By
- Dr. Keith Roach
ANSWER: Lyme disease is caused by a bacteria called Borrelia burgdorferi, which is spread mostly by deer ticks in the United States. The only Lyme disease vaccine (Lymerix) was voluntarily removed from the market by the manufacturer because of poor sales and concerns about the vaccine causing arthritis, although studies found that this was unlikely
There was a theoretical risk that a portion of the protein that was used could cause the body to attack its own cells in and around the joints. A new vaccine (VLA15) is in the final stages of development and could be released as soon as late 2026. The development of this vaccine included a change to the antigen that was used to try to ensure that there wouldn’t be a risk of arthritis caused by the vaccine
Unfortunately, the Food and Drug Administration has made changes to their approval processes for vaccines, which threatens the ability to get timely new and improved vaccines. So, I cannot state with any confidence when the vaccine will be made commercially available. I live in an area of high Lyme disease prevalence, and I volunteered as (but was not chosen to be) a subject for the vaccine trial. I’d personally very much like to see the vaccine made available
Vaccination alone won’t guarantee protection from Lyme disease, but in addition to appropriate clothing and insect repellant, it can reduce the risk of Lyme disease, which can have serious complications
DEAR DR. ROACH: I recently read in your column that using Flonase can cause cataracts. I think it’d be of service to your readers to also mention that Flonase, or any steroid, can cause an increase in eye pressure, especially for those with glaucoma. I learned this the hard way, and I don’t think that it’s common knowledge
In my case, I regularly used Flonase for about a year, and during this time, my eye pressure steadily increased, even though I was using eye drops for glaucoma. When I finally asked my ophthalmologist about Flonase, he told me to stop taking it, which I did. I still had to have eye surgery (a trabeculectomy), but since quitting Flonase, my eye pressure has been stable. I still use eye drops. This may be worth a warning to your readers. — J.N
ANSWER: Fluticasone (Flonase) is a commonly used over-the-counter nasal steroid for allergic rhinitis and other nasal conditions. It’s generally safe. In one study of over 2,000 subjects, there were zero cases of glaucoma in the nasal steroid group or the placebo group at 12 months
However, what you said is accurate; it can slightly increase intraocular pressure in people with glaucoma (and those who are at risk for glaucoma due to elevated intraocular pressure). Most studies find that they increase the eye pressure by about 1 mmHg, which is of questionable clinical significance. A response like yours is unusual with intranasal steroids
Many of my medical students (and even some medical residents) are still under the impression that glaucoma and increased eye pressure are the same thing. Glaucoma is a disease of the optic nerve, and a common risk factor for it is high eye pressure. However, people can get glaucoma with normal pressure
Not everyone with high eye pressure gets glaucoma, although we usually treat high eye pressure to reduce the risk of developing glaucoma. About 30% of people with high eye pressure will develop glaucoma after 20 years, but this risk can be higher with very high eye pressures
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions toToYourGoodHealth@med.cornell.eduor send mail to 628 Virginia Dr., Orlando, FL 32803
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