Hold your breath, I am about to show my age—not that my follicle sparse dome is not enough of an indicator. In 1994 while I was doing my residency at a secondary ophthalmic surgery center, I worked in a surgical center.
This center was on the cutting edge of all refractive and cataract surgical procedures, either from a clinical trial avenue or as the first to implement. Being that the clinic was in Arizona, a likely office location was in the Sun City area.
There was an established ophthalmologist with a large following in the Sun City locale. This MD would actually fly in one week a month from Chicago to continue his practice in Arizona.
Although my interactions with him were limited, I recall one conversation that has resonated in my clinical acumen.
He boldly expressed, through a mouth full of sugar cookie and coffee, “What is with you and your optometry colleagues being so afraid to use steroids?”
Boom. Life changer.
As this was 25 years ago, the notion of using steroids was considered high-risk and taboo—a sacrament unless an OD absolutely knew there was inflammation.
Rule out everything first, start an antibiotic, take a blood test, count backwards from 1,000, and then ask: Should I really?
Moreover, this was prior to any real advancements (in the U.S.) in the corneal refractive surgery area.
The steroid of choice back then was prednisolone acetate (Pred Forte, Allergan), a suspension medication that has since proven too effective for mild inflammatory reactions. Thus, the idea of using a steroid “more often” was an uncommon occurrence and not viewed as anything more than reckless.
However, the steroid landscape has changed in the last two and a half decades. This has also meant that ODs’ ability and opportunity to use these modern pharmacological drugs has changed as well.
ODs can look no further than how inflammation has been a disruptive force in the most commonly chronic malady that plagues patients: dry eye.