современные технологии в системе образования доклад
Главное меню:
Интересное
современные технологии в системе образования доклад, Antidepressants’ Impact on Ocular Health, A Review of Ocular Complications Associated with Medications Used for , Monitor the eyes for ocular effects from antidepressants - EyeWorld, Antidepressant Medications & Eye-Related Side Effects, Understanding The Link Between Cymbalta And Blurry Vision - MedShun, SSRI Eyes: Vision Issues, Optic Neuropathy, and More, (PDF) Ocular Adverse Effects of Antidepressants – Need for an .
Ocular Conditions Associated with AntidepressantsBe aware that antidepressants can potentially cause or make certain conditions worse.Dry eye syndrome. Antidepressants, particularly those with anticholinergic properties (e.g., TCAs), can disrupt tear film production by inhibiting parasympathetic stimulation of the lacrimal glands. Symptoms include burning, itching and a foreign body sensation in the eye. Again, these patients should have at minimum baseline dry eye testing and a dry eye questionnaire completed so proper monitoring over time can be achieved.Management: Artificial tears, punctal plugs and lifestyle modifications, such as reducing screen time, can mitigate symptoms. Clinicians should monitor patients for secondary complications like superficial punctate keratitis or corneal abrasions. Additionally, lid hygiene should be assessed and treated; proper and specific instructions on warm compresses and lid massage should be given to patients.As a reminder, based on recent literature and research results, there is a high population of individuals with generalized blepharitis that suffer from Demodex blepharitis.7 If identified, appropriate medications such as Xdemvy (lotilaner ophthalmic solution 0.25%, Tarsus Pharmaceuticals) should be prescribed, in addition to other dry eye and meibomian gland therapies, such as meibomian gland expression and low-level light therapy.There is the possibility of patients stopping their antidepressant medications due to dry eye complications. It is important to address this concern with the patient’s primary care provider prior to discontinuation.Glaucoma. Mydriasis induced by SSRIs, SNRIs or TCAs can precipitate acute angle-closure glaucoma in individuals with anatomically narrow anterior chamber angles. Additionally, although the relationship is less direct, chronic use of antidepressants may influence IOP dysregulation, resulting in chronic glaucoma.Management: A detailed family and personal history of glaucoma should be obtained before initiating antidepressants. At-risk patients may benefit from prophylactic laser peripheral iridotomy or other glaucoma interventions.Visual disturbances. TCAs and some atypical antidepressants can cause blurred vision and difficulty with near tasks due to impaired accommodation. These effects are typically dose-dependent and reversible upon discontinuation and are more common than once thought. It is best practice to inquire with patients on TCAs if they are experiencing any visual dysfunctions. Photophobia or light sensitivity is also reported with this class of drugs.Management. Prescribing lower initial doses and gradual titration can help minimize these effects. Ophthalmologic evaluation may be necessary if symptoms persist. If necessary, tinted glasses of various colors may help with light sensitivity.Retinal and optic nerve changes. Rarely, antidepressants have been implicated in retinal toxicity or optic neuropathy. For instance, prolonged use of SSRIs has been associated with subtle changes in retinal ganglion cell function. If there is a concern, at minimum, a ganglion cell analysis can be performed with most OCTs to see if there is change in thickness and potentially associated ganglion cell layer function.8Management: Periodic retinal examinations may be warranted for patients on long-term therapy, particularly those with pre-existing ocular conditions.Ocular motility disorders. Medications like fluoxetine have been linked to oculogyric crises and diplopia, likely due to their effects on neurotransmitter pathways involved in ocular motility.Management. Discontinuing the offending agent typically resolves symptoms. Neurological evaluation may be indicated for persistent cases.When managing any of the above ocular side effects—which may be caused of worsened by psychotropic medications—be careful not to blame the medications to the point the patient decides to abruptly discontinue or alter their treatments. This can cause life-threatening episodes which can result in dire consequences to the patient and their mental health. Instead, suggest that some of their medications can, but will not always, trigger or exacerbate these side effects and that we will work around the medications to treat their ocular conditions. If this becomes unfeasible, contacting the prescribing physician for any alternative therapies and/or appropriate medication changes should be performed by those skilled in prescribing this class of medications.Corneal superficial punctate keratitis in a young adult taking several antidepressants. Click image to enlarge.Specific ConsiderationsTwo specific populations are warranted more attention:Elderly patients. Older adults are more susceptible to the anticholinergic and mydriatic effects of antidepressants, increasing their risk of acute angle-closure glaucoma and dry eye syndrome.Clinical tip: Regular eye examinations and a lower starting dose of antidepressants can help reduce adverse effects in this population. Elderly patients are at a higher risk of falls, especially if they have comorbid visual conditions and are taking psychotropic medications that worsen their ocular side effects. The American Public Health Association addressed this in their policy statement from 2023 titled, “Falls Prevention in Adults Aged 65 and Over: A Call for Increased Use of an Evidence-Based Falls Prevention Algorithm.”9Pediatric patients. Although less common, pediatric use of antidepressants has been associated with transient visual disturbances and loss of accommodation.Clinical tip: Close monitoring and parent education are essential. Make sure to co-manage these patients with the child’s pediatrician and try to develop a treatment plan with the pediatric team.Interdisciplinary ManagementThe complex interplay between antidepressants and ocular health underscores the importance of interdisciplinary collaboration. Key strategies include:• Baseline assessment. Before initiating a course of antidepressants, a detailed ocular history and examination should be performed, particularly for high-risk patients.• Regular monitoring. Follow-up evaluations should include assessments of visual acuity, IOP and ocular surface health.• Patient education. Patients should be informed about potential ocular side effects and advised to report any new or worsening symptoms promptly.• Collaboration. Psychiatrists, optometrists, ophthalmologists and primary care providers should maintain open communication to optimize patient outcomes.The American Optometric Association has addressed the need for annual in-person dilated eye examinations for patients with these conditions and on these medications. Patient education handouts to that effect are available for free download and reference in the Adult and Pediatric eye examination guidelines located here: .Emerging ResearchAdvancements in pharmacogenomics may help identify individuals at higher risk of ocular side effects from specific antidepressants. Additionally, ongoing research into drug delivery systems, such as targeted formulations that minimize systemic exposure, could reduce adverse effects on the eye.TakeawaysAntidepressants, while invaluable for managing mental health disorders, can have significant ocular implications that warrant careful consideration and possible referral. By understanding the mechanisms of action, potential side effects and management strategies, clinicians can ensure comprehensive care for their patients. Ultimately, a proactive approach involving interdisciplinary collaboration and patient education will enhance both mental and ocular health outcomes.Dr. Morgenstern is a graduate of Nova Southeastern University College of Optometry. He completed his optometric training at the Bascom Palmer Eye Institute. Dr. Morgenstern is a contract optometrist for the United States Defense Health Agency - Vision Center of Excellence researching acute eye injury, blast eye injury and vision dysfunction associated with traumatic brain injury. He is also a volunteer clinician at the Walter Reed National Military Medical Center in Bethesda, MD. Dr. Morgenstern serves as the director of the American Optometric Association Clinical Resources Group, as well as assistant professor in the Department of Surgery at the Department of Defense Uniformed Services University School of Medicine. Dr. Morgenstern is a member of the Board of Trustees at the New England College of Optometry and is president and co-founder of the International Keratoconus Academy of Eye Care Professionals. He has no financial disclosures., Medications like venlafaxine (Effexor XR, Viatris) and duloxetine (Cymbalta) inhibit the reuptake of both serotonin and norepinephrine. These neurotransmitters influence vascular tone, which may have implications for retinal and optic nerve blood flow., In patients who are depressed or anxious, there may be an increased use of smoking, alcohol consumption, and illicit drug taking that may also pose risks for ocular health such as cataract, age-related macular degeneration, and vascular occlusions..
Sometimes a psychotropic medication may have to be changed to help counter the ocular side effects, Dr. Riba said. Alternatively, it may be decided to stop an antidepressant or anti-anxiety agent altogether solely due to ocular side effects and switch to a different medication., Antidepressants are drugs that treat disorders such as depression and anxiety. They may also be prescribed for conditions such as chronic pain or migraine. These drugs can have eye-related side effects such as dry eye, dilated pupils, blur, eye twitching, and, rarely, acute angle-closure glaucoma., Blurry vision is a potential side effect of taking Cymbalta, a medication commonly prescribed for depression and anxiety disorders. While it may not be a common side effect, it is important to be aware of this potential risk when taking the medication., Individuals taking SSRIs have reported a range of vision-related side effects, from transient disturbances to persistent visual changes. These effects stem from serotonin’s widespread presence in ocular tissues and its influence on neural pathways involved in vision., There has also been a significant rise in antidepressant usage by the elderly, which is a population at risk for ocular adverse effects., On various forums, I learned of several users of Cymbalta experiencing vision problems (mostly blurred vision or refraction anomalies). I was diagnosed with Age-Related Macular Degeneration while taking this drug, even though the dr was perplexed that I could have AMD at my age..