"Too Conservative" in Medicine

THIS ARTICLE hit the twitterverse today. It's the California Optometric Association's recommendations for dealing with the itchy, watery eyes from seasonal allergic conjunctivitis: "Use “preservative free” lubricating eye drops: while antihistamines can help with typical symptoms like runny noses and sneezing, doctors of optometry warn those medications can make ocular symptoms worse by reducing tear quality and quantity. The COA recommends using “preservative free” eye drops, or if you wear contact lenses, rewetting drops. Apply a cold compress: using a cold compress on the eyes will provide quick, temporary relieve from itching and redness by constricting the blood vessels that are releasing histamine in the eyes. Take contact lenses out each night: removing contact lenses and cleaning them every night can keep them free of pollen. Wear large sunglasses: Protecting your eyes when you are outside can keep pollen from getting into your eyes and irritating them. Wash your face and hair each night: If you wake up each morning with eye allergy symptoms, try washing your hair and face (especially around the eyes) each night to rinse out pollen and allergens. Take fish oil supplements: omega-3 fish oil also has anti-inflammatory properties that can help reduce redness and irritation. Maintain a healthy diet: foods rich in anti-oxidants including, spinach, kale, broccoli carrots and red peppers, help to improve the immune system and combat the symptoms of eye allergies." This stuff drives me insane. So for ocular itching, redness and watering from seasonal allergies, the C.O.A. recommends artifical tears, cold compresses, washing your face, omega-3 fish oils and "big sunglasses". Um, no topical antihistamines? I mean there are some topical antihistamines that have been available over the counter now since like 2007 (ketotifen fumarate, available as the brand names "Alaway", "Zaditor" and others) that absolutely work AWESOME for this. INSTANTLY stops itching and watering and associated redness from airborne allergens...like in less than 30 seconds, with a 12 hour duration of action. No mention of this in the article. I distinctly remember having an argument about this exact scenario with a supervising doc I had at SUNY. We had this lady who was MISERABLE from obvious ocular allergy. I wanted to Rx Patanol (the leading Rx antihistamine at the time). He said "no". He was actually quite appalled that I wanted to "leap" so quickly to a medication when this problem clearly should be treated initially with artificial tears in his opinion. REALLY? Really. He was serious. Well let me tell you: artifical tears don't do SQUAT for ocular allergy. "Palliative" care at best. Come on, man! We know what the problem is! Gosh why are we making this so hard? Just Rx the dang antihistamine. THAT'S WHAT IT'S FOR! It's not like it's dangerous or something! I ended up going behind his back (oops) and giving her samples of it anyway instead of his worthless artifical tear idea (#rebelOD). I feel like a lot of my optometry collegues do whatever they can to be as conservative as possible, and I don't understand why. This problem (seasonal allergic conjunctivitis) has an OVER-THE-COUNTER solution! Why are we messing around with telling them to wash their face and wear big sunglasses? Is this a joke? I mean it's embarassing to the profession. Or at least *I* am embarassed by this article. They came to you with a problem that is (on paper) easy to solve. We know what the problem is and we have a cheap, OTC fix for it. Why avoid topical antihistamines? The article mentions that oral antihistamines can "reduce tear quality". WHO CARES? I mean it sounds to me like they're probably more worried with the itching, watering and redness, no? Fix the problem. Stop beating around the bush. "Maintain a healthy diet", the article says. Um...I'm sorry but that is holistic nonsense. Eating foods "rich in antioxidants" is NOT NOT NOT going to solve your itchy, red, watery eyes. Not in the short term and not in the long term, either. Who comes up with this stuff? This is not (in my opinion) medically sound advice. This also makes it sound like it's somehow the patient's fault that that they are allergic to pollen. If they would have only eaten healthier this wouldn't have happened, right? It's just a lack of kale and broccoli in their diet, right? No. It's allergy. Treat it with antihistamines. I mean how is this not painfully obvious? Well, it is to me. Sorry, C.O.A. (and my supervising SUNY doc circa 1999). To quote Donald Trump: "YOU'RE FIRED!".