CAN MY MEDICATIONS YES ABSOLUTELY!! CAUSE VISION …€¦ · 1 CAN MY MEDICATIONS CAUSE VISION PROBLEMS? Dr. Kris Kerestan Garbig [email protected] YES ABSOLUTELY!! v It's very

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CAN MY MEDICATIONS CAUSE VISION PROBLEMS?

Dr. Kris Kerestan [email protected]

YES ABSOLUTELY!!

v It's very important for people to be aware of what conditions they have, what medications they'retaking and how these meds may increase the risk ofcertain vision problems.

WHAT’S THE DANGER?

Every med. has an effect on Multiple Organs


70 % of Americans are on at least ONEprescription drug50 % take at least TWO prescriptions20 % take at least FIVE prescriptions


The most commonly prescribed drugs are:Ø Antibiotics -- taken by 17 % of AmericansØ Antidepressants -- 13 % of AmericansØ Opiods (Pain) -- 13 % of Americans.

Followed by:Ø HBP -- 11%Ø Vaccines -- 11%

AEP Course 6 Saturday 9:00 - 10:00 am

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CHRONIC CONDITION OR OTHER?

Chronic ConditionHeart Disease/ Diabetes/Arthritis

DepressionNearly 20 % of women ages 50 to 64 13 % of the overall population were found to be on antidepressants

PainOpiods – High addiction rate (WVA and KY two of highest)

MEDS BY AGE

Younger than 19Ø VaccinesØ AntibioticØ Anti-Asthma

Middle AgeØ AntidepressantØ Opiods

OlderØ Cardiovascular

COURSE OBJECTIVES…

Ø What are the most common Systemic meds.that cause Visual side effects?

Ø What are the specific Visual side effects?

Ø How to minimize visual loss while takingthese meds?

ROLE OF OPTOMETRIC ASSISTANT

Must be familiar with common systemic medsand their associatedvisual side effects

Ø TransientØ MildØ ModerateØ Severe

Ø Vision Loss

ROLE OF OPTOMETRIC ASSISTANT

It ALL begins with the CASE HISTORY!!!

A careful and detailed Case Hx. is critical to revealing the patients Medication Hx.

Can often identify the problem even before any testing is completed

MU 2 Rx requirements-complete list from physician

CASE HISTORY

q Chief Complaint/RFV q Visual and Ocular historyq General Health historyq ALL Medications q Allergies to medications q Family Eye and Medical histories


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# 1ACNE MEDICATIONS

(ISORETINOIN)

Brand namesØ AcutaneØ AmnesteemØ ClaravisØ Sotret

ACNE MEDICATIONS

Uses:Treatment of severe acne that hasn’tresponded to other treatments

Initial SCIENTIFIC Treatments

Benzoyl Peroxide -Kills Acne bacteria

Salicylic Acid - Unclogs Pores

Glycolic Acid -Renews Skin

Sulfur - Dries Sebum

Azelaic Acid - Normalizes Skin

OTC OPTIONS NATURAL ALTERNATIVES

Green Tea - Kills Acne Bacteria

Passion Flower - Reduces inflammation

Aloe Vera - Soothes Irritated Skin

Sage Extract - Fights Free Radicals

Gotu Kola - Improves Skin Healing


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VISUAL SIDE EFFECTS

Dry Eyes- mild to severeDecreased CL toleranceBlepharoconjunctivitisKeratitisPhotophobiaIncrease in hordeolumand chalazion frequencyCorneal opacities

VISUAL SIDE EFFECTS

HeadacheTransient blurred visionSudden decrease in night visionSubjective visual obscurations

PhotosensitivityTinnitis

Papilledema

PAPILLEDEMA

Swelling of Optic Nerve caused by increase in intracranial pressure

Usually Bilateral

PAPILLEDEMA

Symptoms

None early on Headache Enlargement of the blind spotBlurred visionTotal loss of visionmay ultimately occur

Signs

Venous engorgementLoss of venous pulsationHemorrhages over and adjacent to the optic discBlurring of optic marginsElevation of optic discPaton's lines = radial retinal lines cascading from the optic disc

OTHER SIDE EFFECTS

Ø Chapped lips (90%)

Ø Dry and itchy skin (80%)

Ø Dryness of nose/nosebleeds (80%)

Ø Irritation of eyes and eyelids (40%)

Ø Joint and muscle pain (15%)

PREVENTION

q Comprehensive Case History

q Discussion and review of ALL meds

q 6 month Office Visit while taking meds

q Annual Comprehensive Vision Exams


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#2ANTIHISTAMINES

Ø ClaritinØ ZyrtecØ AllegraØ BenadrylØ Sudafed

#2ANTIHISTAMINES

Uses:Relieves hay fever and allergy symptomsReduces inflammation due to allergic reactions

Mechanism of Action:Blocks the histamines that are produced by the body that

cause runny nose, watery eyes, sneezing, itching and inflammation due to allergic rxn. or the common cold

VISUAL SIDE EFFECTS

Dry eyes

Mydriasis

Blurred vision due to the loss of accommodation

Lacrimation

Angle Closure Glaucoma (Ocular Emergency)Ø Rapid increase in ocular pressureØ Ocular and Systemic symptoms

§ Headache§ Severe eye pain§ Nausea and vomiting§ Blurred vision§ Seeing halos around lights

VISUAL SIDE EFFECTS

Anatomy and Physiology of Acute Angle Closure Glaucoma

OTHER SIDE EFFECTS

Dry mouthDrowsinessDizzinessNausea/Vomiting

Restlessness or moodiness (in some children)Blurred visionConfusionTrouble urinating


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PREVENTION

q Avoid mydriatics (pupil dilating agents)

q Avoid Anticholinergics and AntispasmodicsØ Asthma and COPD meds Ø Scopalomine patches used for dizziness and

sea sicknessØ Drugs that calm diarrhea and muscle spasms

in people with GI problems

q Annual comprehensive vision exams

#3ANTIMALARIALS

Plaquenil (Hydroxychloroquine)QuineproxAralen (Chloroquine)

Uses:Rheumatoid arthritisLupus ErythemtosusSjogren’s SyndromePrevention of and treatment for Malaria

(Parasitic disease kills 2.7 million people annually)

VISUAL SIDE EFFECTS

Keratopathy

Retinal toxicity leading to permanent and irreversiblevision loss (Dose related toxicity)

Ø Bilateral Pigmentary RetinopathyØ Asymptomatic early on

BULL’S EYE MACULOPATHY

ØLater - Bull’s eye maculopathy accompanied by paracentral and central scotomas

Ø End stage - Widespread RPE and retinal atrophy with aloss of central vision, peripheral vision, and night vision

OTHER SIDE EFFECTS

GI problems

Skin changes

CNS involvement

Neuromuscular toxicity

Cardiac toxicity


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PREVENTION

q Baseline vision exam prior to treatment

Ø SLE Q 6 monthsØ 10-2 Humphrey Visual FieldØ Macular OCTØ Fundus autofluorescence (Optomap Daytona)

q Annual comprehensive vision examsrepeating the above tests

# 4CORTICOSTEROIDS

PrednisoneCortisoneDexamethasoneHydrocortisone

Primary Uses:Ø Systemic inflammatory conditions…arthritis,

lupus, psoriasisØ Severe allergies, asthma, breathing

disorders, bronchitis, ulcerative colitisØ Ocular conditions…Contact dermatitis, Acute Allergic

rxn, Anterior uveitis

Posterior Subcapsular CataractsElevated IOPGlaucomaDecreased vision MydriasisPhotophobia

VISUAL SIDE EFFECTS

VISUAL SIDE EFFECTS OTHER SIDE EFFECTS

Ø Adrenal Insufficiency- decreased ability to respond tophysical stress (Fight or Flight)

Ø Immunosuppression- Can’t fight off infections

Ø Steroid Withdrawal Syndrome– could resultin fatigue, joint pain, muscle stiffness, muscletenderness, fever and Flu-like symptoms


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OTHER SIDE EFFECTS

Ø Gastrointestinal Ulcers or BleedingØ OsteoporosisØ Weight gainØ InsomniaØ Mood ChangesØ Fluid RetentionØ Elevated BPØ Elevated Blood Sugar:

PREVENTION

q Comprehensive Eye exam immediately afterstart steroids for SLE and IOP check

q Monitor IOP Q 3 months

q Call if develop eye pain, halos around lights or blurred vision

q Annual Comprehensive Vision Exam

# 5ERECTILE DYSFUNCTION

MEDS

Viagra CialisLevitra

VISUAL SIDE EFFECTS

Seeing a temporary blue tinge to objects

Blurred Vision

Sensitivity to light

Conjunctival Hyperemia

Sudden vision loss (advertised on commercial)

Non Arteritic Ischemic Optic Neuropathy

NON ARTERITIC ISCHEMIC OPTIC NEUROPATHY -NAION

NAION is an ischemic insult to the optic nerve

Ø AcuteØ Monocular Ø Painless Ø Visual Loss Ø Optic disc swellingØ Pallor of the Optic Nerve


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OTHER SIDE EFFECTS

Headache

Stuffy nose

Facial Flushing

Dizziness

Lightheadedness.

PREVENTION

q Comprehensive Case History

q Discussion and review of ALL meds

q Call if notice any vision changes


# 6ETHAMBUTOL

Myambutol

Uses:Antibiotic used to treat tuberculosis (TB)

VISUAL SIDE EFFECTS

Decrease in visual acuity/clarityDifficulty seeing certain colorsToxic Optic Neuropathy

TOXIC OPTIC NEUROPATHY

Visual symptoms generally appear between4 months to a year after taking meds:

(Dose Dependant)

Mild Unilateral Dimness of vision initiallyPainless Visual LossBilateral vision loss no worse than 20/200

TOXIC OPTIC NEUROPATHY

Pupils are bilaterally sluggish to lightAlways R/G or B/Y defectNormal-appearing optic nerves initiallymaking early diagnosis a challengeVisible Optic Atrophy develops later


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TOXIC OPTIC NEUROPATHY TOXIC OPTIC NEUROPATHY

Papillomacular bundle damage with Central or Ceco-central Scotoma

OTHER SIDE EFFECTS

Headache

Loss of appetite

Upset stomach

Nausea

Vomiting

PREVENTION

q Baseline Vision Exam

q Color Vision testingq Amsler Gridq Visual field testingq OCT

q Call if vision or color vision changes


# 7FLOMAX

Uses:

Treatment of Benign Prostatic Hyperplasia

ØMinimizes pain during urination in men withenlarged prostates

Ø Work by relaxing bladder and prostate muscles

VISUAL SIDE EFFECTS

Ø Medication builds up in the iris preventing pupil from being able to dilate

Ø Intra-Operative Floppy Iris Syndrome - cataract surgery

Ø Incidence of IFIS with the use of flomax is 43% to 63%while revalence in general population is only 1-2%


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IFIS

Miotic Pupils

Iris clips

OTHER SIDE EFFECTS

Headache - 4% to 20%

Dizziness - 5% to 15%

Back or chest pains - 4% to 8%

Diarrhea - 5%

Nausea and vomiting - 3%

Flu-like syndrome or infection –2%

PREVENTION

q Men considering cataract surgery MUST make cataract surgeon aware

q Annual vision exams

#8PHENOTHIAZINES

ThorazineMellaril

Uses:Antipsychotic used to treat schizophrenia and other severe mental/emotional illnessUsed to treat nausea and vomitingSevere hiccups

VISUAL SIDE EFFECTS

Sensitivity to light

Color vision changes

Difficulty with night vision

Pigment changes on the lens

OTHER SIDE EFFECTS

Inability to move eyes

Constipation – Mild

Drowsiness

Dry mouth


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OTHER SIDE EFFECTS

Dizziness

Lightheadedness

Decreased sweating

Nasal congestion

PREVENTION

q Take LOWEST dose possible

q Avoid long term use

q If any symptoms persist or worsen,notify your doctor

q Annual comprehensive eye exams

#9TAMOXIFEN

SoltamoxNolvadex

Uses:Anti-estrogen drug used to treat breast cancer

VISUAL SIDE EFFECTS

Blurred Vision

Sub-epithelial corneal opacities

Increased risk of Cataracts

Crystalline Retinopathy

Crystalline Retinopathy

Initially asymptomaticDecrease in visionDyschromatopsiaDose dependent - >120mg BID

OTHER SIDE EFFECTS

Irregular periodsHot flashesNausea/VomitingNoisy or rattling breathingRedness of the face, neck, arms or occasionally, upper chest


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OTHER SIDE EFFECTS

Skin changes

Swelling of the fingers, hands, feet, or lower legs

Troubled breathing at rest

Weight gain or loss

PREVENTION

q Baseline Comprehensive Vision Exam

q Report any visual or systemicside effects to your doc


#10TOPIRAMATE

Topamax

Uses:Anti-convulsant used to treat seizure disordersPrevention of migraine headachesTreament of Bipolar Disorder, OCD and PTSDWeight loss in ObesityTreatment for Pseudo-tumor Cerebri

Angle-Closure Glaucoma (Medical Emergency)

ØRapid increase in IOP due to:

Swelling of the Ciliary Body Closing of the Angle between the Iris and Cornea

VISUAL SIDE EFFECTS

ANGLE-CLOSURE GLAUCOMA

Severe peri-ocular painPhotophobiaCircum-limbal hyperemiaCorneal edemaNon-responsive pupil

ANGLE-CLOSURE GLAUCOMA

Extreme Headache

Blurred or double vision

Nausea and vomiting

Seeing halos or rainbows around lights


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OTHER VISUAL SIDE EFFECTS

Blurred Vision

Visual Disturbances

Peri-orbital pain

Visual Field Defects (April 2014)

OTHER SIDE EFFECTS

Paresthesia- numbness and tingling

FatigueTaste changeWeight loss

Difficulty with concentration/attention/memory

PREVENTION

q Baseline Comprehensive Vision Exam

q Report any visual or systemicside effects to your doc


THANK YOU!!!Any ????

Dr. Kris Kerestan [email protected]


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CAN MY MEDICATIONS YES ABSOLUTELY!! CAUSE VISION …€¦ · 1 CAN MY MEDICATIONS CAUSE VISION PROBLEMS? Dr. Kris Kerestan Garbig [email protected] YES ABSOLUTELY!! v It's very