 Okay, everyone we're gonna get started. So I'm Tara Han and I'm the PGY1 on ophthalmology this four months and our first speaker is Tyler Anderson coming from Virginia Commonwealth and he is presenting implications of popular eye remedies Good morning So this morning, I'm gonna talk about As it says popular eye remedies. I'm gonna focus mostly on over-the-counter products This is I'm pulling this from some research I published this summer Obviously our time is short. So we won't go in too much detail, but I feel like understanding what types of products are for sale And especially advertised heavily to our patients will help us because we're inevitably gonna get questions that over-the-counter I am I care market was almost a billion dollars last year and that number doesn't include home remedies herbal remedies homeopathic remedies The advertising is relentless people our patients see commercials and billboards and things like that and inevitably we're gonna get questions I Feel like a useful way to to understand In context what's for sale today is to kind of learn a little bit about where we've come from and where things were a hundred years ago This is a newspaper advertisement for a very popular product from about 1916 and at least 1922 called Bon Apto and This advertisement was It found in periodicals around the country very popular at the time and they they promised some pretty miraculous results for their Little eye water is guaranteed to strengthen eyesight 50% in one week's time in many instances Many who once wore glasses say they have thrown them away and there's also some dire warnings about those who don't take care of their eyes And the implication is that this product can help prevent those horrible outcomes So either things have changed in the advertising realm or we've forgotten some of the miracle ingredients that they used to use because Obviously, we don't make promises like this anymore This is a list of Popular products of about a hundred years ago. I got this list by using the Library of Congress newspaper periodical archives they digitized thousands of newspapers and These products were for sale in at least multiple states for multiple years The database ended in 1922. So some of these may have been for sale for a longer time, but these products were The table might be a little hard to read, but they contain some very interesting ingredients There's another pair of advertisements at the bottom again promising relief from virtually any eye complaint You can imagine Levoptic over here on the right was very proud of their eye wash thing that was included I highlighted some of the interesting ingredients here At least three of the popular products contained mercury Couldn't find any recent clinical trials on applying mercury to the eyeball, but It's generally considered a dangerous compound even as a skin ointment based on research done in the early 1900s Morphine was popular quinine was actually directly poured onto the eyeball in Christos There's a lot of plant products and those these plant products actually many of them continue to be popular today Although some of these are have since been discovered to be somewhat toxic one of them is an insecticide now Zinc products were also popular. This is a picture of a Papyrus prescription from the first century AD and it included Calamine is one of the core ingredients of an eye care product and Calamine is a zinc oxide compound that Has been popular for hundreds of years and many of these products contain zinc. I didn't highlight them here Boric acid also popular and we'll talk about that in a minute There's been some changes over the last hundred years Obviously in 1912 an amendment began the crackdown on some of these false therapeutic claims Although enforcement wasn't very strong until the thalidomide tragedy in the 1960s. That's when things really changed and Now today advertisements are generally milder They don't promise the to be able to throw your glasses away in a week and this is the type of things that our patients see often and The the general nature of the advertisements Lends itself to questions that we might receive This is these are just pictures of some of the products that I identified that are popular today. I Looked at the four biggest retail pharmacies, which is Walgreens CVS Rite Aid and Walmart and identified products that are for sale in all four of those and I threw out contact lens cleaning solutions and also There's many of these products have multiple formulations like red eye or nighttime And I this is a table of basically those that are just the core basic formulation of each of these brands and Many of the ingredients and I'll actually just highlight some of the things from this table here on this page The many of the modern products today still contain boric acid as a matter of fact the majority contain boric acid which is I'll talk about in a moment many of them contain preservatives and although many of us recommend preservative free products The majority of the the core basic formulations today can still contain these preservatives either benzochonium Chloride or some newer preservatives Chlorobutanol is also in the older one They're salt solutions and then again I mentioned the different formulations and these are the things that patients might ask us about the red eye formulations with alpha blocking Compounds it's really formulations with antihistamines nighttime formulations are doing like creams or appointments There's several that have their advanced or ultra or something like that. It's the higher concentration of active ingredient Cooling formulations have camphor and menthol and then preservative free formulations, which I think are important to talk about preservatives obviously are used to inhibit microbial contamination They've been used for a really long time It unfortunately many of them Damage the barrier just the barrier function of the corneal epithelium especially when applied in high concentrations many times a day and For that reason many caregivers recommend preservative free formulations. These are some less known button Becoming popular preservatives like purite and there's not very much data on these, but it appears that they also do cause some cytotoxicity to the corneum So preservative free products virtually all contain boric acid which actually serves as a preservative in that it inhibits Microbial contamination and is a buffering agent boric acid is something that was popular 100 years ago. It's still popular today. It's mined in Nevada and Or at least the borax and sodium borate is mined in the Nevada and the California deserts and Both sodium borate and borax or and boric acid have been found to still cause some corneal epithelial damage Even at the concentrations found in iCard products But it's it's generally less than other preservatives I Wish I had time to learn more about and talk more about popular home and herbal remedies. It's a really interesting Topic and there's plenty of interesting cures out there that are popular The research is pretty scant on most of these but these are some of the more common things that are recommended on popular websites Various honey solutions where you dilute honey and either drink it or pour it on your eye Some people recommend breast milk for conductivitis and other applications Obviously warm compresses might be less controversial in some uses, but other people recommend them for things that normally we wouldn't Cold compresses just applying potato slices to the eye and then these are a pair of herbs that were popular a hundred years ago and many of those products also popular for hundreds of years before then and continue to be popular as herbal remedies today and the research on those is again pretty scant or conflicting Homeopathy also something I wouldn't pretend to know a ton about and the research is Again scant and conflicting the the principle behind homeopathic cures is treatment with similars Basically a super low concentration of something that causes the same symptoms that you're trying to treat and there's many many different compounds recommended for virtually every eye complaint I could think of Interestingly similesan, which is a homeopathic product is for sale in virtually all pharmacies today And it contains some very interesting Product compounds at at extraordinarily low concentration. So it has Belladonna, which is the toxin from deadly nightshade at an extremely low concentration, this is the Toxin that atropine is derived from and it also similesan contains mercury They they don't really define what mercury subliminate mercurious subliminus means, but the concentration is very low Presumably much lower than the mercury that was in the products a hundred years ago I Really enjoyed learning about some of these things and there's a there's a lot more to learn about I'd like to thank Dr. Leffler at VCU and also my friend Jared Donaldson. They helped me edit this and get it published Does anyone have any questions? Thank you