Eyeworld

56 | EYEWORLD | SUMMER 2025 C ORNEA Relevant disclosures Cohen: None Jeng: None Contact Cohen: Elisabeth.Cohen@nyulangone.org Jeng: Bennie.Jeng@Pennmedicine.upenn.edu produced some interesting data. 2 There were 73 participants in this group. "What we found, in terms of prevalence, is that participants who were younger than 60 years had a significantly lower prevalence of post-herpetic neuralgia at 18 months. When we looked at pain scores, the younger patients with chronic disease had statistically significant lower pain scores at both 12 and 18 months. Those who were in the older chronic group had suggestion of decreased pain, but it wasn't statistically significant," he said. Pain duration was examined as well. There was a statistically significant decrease in pain duration for those who were treated at 18 months. "What's also interesting is there was a statistically significant reduction in the dose of neuropathic medications needed to be used for the patients who were on valacyclovir treat- ment," Dr. Jeng said. Showing that this treatment can reduce the amount of neuropathic pain medication needed was a benefit of the study, Dr. Cohen said, adding that this is important because the most common medicines that are used for pain related to zoster are pregabalin and gabapentin, and they have a lot of side effects. It's not just for post-herpetic neuralgia, which is defined as pain beyond 3 months; Dr. Cohen thinks it may be valuable even earlier as neuropathic pain medications are also used for acute pain management. ZEDS did not show any evidence of serious side effects with the low dose, though Dr. Cohen noted that it is a good idea to get a baseline test for kidney function as was done in the study. The low dose of valacyclovir being used is much better tolerated than neuropathic pain medi- cines, she added. Further examinations and thoughts from the study Dr. Jeng said the study also looked at the impact of vaccination against herpes zoster with the new vaccine that came out during the study and evaluated whether or not vaccinations against zoster affect COVID-19 diagnosis and severity. In terms of the zoster vaccine, Dr. Cohen said the question was if a patient has zoster in the eye already, will the vaccine cause it to flare up. Patient aged 50 years and older should be getting the two-shot series of recombinant zoster vaccine, she said. For those who are immunocompromised, the CDC recommends that they get the two-shot series starting at age 19. Dr. Jeng noted that the sample size for ZEDS was not exactly as hoped for, attributing this to the fact that a lot of cornea specialists thought before the trial results that this treat- ment reduced the endpoints; they already thought the treatment worked and prescribed it, so this made it harder to recruit patients. "The take-home message here is that we think that this treatment works," he said. "If you ask me how's it going to change my management of these patients, I would say that for individuals who have a history of zoster ophthalmicus and have any corneal findings, I would treat with 1 year of valacyclovir." Dr. Cohen said she would also like to en- courage physicians to enter their patients into trials because it helps find out what works and what doesn't. "Expert opinion is expert opin- ion, and data that you get with a randomized clinical trial is really the gold standard," she said. "You want it to not only be effective, but you want it to be safe." Dr. Cohen said there is a tremendous amount of data on valacyclovir. It is FDA approved at this dose and duration to reduce genital herpes simplex virus infections, and it's been around for 30 years, she said, add- ing that it's available in a generic version. "If it works, it's safe, and it's low cost, it's something that we'd like to see used," she said. continued from page 55 CHANGING M I N D S E T S Regarding "Changing mindsets: current solutions and what's ahead," Rom Kandavel, MD, EyeWorld Cataract Editorial Board member, said, "The development of new MIGS devices makes me think that at this growth rate, in under 10 years we will be doing more glaucoma surgical procedures than cataract surgery."

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