By Rizvan Faruk Batha MPharm, PGDip GPP, IPresc, MRPharmS, Superintendent Pharmacist of Specialist Pharmacy.
Bioidentical Hormone Restoration Therapy (BHRT) is an alternative option to traditional synthetic HRT, using bioidentical hormones to treat hormonal conditions in both men and women. BHRT is compounded medicine and put simply, means that the individualised ingredients are mixed together under the direction of a qualified prescriber’s prescription to meet the tailored needs of a patient.
For women going through menopause, compounding treatments are often prescribed later down the line, when a woman has been unable to settle on the appropriate dose of HRT with a General Practitioner, often experiencing severe side effects from either too much or too little HRT. In short, compounded menopause medication offers another route for those patients where the licensed preparation is not appropriate or hasn’t worked.
Patient-led care plays an important role in compounded menopause medicine because the patient is involved throughout the process; during the consultation with the prescribing practitioner, and with the pharmacist developing the customised dosage.
One of the biggest challenges faced by compounding pharmacies is the drugs being classified as unlicensed. For drugs to be licensed, it involves research and clinical trials to assess the efficacy, quality, and safety of the medicines, and because of this process, more often than not it is the recommended route to prescribe licensed medicines. That being said, prescribing unlicensed compounded menopause medicines may be necessary, especially when it comes to the patient’s specific need and interests and where licensed medicines have been unable to satisfactorily meet the needs of the patient or are unsuitable for them.
Utilising compounded menopause medicine as a method to enhance patient care could be beneficial for the many patients that need specific dosing or formulation requirements, but sadly more often than not we see delays to patient needs and treatment, as the rise of mass manufactured licensed medicines have grown in popularity. Compounding menopause medicine could offer huge potential for many, but prescribing practices have moved towards evidence-based medicines because of the responsibility imposed on prescribers for prescribing compounded therapies. Clinicians need to understand that even licensed products are not safe or effective for all patients particularly if the product is being used in a population that were not part of the original clinical trials for the drug.
It is important to know that compounding pharmacies and pharmacists in the UK are also regulated and licensed by the General Pharmaceutical Council (GPhC). The GPhC set standards for pharmacists and pharmacies to meet to remain on their register with the aim to protect the public and give them assurance that they will receive safe and effective care when using pharmacy services.
So even though compounded medicines are ‘unlicensed’, there is a lot of due diligence exercised by the pharmacists to ensure the products meet the safe and effective care criteria. This is generally demonstrated through the purchase of medical grade active and inactive pharmaceutical ingredients (with certificates of analysis and safety data sheets), trained staff, following and updating SOPs, audits, traceability of ingredients and products during recalls, as well as continuous learning and error reporting being supported in the pharmacy.
Ultimately, how compounded menopause medicine is viewed will depend on the knowledge and experience of the patients and professionals involved. Although the medicine is unlicensed it is important to understand that experienced clinicians and pharmacists involved in the process of making the decisions are regulated, and patients are consistently monitored during their response to the medicine. If compounded menopause medicine was integrated in the healthcare system, it could change and improve the quality of life of many patients suffering with debilitating menopause symptoms, and we hope as a pharmacy that in the future we will see a shift in how compounded medicine is viewed.
School’s (nearly) out and it could wreak havoc on our children’s eyes thanks to digital eye strain
The UK summer holidays are nearly here, leaving more than 9 million kids with nothing to do. Working parents across the country may need to entertain their kids at home, granting them the freedom to indulge in excessive TV watching, playing video games, and spending far more time than necessary on tablets. A lot of entertainment is based on screens nowadays and, with the cost-of-living crisis taking its toll, it is a cheap boredom buster option for many families.
But too much screen time comes with a different price. Excessive screen time could cause children to develop computer vision syndrome, also known as digital eye strain. The symptoms for which include headaches, dry eyes and blurry vision.
Nimmi Mistry, professional services optician at Vision Direct, explains what computer vision syndrome is and provides some tips on how to avoid it.
What is computer vision syndrome (digital eye strain)?
Computer vision syndrome (CVS), also known as digital eye strain or digital visual syndrome (DVS), is a term given to a set of symptoms that can arise from using digital devices for a long time. Looking at a screen that emits intense light while having to focus and defocus at different distances requires an accommodative effort for many hours at a time. This, in addition to glare from screens, can be harmful to kids’ eye health.
Just for adults, spending more than three hours a day looking at a phone, computer or tablet is enough time to negatively impact eye health.
In the UK, a child spends 6.3 hours in front of screens – probably even more during the holidays. Children are particularly susceptible to CVS due to their developing visual systems and often lack awareness about their screen usage habits.
That excessive amount of screen time can result in potentially serious eye health problems.
What are the symptoms of computer vision syndrome?
Eye fatigue: Due to the prolonged accommodative effort demanded of our eyes without sufficient breaks, this can lead to eye fatigue which presents as blurred vision and tired eyes.
Dry eye: Dry eye is one of the most common symptoms of CVS. Recent studies have shown that when we use a screen we tend to blink less, which means your eyes get less lubrication, end up with eye dryness and leave them feeling sore and tired.
Headache: The intense light and the pressure to which our eyes are subjected continuously can cause more headaches which can make focusing or going about daily tasks a little more difficult.
Photophobia: CVS can also be responsible for the development of hypersensitivity to light, both natural and artificial – not something you want as we head into the longer days of summer.
It’s also important to remember that screens emit blue light which interrupts and reduces the production of melatonin, the sleep hormone. Extended screen exposure can therefore cause disruptions to sleeping patterns and quality. Lack of sleep is something that can also negatively impact eye health.
Tips to avoid or treat digital eye strain in children
The summer break is long, we know. And the struggle to pry children away from screens when they spend their time at home seems like a lost battle even before it begins. However, there are small habits you can adopt to minimize the impact on your child’s eyes and prevent digital strain.
1. Appropriate distance from screens: When it comes to eye health ergonomics plays a key role. The screen or monitor should be at least between 50 and 65 cm away from your child. It should also be more or less at eye level to avoid neck problems. The monitor and keyboard should be positioned in a straight line.
2. Screen with good resolution: Watching a screen that has a good resolution and is of good quality is necessary to avoid eye strain. When it comes to the actual display on the monitor, having a high-resolution panel (a minimum of 1080p, if not 4K), along with strong RGB colour accuracy settings, and a non-LED panel is what is recommended as better for your eyes.
3. Follow the 20-20-20 rule: To combat and prevent the symptoms of digital eye strain your child should be reminded to incorporate the 20-20-20 rule into daily routine. This involves looking away from the screen every 20 minutes to look for 20 seconds at a fixed point 20 feet away. This exercise will relieve the stress on your eyes and force the habit of taking screen breaks. Why not make it a game and have funny pictures up on the wall to give them a fixed point to look at.
4. Using eye drops: If your child is already experiencing discomfort in their eyes as a result of digital eye strain, then having artificial tears on hand will allow your child to manage the discomfort of dry eyes. However, be aware that not all children will be accepting of having drops administered. Some safe options for kids‘ eye drops include artificial tears, antihistamines, low-dose atropine drops, and dilating eye drops
5. Conscious blinking: When we are concentrating or staring at screens, we often forget to blink without even realising. Forcing your child to blink is a handy exercise to alleviate dryness and eye strain.
6. Take your child to an ophthalmologist. In more severe cases in which the symptoms persist in a severe and prolonged manner, you should make an appointment with a specialist.
7. Have an eye examination. If your child spends a lot of time in front of screens and you see that they are squinting or rubbing their eyes, it’s vital to have their eyes tested.
8. Screen detox. We know that it is easier to keep your child happy during the summer break by giving them their screen time but keeping them busy in other ways is much more important.
Ensure you break up screen time by encouraging children to engage in other activities such as drawing, building, playing outside and so on.
In this digital world where electronic devices play an important role in our lives, it’s easy to forget to pay attention to the health of our and our kids’ eyes.
Digital detox or limits may come with a bit of protesting, but their eyes will be grateful.
Is your child blinking too much or is it just a habit? Excessive blinking could be a sign of one of these issues, according to an optician.
Blinking is usually a subconscious natural action that hydrates and cleans your eyes by spreading your tears over their outer surface. It also protects your eye by closing it to keep out dust, other irritants, very bright light, and foreign objects. However, there’s such a thing as too much blinking. Excessive blinking could be a symptom of various issues, some of which may require a trip to your GP.
As part of a recent study Vision Direct looked at blinking patterns and has asked Nimmi Mistry, professional services optician at Vision Direct, to share what “normal” looks like when it comes to blinking and what excessive blinking could indicate.
What does normal blinking look like?
As we age our blinking frequency changes. New-born babies only blink about two times per minute, but by the time you’re an adult, this increases to 14 to 17 times per minute and then stays around this number for the rest of your life.
Blinking patterns can change with certain situations, for example it may slow during periods of focus and speed up when you’re in a stressful situation. Excessive blinking is therefore categorised as frequent rapid blinking which may interfere with your daily life, activities, or vision.
Eight possible causes of excessive blinking
The good news is that most of the issues which cause excessive blinking aren’t serious and, in many cases, will either resolve on their own or require minimum treatment. Some, however, can lead to eye health complications if not addressed quickly.
1. Hay fever
Hay fever is an allergic reaction to pollen which is usually at its worst between March and September when the pollen count is at its highest. Typical symptoms include sneezing, a runny nose, or a headache, while the pollen irritating your eyes can cause you to blink more often.
Although there’s no cure for hay fever, there are several treatments which can lessen the impact, including antihistamines, Vaseline under your child’s nostrils to stop pollen getting into the nasal passage and wraparound sunglasses to prevent pollen reaching their eyes.
2. Dry eyes
Dryness can lead to eyes feeling sore, watery, and gritty. Your tear film has three layers: fatty oils, aqueous fluid, and mucus, all of which combine to help keep the surface of your eyes sufficiently lubricated, clear and protected. Problems with any of these layers can cause dry eyes and as a result, increased blinking to soothe these symptoms.
The remedies for dry eye include the use of artificial tears, regular screen breaks, and ensuring your child is getting enough sleep, particularly as we approach the summer holidays. Prolonged dry eye however can also increase your risk of an eye infection due to a reduction in tear production. If your child’s dry eyes are constantly reoccurring, you should arrange to see a health professional to identify and eliminate any underlying causes.
Dry eyes may not sound very serious but if left untreated, severe dry eye may lead to eye inflammation, abrasion of the corneal surface, corneal ulcers and complications with the quality of your child’s vision.
3. Corneal abrasion (or other eye injury)
A corneal abrasion is a small scratch on the cornea. Common causes include a fingernail scraping the eye and getting grit in the eye, particularly if the grit is rubbed in further which is more likely to be a natural response to sore eyes for a child.
This type of injury, although small, can be extremely painful due to the number of nerves that supply the cornea. The pain typically starts to subside as the scratch heals, which can take approximately 24 to 48 hours for mild abrasions. However, if you find the severity of the pain increases, with extreme sensitivity to lights, a decline in vision, or a general worsening of the appearance of your child’s eyes, you should seek immediate medical advice.
Conjunctivitis, also known as pink eye, is an inflammation or infection of the conjunctiva, which is the thin, mucus membrane that covers the white part of the eye and lines the inner surface of the eyelid. It can affect one or both eyes and is a common condition that can occur in people of all ages.
There are several types of conjunctivitis, including:
Viral Conjunctivitis: This is the most common form and is usually caused by a virus, such as a cold, something young children are particularly susceptible to. It’s highly contagious and can spread easily through droplet contact with infected individuals or objects. A viral form of the infection normally causes a watery discharge during the day and crusty eyelids in the morning. There’s no cure and those with this type of conjunctivitis simply need to wait it out, but you can relieve symptoms by cleaning your eyes with cool boiled water and clean cotton pads, use a clean pad for each eye and never double dip in the water.
Bacterial Conjunctivitis: This type of conjunctivitis is caused by bacteria, such as Staphylococcus aureus or Streptococcus pneumoniae. Children are not renowned for being the most hygienic, especially after using the bathroom, making them more at risk of bacterial pink eye. If a bacterium is responsible for the infection, it will normally cause a yellow or green sticky discharge throughout the day. There are antibiotic eye drops which can either be prescribed or bought over the counter which will help clear up the infection, but ensure you consult your GP or pharmacist before using any type of new medication on your child.
Allergic Conjunctivitis: This occurs when the conjunctiva becomes irritated due to an allergic reaction to substances like pollen, dust mites, pet dander, or certain products. It presents in a similar way to viral conjunctivitis but is usually accompanied by nasal congestion and sneezing. It is not contagious but is likely to reoccur in those that suffer with this type.
Blepharitis causes an inflammation of the eyelids that leads to, among other things, intermittent blurring of your vision, redness of parts of the eyelids and itching.
It can be caused by various factors, including bacterial infection, blockage of the Meibomian glands in the eyelids (responsible for producing the oily component of your tears), or skin conditions such as seborrheic dermatitis can increase the risk factor.
Blepharitis and its associated dryness give a foreign body sensation, so your blinking reflex works harder to alleviate this irritation. This can result in increased blinking or even a repetitive blinking pattern.
6. Eye strain
Eyestrain, also known as asthenopia, is a condition characterised by discomfort or fatigue in the eyes. It typically occurs after prolonged periods of visual activities that require intense concentration, such as using a computer or tablet.
Eyestrain can manifest as a variety of symptoms, including eye fatigue, dryness, blurred vision, headaches, and, of course, excessive blinking.
To help alleviate these symptoms it’s important to encourage your child to take regular screen breaks, the 20-20-20 rule can be good for this. Challenge them to stare
7. Vision problems
Undiagnosed visual problems can also cause a child to excessively blink as the eyes try to focus and become strained as a result. If your child is finding it more difficult to see long distance or read up close, then it’s recommended that they see an optician for an eye test.
It’s important to have an eye test every two years, but, if your child has been experiencing any of the symptoms above for a prolonged period, it’s essential to see an eye care professional as soon as you can to eliminate any visual complications.
When we are tired, the muscles responsible for controlling eye movement and maintaining focus may become fatigued. Blinking can help momentarily relieve any discomfort, which is partially why blinking increases when we’re tired.
Fatigued eyes usually caused by excessive screen time and lack of sleep which can aggravate dry eyes. Blinking helps spread tears across the surface of the eye, providing moisture and alleviating symptoms of dryness.
Metal is the ideal packaging for vitamins
Carlo Rodrigo Borges, Business Development Manager, Trivium Packaging
The vitamins and supplements market is booming. A 2022 European survey by Ipsos found that in 14 EU member states almost 9 in 10 European consumers had taken food supplements in their lives and 93% had done so in the last 12 months. As a result, the Europe nutrition and supplements market size was valued at USD 61.8 billion in 2021 and is expected to expand at a compound annual growth rate (CAGR) of 5.8% from 2022 to 2030.
As Europe’s population has become more aware of health and fitness, consumers have been increasingly adopting nutritional supplementation to achieve their dietary and wellness goals. The demand for natural and organic products has grown, alongside the demand for plant-based products and functional foods, owing to the rapidly ageing population.
The push to go green
As a growing sector, there is potential for vitamins and supplements to contribute to consumers’ and brands’ increasing focus on sustainability.
The drive to eliminate wasteful packaging, especially single-use plastic, is well documented.
Brands are under pressure to amplify and fulfil their ESG credentials. In addition to a brand’s own sustainability goals and initiatives, legislation is forcing a shift with a host of sustainability-focused legislation throughout Europe already and likely more to come.
Consumers are also driving pressure on brands to offer more sustainable packaging as they increasingly turn away from single-use plastics and look for more sustainable options. The 2023 Buying Green Report shows that 71% of consumers have chosen a product in the last six months based on its sustainability and credentials and 63% of consumers are “less likely” to buy products in harmful packaging. In addition, 90% of consumers among younger generations (18-24 years old) showed a willingness to pay more for products in sustainable packaging. In
Europe, 60% of respondents considered plastic to be harmful and related plastic to ocean pollution. With 51% of consumers in this region saying they won’t buy products in packaging harmful to the environment, there is a significant opportunity for brands to tap into a wave of consciousness around sustainability.
Metal: a sustainable solution
If you look at vitamins and supplements on shelves in stores today – you’ll see a plethora of plastic containers, and it can be hard to differentiate one brand from the next. Even those containers that are recyclable may not be recycled. Currently, in Europe, only 14% of plastic is recycled. Recyclability depends on multiple considerations including the make-up of the material, whether it has a label, the availability and capabilities of local recycling facilities and, of course, consumer behaviour. The use of metal in packaging minimizes these variables – metal makes it easy to recycle without limits allowing recycling facilities to process it without difficulty. The only variable left is consumer behaviour.
Metal can be easily recycled over and over without degradation. As such, metal is infinitely recyclable, and its true circularity gives it a unique role in helping to protect the planet for generations to come. In fact, 75% of aluminium that’s ever been produced is still in use today. While companies may opt to use glass, the only other infinitely recyclable material, metal has some advantages over glass as it is lighter to transport and more durable for both transit and consumer use. Metal also requires less energy than glass to recycle. In addition, metal packaging allows printing directly onto the bottle, while glass and plastic need adhesive labels which often cannot be recycled by local councils.
As the Protect, Promote, Preserve report explains, choosing the right packaging for a brand’s products is a decision that brands will often dedicate considerable time. Optimal packaging, in terms of format, size, and material can help maintain product integrity and enhance the customer experience. Selecting the right type of packaging is particularly important for products being consumed, which require exceptional protection to reduce the risk of damage and food waste during storage, handling, and consumption. This is why many brands are turning to metal which offers superior levels of robustness and durability relative to alternatives on the market. Metal ensures that oxygen, damaging UV light, and moisture cannot permeate its contents – an important consideration to keep products safe for consumption.
Alongside protecting and preserving their products, metal packaging can be an extremely effective brand tool. Metal packaging provides greater and more sustainable opportunities for brands looking to differentiate their product offerings. By printing directly onto the packaging, brands can use the entire surface area and make use of advanced graphics and prominent colours on their cans and bottles without sacrificing packaging functionality and/or recyclability all without the inclusion of unrecyclable labels. Research suggests that one-third of consumer purchasing choices are based on packaging alone, so the opportunities for brand creativity can be a game-changer for brand growth. Metal printing also does not compromise product safety because of the impermeability of metal, and because the inks used are fully compliant with strict food safety regulations. The metal container itself can also be adapted for numerous different shapes and sizes of containers offering huge versatility. With so many choices, packaging producers can collaborate with their customers and help guide them to the right solution which can be tailored to their audience and brand image.
The vitamins and supplements sector continues to grow, and as the sector grows so does its impact on the environment. Improving sustainability is not just about checking boxes but also about attracting customers and improving the bottom line in an increasingly competitive marketplace. Consumers are taking note of the sustainability of metal packaging and making purchasing decisions based on sustainability, however, consumers continue to remain drawn in by packaging’s presentations and aesthetics. Metal offers a sustainable solution that meets consumers’ needs with a premium look and feel while providing the vital protection needed for the contents inside. Brands that invest – time and money – in the switch to metal packaging now are set up to benefit in the long term.