MAY 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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46 EW FEATURE February challenges/MIGS May 2013 Glaucoma 2011 Prostaglandin continued from page 45 particularly helpful for some in minimizing ocular surface issues when considering the treatment tree in which the prostaglandins are front and center. "We go in a step-wise fashion," Dr. Rhee said. "We start with a prostaglandin, and what you add on next adjunctively depends on the practitioner." This means that particularly when faced with a patient who is sensitive to preservatives, it is not necessary to go to a different class of medication first just because it offers a preservativefree option. One potential deterrent for selecting Zioptan has been cost, Dr. Reynolds observed, since in the bestcase scenario this is considered a tier two or three drug by insurance com- panies and in the worst case is not covered at all. That potentially poses a problem for patients. Cognizant of this, the company has recently come out with its own payment plan in most cases making the cost of Zioptan to the patient akin to a tier two agent. "What that means is for them the cost of use will be the same or maybe a little lower than Lumigan or Travatan," Dr. Reynolds said. Dr. Rhee noted that the singleuse vials have likewise proven to be an obstacle for some. "There are some people who don't like the single-dose delivery system," Dr. Rhee said. In his experience, however, he has not had any patients who have wanted to change their therapy as a result of it. To the contrary, Dr. Rhee has had many patients who favor the single-dose unit, which helps them keep track of whether they have taken their daily dose of Zioptan. Overall, Dr. Reynolds views the gains with the preservative-free approach as remaining controversial. "There's still [the thinking] out there that we should have all patients on as much preservative-free (medication) as possible," he said. "I personally would like to see more clinical data supporting this idea." At this point, he generally reserves the preservative-free drops for intolerant patients. "For me it's more of the BAK intolerance and more of the patients who already have ocular surface disease problems," he said. This is not something ubiquitous that everyone needs to be on, Dr. Reynolds concluded. EW Editors' note: Dr. Noecker has financial interests with Alcon, Allergan, and Merck. Dr. Rhee has financial interests with Alcon, Allergan, AqueSys (Aliso Viejo, Calif.), Merck, and Santen (Osaka, Japan). Dr. Reynolds has no financial interests related to this article. Contact information Noecker: 203-366-8000, noeckerrj@gmail.com Rhee: 617-573-3670, dougrhee@aol.com Reynolds: 208-373-1200, adamreynolds@cableone.net EyeWorld factoid Primary congenital glaucoma accounts for approximately 50% to 70% of all cases of congenital glaucoma. Eighty percent of cases of pediatric glaucoma are diagnosed by 1 year. Source: Glaucoma Research Foundation

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