a Handle on Ocular Allergy
are uniquely suited to dealing with the problem, and doing so brings benefits to
LUTHE, Senior Associate Editor
is everywhere according to the American Academy of Allergy, Asthma and Immunology,
allergic diseases affect more than 20% of the U.S. population. Many O.D.s have learned
to turn this unfortunate fact of life to their advantage, helping patients find
relief and accruing profits and prestige in return. With a proactive attitude and
a nose for clues, they say that other optometrists can do the same.
A careful patient history remains the first place to look
for allergy clues. While hay fever sufferers may already know their triggers, pin-pointing
the cause of an allergic reaction can still be tricky. Experts agree that a careful
study of a patient's environment and lifestyle are essential. "Usually," says Steven
J. Gradowski, O.D., F.A.A.O., Omaha, Neb., "patients don't make the connection between
environmental, nutritional and other triggers to their ocular allergies."
What's more, when patients present for their annual exam
typically the only time you'll see them they may not be experiencing allergies,
particularly if their problem is seasonal. Because of this, Glenn Corbin, O.D.,
of Reading, Pa., recommends a proactive approach. "I make the assumption that everyone
potentially has allergy," he says. He questions "every single patient" about ocular
redness, itching, etc.
In addition to questions about pets in patients' homes and medications,
experts recommend you ask about common household items. William Townsend, O.D.,
of Amarillo, Texas, says it's crucial to ask about the flooring material in the
home. "We encourage patients to get rid of carpet, if possible," he says. "This
has been shown to reduce the severity and duration of allergy." Also ask patients
about the chemicals they use around the house, such as detergents or air fresheners.
Bobby Christensen, O.D., of Midwest City, Okla., points out that fabric softeners
have been linked to allergies; even the patient's car and pillow are suspects. "You
need to find out where they're having the most reaction, and when it's most severe,"
10 U.S. Cities for Allergy
GRAND RAPIDS, MICH.
According to the Asthma and Allergy Foundation
There are plenty of options short of medication that can help
patients achieve allergy relief. With pets often linked to allergies, you can advise
getting rid of the animal, although for some patients this is an extreme solution.
Experts agree that keeping the pet off of the bed, and preferably out of the bedroom,
is crucial, as is more frequent grooming. Dr. Christensen advises looking for fragrance-free
pet shampoos to avoid another potential irritant.
When it comes to personal grooming, Dr. Townsend advises patients
bathe before bed. "You come in the house with pollen and other allergens in your
hair," he explains. "If you put your head on the pillow, you deposit these, which
are then in contact with your face and ocular adnexa all night."
Around the house, emphasize cleaning air ducts and furniture more
frequently, as well as shampooing carpets if patients can't remove them altogether.
Air filters designed to remove allergens also help. For contact lens wearers, Dr.
Gradowski suggests cleaning with a hydrogen peroxide system with non-preserved saline
When a patient comes to the end of options for avoidance, it's
time for medications. Most patients come to you because their chosen over-the-counter
(OTC) products haven't worked, so they're ready to accept this. However, some patient
education goes a long way in getting them to fill your prescription. "Patients assume
that taking oral OTC medication should address all their allergy symptoms," Dr.
Corbin says. "But it doesn't address ocular ones."
He tells patients that topical medications are the best way to
treat ocular symptoms. It's also important to inform patients that prescription
medications require much less frequent dosing than OTCs, providing convenience as
well as greater efficacy. "The duration of action for these [OTC] antihistamine/decongestant
products is about two hours, yet the recommended dosage is four times a day," Ernie
Bowling, O.D., M.S., F.A.A.O., of Summerville, Ga., points out. "So what the patient
winds up doing is using the medication more than recommended, which can produce
a number of problems, such as a rebound conjunctival hyperemia or a chemical keratitis."
However, the antihistamic effects of the combination antihistamine/mast cell stabilizers
that allergy experts recommend last for approximately 12 hours.
Dr. Townsend informs patients that BAK, found in most OTC drops,
can further dry out the ocular surface. Most prescription products, he says, cause
minimal drying comparatively.
Keep them in contact lenses
Prescription mast cell stabilizers/antihistamine drops, experts
say, not only treat both seasonal and perennial allergies effectively, they also
help prevent that dreaded side effect of ocular irritation discontinuation
of contact lens wear. Dr. Bowling gives his patients a prescription for a combination
mast cell stabilizers/antihistamine before allergy season begins, for "pre-loading."
Dr. Christensen instructs his patients to instill a drop of Patanol (olopatadine
hydrochloride, Alcon) in each eye first thing in the morning and at least five minutes
before inserting their lenses; he tells them to instill the second dose in the evening
after they've removed their lenses. A trial run of two weeks at this schedule may
be necessary because resolution may take more than one week, Dr. Christensen says.
Other tips include a change in wearing schedules. Dr. Bowling
acknowledges that while few patients will likely decrease their wear time, they
may be amen-able to a more frequent replacement schedule. "If they replace lenses
every two weeks, try changing them weekly," he says. "And instruct patients to clean
their lenses every day. Or change to a daily replacement lens during allergy season."
Getting the message out
Treating ocular allergy requires little investment for marketing
or staff training. Dr. Christensen has trained his staff to give patients tips on
what they can do to address allergy symptoms until their appointment. Dr. Bowling
has an "allergy questionnaire" posted on the walls of his reception area, optical
department and each of the exam rooms. "It's just three questions that at least
get patients to think about what they may be experiencing," he says.
Dr. Townsend asks patients if other family members have the same
symptoms. "Since this condition is genetically driven, they often do. We ask them
to refer family members as well, and that is a very effective and inexpensive form
Scot Morris, O.D., of Conifer, Colo., pursues a more aggressive
marketing strategy, sending out fliers to his community and posting ads in local
newspapers to reach new patients. While it may be more expensive, "If I can get
the patient in for allergies, I can keep him in for all his other eyecare needs,"
Assert your authority
Treating ocular allergy is profitable in two ways, say practitioners.
First, patients suffering from seasonal allergies typically require one to two visits,
while those with perennial allergies may need to come in as often as every six weeks,
according to Dr. Morris. "Many docs overlook this," he says. "Other O.D.s won't
see these patients enough and so they end up going somewhere else."
The other, equally valuable benefit is the assertion of prescription
authority and full-scope eye care practice. (See "How to Maximize Prescription Authority,"
on page 36.) "Every time you have a patient who presents a prescribing opportunity,
issue one to show the patient that you treat eye disease," Dr. Corbin says. "Treating
ocular allergy is easy and sets a precedent."
Will patients visit an O.D. for treatment instead of their primary
care physician? Dr. Gradowski believes so. "Although many allergists will prescribe
the same eye drops we might," he says, "they usually do not have a slit lamp to
evaluate the lids, conjunctiva and tarsal plates to see just how the allergic response
affects these tissues. With the tools optometrists have at our disposal, we can
reduce the number of visits patients need to just one or two. You can really make
a believer out of someone who's suffered for years with ocular allergies and they
become a great referral source."
Optometric Management, Issue: November 2006