AOA 2023: Treating photophobia

Jacqueline Theis, OD, FAAO, caught up with Optometry Times at the 2023 AOA Optometry's Meeting in Washington, DC, to share key takeaways from her discussion, "Photophobia - When light hurts after brain injury, migraines, and beyond."

Video transcript

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

Hi, my name is Jacqueline Thies, and I'm a practicing optometrist from Richmond, Virginia. I currently work in a multidisciplinary brain injury clinic. So we have brain injury medicine, physiatry, neuro endocrinology, physical therapy and myself that provides eye care —so in optometry.

And this weekend, I gave a lecture on photophobia, and the differential diagnosis of. So one of the things I'm really passionate about in my practice—obviously, being in brain injury, I see a lot of patients with photophobia. But there was a study that came out a few years ago that showed that of patients who get better with photophobia, they were actually less likely to be wearing sunglasses. And over the last few years, I've been deep diving, because that's the standard of care that we do. When someone says they're light sensitive, we just tell them to wear tinted lenses.

And when you actually look at the data, wearing tinted lenses for some populations can actually make their photophobia worse. So what I started deep diving into in my own practice—and then in this lecture—is how can we differentiate what is causing the photophobia, so that we can actually treat it and fix it? And how you can use photophobia, and the symptoms that they have, to be able to figure out where their pain is coming from.
And I think one of the—photophobia is one of those things that everybody has it, you know, and we don't treat it very well, and the problem is, it can be a debilitating condition for people. If people can't tolerate fluorescent lights or electronic devices or sunlight, they literally live in their houses. And I have cases where patients have been in their homes, living in the basement in the dark for years, and the problem is when they do that behavior, it actually makes their light sensitivity worse.

And I think one of the—photophobia is one of those things that everybody has it, you know, and we don't treat it very well, and the problem is, it can be a debilitating condition for people. If people can't tolerate fluorescent lights or electronic devices or sunlight, they literally live in their houses. And I have cases where patients have been in their homes, living in the basement in the dark for years, and the problem is when they do that behavior, it actually makes their light sensitivity worse.
And so how do you treat that patient who is severely photophobic? And then what are the other things that could be causing it? Is it occipital neuralgia? Is it uveitis? Is it, iritis? And so the lecture kind of goes into different ways that photophobia can present and how you can treat it a little bit better.

And so how do you treat that patient who is severely photophobic? And then what are the other things that could be causing it? Is it occipital neuralgia? Is it uveitis? Is it, iritis? And so the lecture kind of goes into different ways that photophobia can present and how you can treat it a little bit better.

I think the big thing is to consistently think that if the patient's coming back with a photophobia complaint, what you're doing is not working; you need to dig a little bit deeper to figure out what's causing it. And that to just recognize that photophobia can be a multidisciplinary problem. So patients can have psychiatric conditions that's causing their photophobia; depression and anxiety can cause light sensitivity, chronic fibromyalgia can cause it, obviously traumatic brain injury. And so sometimes you have to think a little bit outside of your wheelhouse to figure out why the patient's having it. And then when you fix the underlying cause it'll go away, and has nothing to do with the sunglasses that you prescribed.

My key takeaways. Well, I will get on a big soapbox on blue light blockers when I'm in my lecture. And the big thing is that blue light has a purpose, and it comes from the sun. And so because of that, it helps us with our sleep/wake cycles. So when blue light is out, we feel awake, we don't secrete any melatonin; and then when blue light goes away, we start to secrete melatonin and get sleepy. So I'm very cautious with prescribing blue blockers to people to wear all day long, because blue light is supposed to tell us that we're awake and we're alive. And you can actually disrupt circadian rhythms by giving blue blockers to people that don't need it.

So we go into that a little bit in the lecture, about when to use a blue blocker, when not to, how to dose it, and things like that because you can really—light is the main way that we regulate our sleep/wake cycle and you don't want to disrupt circadian rhythms just because you're worried about them using their computer too much.