EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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22 EW NEWS & OPINION February 2013 Dousing continued from page 21 insurance coverage, according to Dr. Mamalis. ���The nice thing is that there are a lot of NSAIDs available now [that patients] can take either once or twice a day���they don���t have to take them four times a day,��� he said. ���They���re very well tolerated and have very good efficaciousness, but a lot of times patients��� insurance plans do not cover these so we���re left with a generic NSAID such as ketorolac.��� The problem he finds with many generics is with patient tolerance. ���I think that the formulation of some of the generic drops in terms of the other constituents that they put in, aside from the active medication, make it so that patients have more post-operative irritation from the drops,��� Dr. Mamalis said. ���With the generic I found that the patients tend to have more irritation on the surface of the eye, they have more dry eye symptoms, and they have more punctate keratopathy.��� Dr. Yoo agreed. She doesn���t generally use generic NSAIDs. ���The active drug may be similar, however, the formulation can make a difference for the patient in terms of being able to tolerate it,��� she said. ���They have the side effect of burning on installation. That being said, I do use generics in patients who have difficulty affording the (brand name) medication.��� Dr. Donnenfeld worries that the generic medications don���t have the same efficacy. ���My concern is that in many cases there are so many different generic manufacturers now for NSAIDs in particular that you don���t have control over the quality of the formulation that the patient is receiving,��� he said. ���Ten years ago there was a rash of corneal melts associated with the generic NSAIDs, and that was a very bitter reminder to me of the potential problems with using generic medications.��� These days, while he hasn���t seen any melts as of yet, he has found that superficial punctate keratopathy associated with generic nonsteroidals has been on the rise. ���That does worry me, so I always give patients a premium steroid and nonsteroidal, but give them the option that if they want to have a generic, they can have a generic.��� One thing that Dr. Yoo views as missing from the armamentarium is an intracameral nonsteroidal medication. She pointed out that a depot of intracameral steroid inside the eye can result in elevated IOP. ���It would be nice to have an intravitreal nonsteroidal available to use,��� Dr. Yoo said. Meanwhile, Dr. Davis would like to one day see a pellet of long-acting combination steroid and anti-inflammatory medication, as well as possibly antibiotics so that patients no longer have to take drops long term. This may boost patient compliance. ���Some of these are older patients,��� Dr. Davis said. It���s difficult for some to get drops in and remembering to do so can be an issue. ���The more simplified that we can make it, the more compliant patients will become and the more effective our treatments will be,��� she said. Overall, Dr. Donnenfeld points to a change in mindset on anti-inflammatory medications. He cited a study he took part in published in the October 2008 issue of the American Journal of Ophthalmology that showed that patients who had even mild macular thickening suffered a loss of contrast sensitivity, three times higher than the control groups. The view now is that once a patient has macular edema, the retina is never the same. ���Today I���m looking to eliminate inflammation and never to allow it to occur, where in the past I responded and I treated inflammation,��� Dr. Donnenfeld said. ���That change in mindset has resulted in a great improvement in patient satisfaction and visual outcomes.��� EW Editors��� note: Dr. Davis has financial interests with Bausch + Lomb. Dr. Donnenfeld has financial interests with Allergan, Alcon, and Bausch + Lomb. Drs. Mamalis and Yoo have no financial interests related to this article. Contact information Davis: 952-885-2467, eadavis@mneye.com Donnenfeld: 516-446-3525, ericdonnenfeld@gmail.com Mamalis: 801-581-6586, nick.mamalis@hsc.utah.edu Yoo: 305-326-6322, syoo@med.miami.edu ASCRS member taking the lead A SCRS member David Goldman, M.D., has been chosen to represent ASCRS in the American Academy of Ophthalmology���s 2013 Leadership Development Program. Each year, 20 participants are selected from a large group of nominees from across the United States. This year���s class also included one international candidate from Vietnam. Along with his classmates, Dr. Goldman will take part in an interactive session in San Francisco; attend the Academy���s mid-year forum in Washington, D.C. in April, where he will visit with senators and representatives to discuss medical issues; hear from U.S. Congressional officials and key health staff about building effective relationships and best lobbying practices; and attend the Academy���s annual meeting in New Orleans. EW Contact information Sebrell: csebrell@ascrs.org by Cindy Sebrell ASCRS���ASOA Director of Public Affairs The following nominees were selected to the Academy���s 2013 Leadership Development Program: American Osteopathic College of Ophthalmology Sirtaz S. Sibia, D.O. Mississippi Academy of Eye Physicians and Surgeons Michael J. Borne, M.D. American Society of Cataract & Refractive Surgery David A. Goldman, M.D. Missouri Society of Eye Physicians and Surgeons P. Kumar Rao, M.D. American Uveitis Society Nisha Acharya, M.D. Montana Academy of Ophthalmology Wesley H. Adams, M.D. Asia-Paci���c Academy of Ophthalmology/ Vietnam Ophthalmology Society NamTran H. Pham, M.D. National Medical Association, Ophthalmology Section Chasidy D. Singleton, M.D. Connecticut Society of Eye Physicians David H. McCullough, M.D. North Dakota Society of Eye Physicians and Surgeons Anne Marjorie Keating, M.D. Delaware Academy of Ophthalmology Jonathan H. Salvin, M.D. Ophthalmic Mutual Insurance Company Denise R. Chamblee, M.D. Idaho Society of Ophthalmology Adam C. Reynolds, M.D. South Carolina Society of Ophthalmology Anika G. Bradley, M.D. Iowa Academy of Ophthalmology Brian Privett, M.D. Washington Academy of Eye Physicians and Surgeons G. Atma Vemulakonda, M.D. Macula Society Judy E. Kim, M.D. Wisconsin Academy of Ophthalmology Arvind Saini, M.D. Maryland Society of Eye Physicians and Surgeons Lee Alison Snyder, M.D. Women in Ophthalmology Lama A. Al-Aswad, M.D.