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This is especially important for our new glaucoma patients. Most people have an incomplete understanding of the proper technique, and giving them a live demonstration greatly enhances the efficacy of therapy. • While neomycin and benzalkonium chloride (BAK) suffer much abuse, neither merit it. In a large study, neomycin allergy developed in only 1.5% of subjects. When such does occur, it is only a mild annoyance or aggravation. Discontinuation of the offending drop, optional use of cool compresses and/or triamcinolone 0.1% cream can be used for two to three days. An article in the British literature provides a more practical perspective on BAK (see slide above). Further, it is well known that the original 0.3% Lumigan (Allergan) caused a fair amount of conjunctival and eyelid irritation. It was reformulated to a much more tolerable 0.1%. However, there is four times more BAK in the 0.1% formulation. Deductive reasoning will now soften the accusations against this maligned preservative. • What about online “symptomcheckers”? More and more patients are seeking advice via these. An interesting article in the June 2019 JAMA Ophthalmology found that the WebMD site listed the correct diagnosis as the first diagnosis in 26% of cases. The correct diagnosis was not on the list at all in 43% of cases. Their euphemistic conclusion: “There is room for improvement in the domain of online symptom-checkers for ophthalmic symptoms.” Bottom line—just see an optometrist! Like all technologies affecting human medical care, these sites will improve over time, and while they may be helpful adjunctively to clinic-based care, nothing will replace the care and attention of a face-to-face doctor visit. • Thankfully, newer, better and easier to use antithrombotic medicines are dampening the prevalence of Coumadin (warfarin). However, there is still an abundance of people on warfarin for stroke prevention. A blood assay known as the International Normalized Ratio (INR) quantifies thrombotic control. It is yet another blood test beyond CBC, sed rate and C-reactive protein (CRP) with which we all need to be familiar. In our tireless pursuit of simplicity, just know INR generally needs to be between 2 and 3 for warfarin patients. This metric is not applicable to any other drug. Essentially, if the INR is 3, the risk of hemorrhagic events is increased. • There are three commonly used antibiotic-steroid combinations.
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