, during the rest of the year, these antihistamines simply cause symptoms of dry eye. Ocular surface disease symptoms often are dramatically reduced simply by taking a patient off unnecessary antihistamines.
An additional method to reduce allergy treatment’s impact is to swap in low dry other medications with H1 receptor specific properties and low dry eye side effects, such as bepostastine or alcaftadine. In some cases, this strategy of replacing antihistamines with other agents significantly reduces ocular surface disease symptoms.
Allergy testing helps to determine if patients are in fact allergic to environmental factors and do not actually have allergies. Seasonal pollens are often triggers, while dust mites act as perennial allergen triggers.
Ophthalmologists do more than treat allergies in their patients. They also help them to learn about strategies to avoid allergens, including not allowing pets in the bedroom or the use of dust mite covers.
Allergy tests provide the types of information that lets you know when treatments should be stopped as well as when to treat ocular surface disease. For many patients, allergies are a big risk factor and an allergy test allows these risks to be collected and assessed.
Of course, the allergy tests are combined with many other diagnostic tests to determine if the problem is due to allergies, or other problems such as problems with evaporation, an aqueous deficiency, mebomian gland dysfunction, Sjogren’s, osmolarity, inflammation, or a combination of issues, according to the doctor. The most appropriate treatment can be readily found by starting with an in-office allergy test.
However, additional office visits are required to complete the tests for allergies. That’s because most insurance companies will not pay for a test for allergies on the same day that they pay for an office exam.
To make sure that medications are not masking the results, five days prior to the test, patients are asked to stop any intranasal, inhaled, oral, systemic, or topical antihistamines. A few minutes after taking the test, the results are available for discussion with the patient.
Numerous questions can be answered by the test, including: Do I have any allergies? Should allergens be avoided? Are dust mite covers or HEPA filters needed? Are my allergies seasonal? Is treatment for allergies necessary?
Dr. Jackson stated that part of the diagnostic work-up should be tested for allergies if a patient is thinking of having LASI, cataract, or another surgery and they have an ocular surface disease.
The in-office allergy tests are great for ophthalmology practices since they are so easy to implement and use. Because the cost of these tests is reimbursed, value is added to your clinical practice and your patients, who will appreciate the high level of care provided.