Shingrix Vaccine is a MUST for patients 50 and older to prevent painful shingles outbreaks

A controversy existed because the American Academy of Ophthalmology and the American Dermatologic Society recommended that patients over 50 years be vaccinated for shingles but the CDC recommendation was 60 years and above, Pepose said.

Now all recommendations are in line.

In October, the U.S. FDA indicated all healthy adults over 50 years be vaccinated and Shingrix (GSK) was selected as the preferred vaccine.

There are 1 million new cases of zoster annually in the U.S. versus 35,000 new cases of herpes simplex keratitis (HSK), he said. Along with 100,000 new cases of zoster ophthalmicus.

One in two people over 70 years will get shingles in their lifetime, he said.

The risk of stroke increases by 30% within 1 year of zoster and 4.5 times following herpes zoster ophthalmicus, Pepose said.

“This is thought to be related to varicella zoster virus (VZV) travelling down the afferent sensory fibers of the trigeminal nerve to internal carotid and its intracranial branches,” he said.

There are common misconceptions about shingles, he added.

It was thought that the vaccine could perhaps curb immunity in older patients.

“It turns out the incidence of zoster was increasing with age even before the production of the vaccine,” Pepose said.

The vast majority of zoster patients are healthy, he said. The mean age of onset for shingles is 52 years.

The ocular disease usually occurs weeks after.

“Although zoster is more severe in immunocompromised individuals, 92% of zoster patients are healthy,” he said.

The risk of PHN increases with age. PHN is associated with depression and is the leading cause of suicide in chronic pain patients over 70 years.

“Both varicella and varicella vaccine establish an immune response and lifelong neuronal latency, but changes in cell-mediated immunity lead to reactivation,” Pepose said.

He added that only 24% of eligible patients aged 60 years or older have been vaccinated.

“All patients over age 50 years should be vaccinated. I think you’ll have to be cautious with this in first quarter as the reimbursement is going through for the insurance company,” he said.

Zoster trials are ongoing.

“In those who currently have zoster, I wouldn’t vaccinate after it clears but wait a year and then vaccinate. I don’t think there is any evidence that proves the vaccine causes reactivation,” he concluded. – by Abigail Sutton

Reference:

Pepose JS. The shingles vaccine and zoster ophthalmicus. Presented at: Hawaiian Eye; Jan. 13-19, 2018; Wailea, Hawaii.

I have exciting news! My office started carrying a leading  ANTI AGING skin care line, Rodan & Fields. Dr. Rodan & Dr. Fields are two dermatologists, who created acne fighting product Proactive in late 90s. In early 2000s they have extended their expertise into the anti aging skin care line for men and women interested in looking their best every day. The new line has a sun protection and age defying regimen REVERSE, as well as a skin maintenance and rejuvenation kits REDEFINE.  There is an improved acne fighting line UNBLEMISH as well for younger patients, and people suffering from adult acne.  The most revolutionary product to me as an ophthalmologist is LASH BOOST which GROWS your lashes over 2 months of use. NO MORE EXTENSIONS!

I am so excited to be part of R & F team, and to be able to extend the years of research from the leading dermatologists to benefit my patients.

Summer is the perfect time to protect your face from sun damaging rays as well as rejuvenate and repair skin, boost eyelashes and eliminate fine lines.

Starting June 22, 2017 purchase skin care kit+LASH BOOST to receive 20% off.

*First three patients in the month of June to come to our office for an eye exam and mention this ad, will get a FREE sample of GLOW packet for skin rejuvenation and 10% towards LASH BOOST purchase!* 

See more at: drkurteeva.randf.com and shop the skin care line of your choice.

Have you noticed your "sunkissed" eyes looking yellow lately?

Southern California boasts 281 sunny days a year. Sunny days means tremendous amount of direct ultraviolet radiation exposure to our skin and eye surface. Without the physical protection of sunglasses and a wide brim hat, continuous UV radiation results in chronic and permanent changes on the white part of the eye called conjunctiva. 

Conjunctiva when healthy is smooth, moist, and white; it has a glistening reflection from an abundant tear film covering it. Sun leads to mutations in the way elastin and collagen, the soft tissue building blocks, are synthesized on the eye surface and dermis of the skin. These mutations lead to permanent deposition of yellow, fatty, elevated tissue on the white of the conjunctiva. These striking deposits grow over time to unsightly and commonly irritating lesions called pingueculi. These areas are frequently easily irritated by wind or allergies and turn the whole eye red.  When the fatty deposits cross over the cornea, the clear window of the eye, the clarity of vision is affected by the pulling of the scar affecting the optics of the eye.

Most people are not aware that removal of the pterygium is a short outpatient procedure with minimal down time. It is done at an outpatient facility and most patients return to desk jobs within two days. With the use of doctor prescribed eye drops the healing process continues for a month after surgery until the eye looks “pristine” and white as it did before sun damage ravaged the ocular surface.

Surfers and farm workers are people that are most affected by pterygia. People who spend significant hours outdoors golfing, sailing, fishing or playing tennis maybe at risk as well if sunglasses are not worn. Some people have a genetic predisposition to develop sun damage

as early as teens. For those patients the cosmetic effect of the pterygium or even pingueculum is quite significant.

Our office speciliazes in identifying and treating sun damage of the ocular surface with medical options as well as a more definitive surgical removal.

Grapes may support ocular health

Compounds found in grapes may help protect against eye disease, according to new research led by researchers at the Bascom Palmer Eye Institute, University of Miami Miller School of Medicine. The study showed that a diet supplemented with grapes was able to counter damage from oxidative stress and preserve retinal structure and function in a laboratory model of retinal degeneration, the university said. The study was funded by the California Table Grape Commission; researchers investigated whether a diet supplemented with grapes, in the form of whole grape freeze-dried powder, would protect the photoreceptors of the retina from degeneration induced by acute oxidative stress. Mice were fed the grape-supplemented diet (corresponding to about 3 servings per day for humans), a sugar-matched control diet, or a normal chow control diet. Both retinal structure and function were preserved in the mice consuming the grape-enriched diet, where they maintained their retinal thickness, the quantity of photoreceptors, and the amount of photoreceptor activity, despite the elevated oxidative stress conditions. Conversely, in the non-grape consuming group, retinas were damaged, displaying holes and lesions, and with a significant decrease in thickness.

More toddlers suffer eye burns from laundry packets, study says

(CNN)From 2012 to 2015, the number of chemical burns to the eye linked to laundry detergent packets rose more than 30 times among young children, a new study says. More than 1,200 3- and 4-year-olds received such burns in that time period, according to the research published Thursday in the medical journal JAMA Ophthalmology.

Single-dose detergent packs, known as laundry packets or pods, entered the mass market in 2012.

"Each pod consists of a detergent mixture wrapped in a water-soluble film, made up of a proprietary polyvinyl alcohol polymer," said Eric J. Moorhead, president and principal scientist of Good Chemistry LLC, a consulting firm.

Laundry detergent pods are 'real risk' to poison kids

"The liquid detergent in the pods is not the same as regular liquid detergent. It has a higher concentration of surfactants, chemicals that are responsible for stain removal," said Moorhead, who was not involved in the new study. "At high concentrations, these ordinarily safe ingredients can cause irritation, especially in sensitive areas like the eyes."

'Among the worst chemicals'

Among kids between 3 and 4 years old, the number of chemical burns in the eye caused by laundry detergent packets increased from 12 instances in 2012 to 480 in 2015. Proportionally, the total chemical eye injuries associated with the packets increased from 0.8% of all burns in 2012 to 26% in 2015.

Children can injure themselves when the packets break and the contents squirt into one or both eyes, or when the contents leak onto the children's hands and they rub their eyes.

Most of these burns happened in the home, where kids are playing with the brightly colored packets, "wondering if they're toys, if they're candy," said the lead researcher, Dr. R. Sterling Haring of Johns Hopkins University. They're neither.

Laundry packet poisonings increase in kids

The detergents inside the pods "are among the worst chemicals that the eye can be exposed to," Haring said: Detergents are alkaline in nature, and alkaline burns are typically more severe than acid burns in the eye. "They penetrate deeper, they burn faster, and they are more caustic to the tissues in the eye itself."

Because the cornea doesn't have blood vessels, it doesn't heal well, so if you scar it with detergent packet chemicals, "there's a high risk of long-term vision impairment," Haring said.

"We'd done another study a few months ago that showed that small children are at highest risk for all types of chemical ocular burns, and that kind of flew in the face of conventional wisdom," he said. "They always thought that working-age men were the highest risk group: working in factories, splashing chemical in their eyes."

Instead, he and his colleagues were surprised to find that young children have a 50% higher risk than the highest-risk adult, Haring said. Once that news got out, community physicians insisted that the cause was laundry detergent packets. Haring and his team discovered that they were right. Their study concludes with recommendations that parents properly store these packets and that manufacturers consider new, redesigned packaging.

In essence, these recommendations "are already in play," said Brian Sansoni, vice president of sustainability initiatives at the American Cleaning Institute, which represents the US cleaning products industry.

He said the new study analyzed data prior to the new safety standards that were published in December 2015 by ASTM International, formerly American Society for Testing and Materials International, a non-profit that develops voluntary consensus standards for consumer manufacturers. The American Cleaning Institute helped identify proper standards for the packets.

Following publication of the safety standards, Procter & Gamble, the company that makes Gain and Tide brand laundry detergent pods, launched ad campaigns to raise awareness of the dangers and made its packaging more difficult for small children to open. Other companies also followed suit.

"Make sure you keep these products up and away from children -- like a lot of household products," said Sansoni.

What should parents do?

Dr. Michael Grosso, chairman of the department of pediatrics and chief medical officer at Northwell Health's Huntington Hospital in Huntington, New York, said parents need to worry about these laundry packets and keep them out of the way.

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"It's not only eye injuries. Children will also swallow these," said Grosso, who was not involved in the study. Eye injuries caused by the packets "can be quite serious," he added.

"The majority of individuals will recover their vision after this kind of injury," he said. However, these burns can be "very, very painful. They require extensive emergency treatment and extensive follow-up treatment by an ophthalmologist."

The first thing parents should do is "prevent this by keeping these pods out of the way. They need to be kept up high in cabinets beyond the reach of a preschool child, the group that's most at risk."

If a child does get detergent in their eye, a parent should immediately irrigate the child's eyes.

"Cool tap water, as much as possible, as soon as possible," Grosso said. "And then the very next step would be a trip to the emergency department."

Haring echoed this advice. "Take your child and put their eye under cool water under the faucet and flush it with cool water for 20 minutes," he said, noting that if the burn is extremely severe, some loss of vision could occur.

"Don't stop and take them to the hospital. Don't call and wait for an ambulance to show up. Flush the eye with cool water before you do anything else," Haring said. "That's going to be the deciding factor about long-term outcome for this injury."

Dry Eye Relief Reinforced

There are estimates of 16 million dry eye patients in the United States that report symptoms to eye care professionals.  For these patients, good news in the form of Xiidra could not have come sooner.  Manufactured by Shire, Xiidra, aka lifitigrast opthhalmic solution,  a lymphocyte function-associated antigen 1 antagonist, was approved by the FDA for dry eye disease, on July 11, 2016.  

This is exciting news in the world of dry eye treatment.  Since 2005 Restasis, aka cyclosporine ophthalmic emulsion, (Allergan) was the only prescription solution available in the US to our dry eye patients.  Twelve years in the making, Xiidra is a new alternative to patients sensitive to Restasis, and who do not get complete relief from punctal plugs or frequently used artificial tears and other lubricants.

The drug’s safety and efficacy were assessed in more than 2,500 patients in four separate, randomized controlled studies. The results of the studies found that patients treated with Xiidra demonstrated improvement in their signs and symptoms of dry eye compared with patients treated with placebo.

Since FDA approval I have seen patients benefiting from Xiidra use.  When used twice daily, relief is felt two weeks after medication is started.  The only side effect that has been reported by the studies and my patients is a transient metallic taste after the drop is placed in the eye.  This fades with time and is less notable after persistent medication use.  

I am excited to see my patients using Xiidra long term and fighting the chronic inflammatory nature of the dry eye disease.  Currently first month supply is provided for free by the manufacturer given doctor's prescription.  Ask our office about your dry eye relief.

Cataract surgery linked to reduced mortality by 30%

Researchers evaluated the association between cataract surgery and mortality in a 5% random sample of U.S. Medicare beneficiaries. Overall, those who had cataract surgery lived longer.

Data was collected over a 10-year period from a cohort of more than 1.5 million patients.  This is the largest study of its kind making the results more valid since the sample size was so high.  Patients who had cataract surgery had a nearly 30% less mortality compared with those who did not have cataract surgery.

The association between extended life span and cataract surgery was significant outside of differences in systemic health problems like hypertension, high cholesterol and diabetis.  The association was strongest in women, in 80 to 84 year olds, and in those living in Western states.

The authors of this study hypothesize that cataract surgery improves a patient’s ability to care for themselves and remain physically and socially active, thus prolonging their life.