Bill Harvey: Icicles within my brain
Author: Bill Harvey
When I was asked recently whether I might be interested in an article looking at pharmacovigilance in optometric practice, I confess my first thought was to head to Google. ‘Pharmacovigilance is the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other medicine/vaccine-related problem.’
Most of us are aware of the common adverse responses to drugs; those well profiled, not requiring yellow card scheme reporting and lacking the black triangle symbol in their BNF online listing. Last month, I came across a patient showing early posterior subcapsular cataract. On questioning, it was confirmed that some months previously they had been in intensive care with Covid-19 and had been treated with high doses of dexamethasone.
More recently, I saw a 22-year-old man whose ocular surface looked more like mine (not good) and who had started suffering significant dry eye symptoms. As these were new to him, I tried to see if they might be associated with any changes in his life, activities or health. The only possible trigger I could ascertain was a prescription for beta-blockers to be taken for panic attacks. Whether it might be the drug or the newly increased sympathetic nervous activity was impossible to confirm, but the action of the drug could not be ruled out.
An excellent new paper in The Ocular Surface journal has analysed statistical significance of the links between major drug treatments and dry eye and confirms the associations already cited (such as with beta-blockers) as well as highlighting new associations, such as with proton pump inhibitors (over the counter medicines commonly used for heartburn).1
With the increasing onus on primary care, we all need to be better aware of the impact of drugs prescribed for systemic conditions. Look out for a CET feature on pharmacovigilance by the Aston’s Dr Doina Gherghel next month.