We need to share knowledge across specialties.

Two articles in this issue underscore the critical point I chose, serendipitously, to discuss this month: do not practice in the isolation of your specialty. You ultimately could, by omission or commission, harm your patients.

On page 52, a medical student and her instructor write about the potential ocular side effects of topiramate (Topamax, Janssen), specifically secondary angle closure glaucoma. Then they discuss the work they did to tell those specialists who prescribe this anti-seizure medication, neurologists and psychiatrists, about those side effects.

On page 16, an article cites data that link depression and the newly visually impaired. The researchers, from Wills Eye, urge their peers to connect with mental health-care professionals in their geographic locale who might want to serve as referrals. When patients are depressed, they don’t take their medications, regardless of the condition.

ISLANDS ARE FOR VACATION

Some dermatology drugs, like antimalarials, can cause vision issues, including permanent vision impairment. The glucocorticoids? Glaucoma with irreversible optic nerve damage and cataracts. More drug classes are out there.¹

The list of those that can cause ocular side effects, like topiramate, is very extensive, and include antidepressants, H1 and H2 receptor blockers, anticoagulants and steroids.²

Some chemotherapy medications have ocular side effects like tearing. The list of medications — remember the antibiotics — that can affect vision is two miles long.

Did I know the specific ocular side effects of these medications without consulting Epocrates? Some, but a few no, and I have been practicing for many years. What I do know is that I cannot keep up with everything new in every specialty; it’s impossible to do. It is a challenge to stay abreast of what is going on in general ophthalmology, including my own specialty within ophthalmology. I read about my interests, dry eye and refractive cataract surgery. Therefore, communication across specialties to better highlight ocular side effects of systemic medications is vital.

SENDING OUT AN SOS

When a particular problem is more than a challenge, I also consult a colleague, maybe two. If the patient’s situation still does not improve, I think outside my own specialty: neuro-ophthalmology, neurology. I ask a patient with dry eye, for example, whose various test scores haven’t budged despite treatment, about dry mouth; if a woman, dry vagina. If the answers come back yes, I refer to a rheumatologist.

This cross-pollination shortens the time of diagnosis, narrows the treatment protocol. For the general ophthalmologist especially, cross-pollination with other specialties, like rheumatology, neurology, psychiatry and oncology, is very important. They might shed light on a situation that is confusing.

The question is: how do we accomplish interspecialty communication? No one wants another meeting. Digital bulletin? New website? I invite readers to e-mail me suggestions for this intercommunication between specialties from the ophthalmic point of view. OM

REFERENCES

1. Turno-Krcicka A, Grzybowski A, Misiuk-Hojło M, et al. Ocular changes induced by drugs commonly used in dermatology. Clin Dermatol. 2016;34:129-137.
2. Badhu BP, Bhattarai B, Sangraula HP. Drug-induced ocular hypertension and angle-closure glaucoma. Asia Pac J Ophthalmol (Phila). 2013;2:173-176.

Cynthia Matossian MD, FACS is the founder of Matossian Eye Associates.Her e-mail is cmatossian@matossianeye.com