Hawaii doctor takes volcano in stride

Watching and waiting, Hawaiians have held their collective breath for three weeks as Kilauea's massive volcanic eruption stifles daily routines on the Big Island.

From phreatic eruptions to ballistic blocks; fissures and vents; lava flow, ashfall, "vog" and "laze"-each day hurls a geological dictionary of terms that many mainland Americans are only just learning, but Hawaiians have been living since the May 3 eruption. Sure, volcanism is par for the course in Hawaii, but not normally of this magnitude and certainly not in a manner that affects this many, including local doctors of optometry.

Less than 20 miles from the largest active lava flow near Pāhoa, Cedric Mitsui, O.D., Hawaii Optometric Association past president, practices in his downtown Hilo office. But he wouldn't call it business as usual. Although Dr. Mitsui's practice is well away from Kilauea, anything happening on a 4,000-square-mile island is virtually "nearby;" and for many of his patients, it's next door.

"The lava has impacted numerous families south of our office," Dr. Mitsui wrote on Sunday. "We can only hope that they are not affected."

Burning on the ground, in the air

Early on, emergency officials evacuated thousands from at-risk communities in the Big Island's easternmost Puna district, where numerous fissures spewed lava and destroyed dozens of homes and buildings. Days later, Kilauea blew its top in an explosion that hurtled two-foot wide "ballistic blocks" hundreds of yards and prompted an ashfall advisory from a volcanic cloud stretching upward of 30,000 feet skyward; another explosion Tuesday ejected ash 9,000 feet into the air.

Accompanying these periodic eruptions are noxious fumes: sulfur dioxide, mixed with volcanic ash in a combination known as "vog" (volcanic smog) that exacerbates respiratory conditions and irritates everything it touches, including the eyes. Now, where lava meets the sea, there's a new threat—laze (lava haze). Seaside, superheated saltwater releases plumes of hydrochloric acid and particulate matter containing volcanic glass, deadly to those immediately nearby.

All the while, it's the bright-orange, molten rock that's emblematic of the eruption; however, airborne hazards are of immediate concern to Hawaii's Civil Defense Authority. Currently, officials warn of strong trade winds shifting to blow plumes across the island-and its inhabitants-rather than harmlessly seaward. Although respirators are a common sight, and authorities distributed particulate masks, the devices won't filter hydrochloric acid or sulfur dioxide.

Medical centers are seeing the fallout of vog-related symptoms, many cases being respiratory or dry eye complaints. For his part, Dr. Mitsui has noticed the uptick.

"We have had more medical office visits due to the ash and vog," Dr. Mitsui notes. "We've been recommending that contact lens patients, for instance, don't wear contact lenses that are bothering them."

That education and public awareness component is an opportunity for Dr. Mitsui to help his community. He's using the practice website, for instance, to disseminate information that can help residents keep their eyes healthy amid the disaster. Elsewhere, VSP in conjunction with the American Red Cross, has implemented a voucher program to help residents without vision insurance who have subsequently lost their eyewear due to the volcano, Dr. Mitsui says. He's eager to do his part, too.

"We're going to do what we can to help all our patients get through this difficult time," he says.

Clearing the air

When it comes to air quality, Kilauea's noxious smoke clouds mirror similar conditions found during wildfire season in the Pacific northwest. Tad Buckingham, O.D., assistant professor and attending physician at Pacific University College of Optometry and a captain with Forest Grove Fire & Rescue in Oregon, points out that swirling wind patterns associated with wildfires often inundate communities in thick smoke for prolonged periods of time. This can exacerbate ocular discomfort in patients who may otherwise have been borderline with ocular surface issues in the first place.

"We've definitely seen an uptick in red-eye patients,' Dr. Buckingham told AOA during an historic wildfire outbreak in September 2017. "A lot of people are living with a little palliative care, and the same thing with contact lens patients-they're just getting by. But when you have something like this, as the smoke levels go up, it pushes them over the edge."

In that setting, Dr. Buckingham shares four recommendations to help patients clear up their red, irritated and smoky eyes.

1. Remove patients from the environment. If possible, limit outdoor exposure where smoke and particulate matter are rampant and can affect the ocular surface. Patients downwind from billowing smoke should remain indoors (if safe to do so) and make sure car/home air conditioners are set to recirculate so outside air isn't drawn inside.
2. Suggest simple, palliative care options. Similar to ocular allergies, there are easy, self-help therapy options that patients can administer to provide acute relief. Educate patients about what is happening on the ocular surface, then suggest therapies, such as nightly ointments, daily artificial tears or a cold compress.
3. More aggressive options may be necessary. If patients are on that line of ocular surface disease, then it may be appropriate to step up treatment to includes NSAIDs or steroids. Follow this up with education about how to keep patients from regressing.
4. Emphasize good hygiene. Smoke and particulate matter trapped beneath a contact lens may cause discomfort or even inflammation, making it important to educate patients about proper contact lens hygiene. Stress the necessity of adhering to a lens replacement and cleaning schedule, washing and drying hands before handling lenses, and never rinsing lenses in water.

Know a doctor of optometry affected by the volcano? Optometry's Fund for Disaster Relief, managed by Optometry Cares^®—The AOA Foundation can help when it's time to rebuild.

Read more about the impact of Optometry's Fund for Disaster Relief following a particularly disastrous 2017 hurricane season.