Relieving Anxiety May Affect Lens Wearers' Success
BY JULIE A. SCHORNACK, OD, MED, FAAO
In keeping with my theme of mixing contact lens wear with medications that patients use to combat the stress of everyday life, I'll explain how anti-anxiety medications affect lens wear.
The current state of anxiety treatment includes a large variety of drug categories. In addition, physicians may also prescribe anti-anxiety medication for patients who have generalized anxiety disorder (GAD), panic disorder, social anxiety disorder (SAD), post traumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD). Careful investigation into the specific medications your patients use to combat anxiety disorders is important to pinpointing the cause of suspected side effects.
The category of anti-anxiety medication that typically comes to mind is the benzodiazepines, which include lorazepam (Ativan), flurazepam (Dalmane), clolazepam (Klonopin), clorazepate (Valium) and diazepam (Xanax). These drugs work on parts of neurons, resulting in a calming effect. Physicians also prescribe these drugs in higher doses as sleeping aids because of their sedative effect.
Patients taking this class of anti-anxiety medications can experience visual hallucinations, diplopia and blur. Isolated drugs in this category can also result in nystagmus as a side effect. Keep these side effects in mind when your contact lens patients present with related symptoms.
Another major category of medications used to treat anxiety disorders are the selective serotonin reuptake inhibitors (SSRIs), which maintain appropriate levels of serotonin in the brain. Increased levels of serotonin may contribute to anxiety symptoms. SSRIs can also help combat depression when taken at higher doses. Familiar drugs in this category include citalopram (Celexa), fluvoxamine (Luvox), paroxetine (Paxil), fluoxetine (Prozac) and sertraline (Zoloft).
Fewer side effects occur with this category of drugs than with benzodiazepines. General ocular side effects noted with SSRIs include mydriasis, dry eye, blurred vision, decreased accommodation and conjunctivitis. The lower dosing of these drugs for anti-anxiety therapy usually decreases the incidence of these side effects.
Azaspirones behave in a similar fashion to SSRIs by normalizing the levels of serotonin in the brain. Azaspirones, such as buspirone (BuSpar) are not as sedating as the benzodiazepines and they show therapeutic effects sooner than do SSRIs. Some ocular side effects from buspirone use that could alter success in your lens-wearing population include blur, conjunctivitis, conjunctival hyperemia and itching.
Some drug categories that physicians prescribe to treat anxiety disorders are more familiar for treating other maladies. For instance, beta blockers, which commonly treat hypertension, treat anxiety by reducing the body's ability to produce adrenaline. Tricyclic antidepressants also help normalize brain serotonin levels. Physicians have used the anticonvulsant gabapentin (Neurontin) to treat anxiety disorders because it regulates the activity of gamma-amino butyric acid (which regulates neurotransmitters) in the brain.
This brings me to an important point in taking drug histories for lens wearers: You need to find out what they're taking and why they're taking it. Insight into the therapeutic indications may provide information on dosing levels and schedules that may help you determine if ocular side effects are medication-related.
Dr. Schornack is the assistant dean of Clinical Education and serves in the Cornea and Contact Lens Service at the Southern California College of Optometry.