How the optometrist’s role in ocular inflammation has evolved

Optometrists play an expanding role in recognizing and managing ocular surface inflammation and infectious keratitis, particularly in complex patients with chronic disease, immunocompromise, or long-term steroid use. In this Q&A, Bita Asghari, OD, FAAO, FSLS, associate director of Clinical Education and PROSE Provider at BostonSight, discusses how advances in diagnostics and targeted therapeutics have shaped the optometrist’s role, the importance of maintaining a high index of suspicion for fungal and Acanthamoeba keratitis, and the contact lens hygiene habits patients most often overlook. Asghari also outlines the clinical red flags warranting prompt referral to a cornea specialist.

Note: transcript edited lightly for clarity and length.

How has the optometrist's role in diagnosing and managing ocular inflammation changed over your career?

Bita Asghari, OD, FAAO, FSLS: Optometrists have become increasingly integral to early recognition and management of ocular surface inflammation. With advancements in appropriate diagnostic tools, we can identify disease states sooner to initiate appropriate treatment accordingly. There are now various in-office treatment options to better target lid diseases and inflammation. Lastly, with more targeted therapeutics for specific sub-types of dry eye and ocular surface disease, we can offer a better tailored treatment plan for our patients.

What should clinicians keep in mind about fungal and Acanthamoeba keratitis, which are often diagnosed late?

Asghari: It is imperative to get a thorough history of potential environmental exposures, as well to identify certain risk factors (ie, chronic steroid use, immunocompromised state, contact lens wear). A key takeaway is to maintain a high index of suspicion, with close monitoring.

What are the most common causes of keratitis you see, and how much of it relates to contact lenses?

Asghari: In clinical practice, we work with contact lenses wearers with chronic ocular surface diseases. Many of our patients are immunocompromised and/or on chronic steroids drops. In such chronic diseases, we prioritize care to prevent infectious keratitis by educating and assuring compliance regarding proper contact lens hygiene. In cases of active infectious keratitis in our unique patient population, herpetic infections are most common. Occasionally, we will encounter fungal infections as well.

Which contact lens hygiene habits do you emphasize most, and which patient misconceptions do you run into?

Asghari: While we stress patients to avoid the use of tap water and avoid swimming while wearing contact lenses, I find that showering while wearing contact lenses is often missed. Also assuring timely replacement of contact lens hygiene products such as cases or solutions once they have been opened.

At what point do you refer to a cornea specialist?

Asghari: In cases of acute infectious keratitis, patients with vision-threatening presentations, underlying corneal thinning, immunocompromised or monocular state, and concern for atypical infection warrant prompt referral to a corneal specialist.