Tears and fears

3 May 2024
Spring 2024

Jane Veys MCOptom on reducing the tears and fears of our patients

Whether the title of this editorial conjures up lyrics from Joni Mitchell’s classic song Both Sides Now or the tears and fears of professional exam stress will depend on your musical taste, your career stage or, of course, simply your age.

The lyrics from this song have often come to mind when I consider evidence or indeed when I try to resolve a clinical conundrum – it is always good to stop, think and consider an issue from both sides. 

Patients may want or expect antibiotics to treat their eye infection, but evidence indicates that many mild conjunctival infections can resolve on their own without the need for antibiotics, especially when reinforced by good hygiene and supportive care. Optometrists have a significant role to play here in ensuring patients understand the most suitable treatment option and why. 

Antibiotics are an essential part of eye care, but we need to be cognisant that antimicrobial resistance is real and present. I was alarmed to read a recent study that showed almost 60,000 people in England had an antibiotic-resistant infection in 2022, a 4% rise on 2021 (UK Health Security Agency, 2023).

We discuss the rise of antimicrobial resistance, and the role optometrists have in addressing this. Many eye drops are broad-spectrum antibiotics. Their overuse or misuse can lead to resistance in various bacterial species. Experts advise reflecting on our prescribing behaviours. Avoiding over-prescription, using targeted antibiotics and ongoing patient education will all help to curb growing resistance. College Clinical Adviser Daniel Hardiman-McCartney MBE FCOptom encourages all optometrists not to bow to pressure to prescribe, but to trust their professional judgment and the evidence. Always ask, is there a real, clinically justified need for them?

Menopause can cause both tears and fears. Most would associate fluctuating hormones with mood swings and hot flushes, but few women are aware of a connection between the drop in oestrogen, progesterone and androgen, increased tear evaporation and dry eye symptoms.

Experts advise reflecting on our prescribing behaviours

Our article discusses the challenges of understanding whether changes in tear film or vision are menopause-related or not. This helpful read reviews the growing evidence for associations between menopause and ocular conditions, and how optometrists can use their expertise to advise women.

Optometrists, male and female, can play a vital role in educating women about the potential changes associated with menopause and supporting them in their menopausal journey. Progress has been made; menopause should and can be discussed, but greater understanding is needed and more robust evidence sought to address unanswered questions.

A new hope is on the horizon for the many who fear losing their sight from the dry form of age-related macular degeneration (AMD). Our article explores a new treatment for late-stage dry AMD, slowing down visual loss.

With these introductions of new drugs and a considered approach to prescribing drugs that have been with us for many years, there is real hope to reduce tears and fears for both ourselves and our patients.

Jane Veys MSc MCOptom FIACLE

Jane has been involved in optometry for over 30 years and is an experienced educator, facilitator and scientific writer. She has published more than 50 articles, authored a leading contact lens textbook and created industry leading digital education series.

Image credit | Caroline-Andrieu

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