AAOpt 2022: Treating photophobia to empower patients in their everyday life

Jacqueline Theis, OD, FAAO, shares highlights from her discussion titled, "Perioperative management of corneal crosslinking," which she presented during the 2022 American Academy of Optometry meeting held in San Diego.

Editor's note: This transcript has been edited for clarity.

Hi, I'm Jacqueline Thies, and I spoke on, "Photophobia: when light hurts from brain injury, migraine and beyond." This lecture is really near and dear to my heart, because in my practice, I see a lot of patients who have photophobia.

I think we all know when we see these patients, and routinely, all of us treat them the same: we just give them sunglasses. And there have been some recent studies that have come out that have shown that actually, for patients with brain injury, giving them sunglasses can exacerbate their photophobia and make it harder for them to have neural adaptation to get better. So even though the patient feels better in the moment, they're not getting better, which is really important if we want to look at long-term treatment options for patients with photophobia.

Oftentimes, you see these patients—and studies have even shown that patients will come into your office complaining of photophobia. And oftentimes, it doesn't get discussed by the practitioner, nor does it get managed by the practitioner, aside from maybe dry eye treatment, and also sunglasses. And the reason that this is important is because if the patient doesn't have dry eye, or they have a type of light sensitivity that doesn't respond to tinted lenses, you're not really helping the patient at all.

So it's really important that we get a differential diagnosis of what's causing the photophobia, and then make sure that we refer to the practitioner who can maybe diagnose the underlying etiology. So for instance, trigeminal neuralgia, or cervicogenic headache, you can send patients to other physicians, and when they solve the underlying cause, then you end up solving the patient's photophobia.

My lecture goes into a lot about the differential diagnosis and different pathophysiologies that are underlying photophobia, particularly in patients with brain injury, because they can have multiple reasons that they're having light sensitivity. And then I go into what exact treatments you can do for these patients, depending on the pathophysiological pathway.

I also talk a lot about blue blockers. So blue light isn't necessarily evil, it has a role. And if we give people blue blockers all day long, we can sometimes exacerbate cognitive fatigue and inattention. So it's important that we don't just unanimously recommend a tint, and then if we are going to recommend a tint because they really do have trouble with blue light frequencies, that we do one that is actually blocking the tint that is more of a notch filter than necessarily a coating that's only reducing blue light by about 30%. If the patient really has a blue light problem, we need to make sure that we're treating it appropriately. And I think this is important.

I think photophobia is something that if you can't tolerate electronic devices, or fluorescent lights, you really can't function in our society as a whole. You can't go outside, you can't go to restaurants, you can't go to the gym and workout. And then if you think about all of us kind of experienced that lifestyle a little bit when we had the epidemic and COVID, we at least had the benefit of being able to be on our devices and connect with people socially through our devices. But in patients who are truly photophobia to electronic devices and fluorescent lights, not only did they not have a social situation outside of their home, but they also have trouble connecting with people in their home as well unless they live with people because they're socially isolated, not being able to use devices.

And that's really where my passion for these patients come from is that it impacts every single quality of life for them, and if we don't appropriately treat it, a lot of these patients become depressed and anxious and end up getting a whole comorbidity list because we're not treating their appropriate symptoms.