Ocular allergies more than a nuisance—an opportunity

Often negatively affecting quality of life, ocular allergies are never "just allergies" in a patient's eyes, meriting consideration for customized treatment plans instead of one-size-fits-all, over-the-counter (OTC) relief.

Ocular allergies, or allergic conjunctivitis (AC), is one of the most common ocular surface diseases in primary eye care with upward of 40% of Americans affected. Seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC) alone make up 95% of all AC in the U.S. Yet AC is often underdiagnosed, undertreated and underappreciated largely due to its relatively benign nature.While AC is an intermittent, often non-sight-threatening complaint, it's far from trivial. In fact, 69% of AC sufferers in one European study reported significantly reduced quality of life, work productivity and increased utilization of health care services, irrespective of the nasal symptoms associated with allergic rhinitis or hay fever.

"We have a tendency to say, 'oh, it's just allergies,' but to patients, ocular allergies aren't just a nuisance, they're a big deal," says Eric Schmidt, O.D., of Wilmington, North Carolina.

"To me, allergy patients are a lot like dry eye patients; they should be considered for chronic therapy. And maybe we should be seeing these patients before symptoms appear to get them on proper therapy," Dr. Schmidt adds.

Although traditionally associated with the preponderance of seasonal allergic rhinitis cases, ocular allergies, Dr. Schmidt argues, should be viewed chronically; i.e., identifying allergies and their comorbidities, determining the patient's allergic triggers, settling upon a finely tuned therapy that goes beyond OTC drops and adhering to a continuum of care that ensures the patient's relief throughout.

Dr. Schmidt stresses that ocular allergy care has evolved over the past 20 years with treatments more specific to patients' needs, be they steroids or antihistamines in place of a simple wetting drop. Even more, 17 states now permit in-office allergy testing and sublingual therapies to better help patients

"We need to be sure we're not just picking the same eye drop we used 20 years ago," Dr. Schmidt says. "Treatments are so much more sophisticated now, and our ability to figure out the proper treatment is so much better with allergy testing—all that should enhance our ability to trust and design therapy."

Optometry already does a lot to help ocular allergy sufferers, but there's an opportunity to do even more. While allergists consider the respiratory ramifications, doctors of optometry can comanage patients for their ocular allergies, bolstering their overall care and quality of life.

"There's more that we can bring to the table because we understand the eyes so much better, and we should be taking the time to educate and discuss these different eye therapies," Dr. Schmidt says.

Who's got it worse? Top 10 allergen capitals

Spring's been in full bloom for weeks, if not months, in most of the United States, so where might doctors notice the largest uptick in ocular allergies? Below are the top 10 most challenging places to live with spring allergies in 2018, as compiled by the Asthma and Allergy Foundation of America.

1. McAllen, Texas
2. Louisville, Kentucky
3. Jackson, Mississippi
4. Memphis, Tennessee
5. San Antonio, Texas
6. Providence, Rhode Island
7. Dayton, Ohio
8. Syracuse, New York
9. Oklahoma City, Oklahoma
10. Knoxville, Tennessee

Looking for more clinical advice on allergies? Consider these four suggestions for helping patients manage their allergies.