DEC 2013

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

Issue link: https://digital.eyeworld.org/i/227001

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December 2011 February 2013 traditionally say, 'You're on a prostaglandin, use it at night,'" he said. "But if it's easier for them to use it the morning, fine, [use it] in the morning." It's more important to put the drop in once a day on a regular basis at around the same time than to force patients to do something that doesn't fit their normal routine. Dr. Cantor pegs the prostaglandin analogues as the gold standard today for glaucoma medical therapy. "They're the most effective, they're once a day, and they do have a fairly flat diurnal curve," he said. "Some have even shown that if [patients] miss a prostaglandin drop one day, pressure is probably not going to change that much if they get back on it the next day." Dr. Lewis concurs. "There aren't good studies proving this, but I have had patients who have used them every other day, or every third day because they couldn't afford them in the days when it was expensive," he said, adding, "That's a bit of a gamble, too." He recommends following the manufacturer's guidelines. Dr. Lewis thinks that the use of combination products may be an answer for those with compliance issues. "The combination products seem to provide a bigger punch," he said. The downside is patients can be exposed to more side effects, he noted. While the prostaglandins have yet to be validated in a combination model, those would be ideal in his view. "I think in the future our combination products will be not just two drugs, but three compounds in one bottle so that we'll maximize the application of drops and go from putting them in three times a day to once or twice, but also have better pressure reduction," Dr. Lewis said. Ultimately, he thinks the answer will be in emerging drug delivery systems that can be placed in the eye and automatically deliver drugs for sustained periods. "That eliminates compliance as a factor in all of this," Dr. Lewis said. "I think that we have effective drugs to lower pressure and that the emphasis in the future will be on how we can effectively deliver them to reduce side effects and maximize the duration of action." EW Editors' note: Dr. Cantor has financial interests with Allergan (Irvine, Calif.), Bausch + Lomb (Rochester, N.Y.), Chiltern (Berkshire, U.K.), and Mati Therapeutics (Austin, Texas). Dr. Lewis has financial interests with Alcon (Fort Worth, Texas), Allergan, and Aerie Pharmaceuticals (Bedminster, N.J.). His glaucoma. EW GLAUCOMA Contact information Cantor: 317-274-8485, lcantor@iupui.edu Lewis: 916-649-1515, rlewiseyemd@yahoo.com Our motivation. Image is designed to represent glaucoma visual impairment and is not intended to be medically accurate. For illustrative purposes only. To explore what's new at Santen, scan this code with your mobile device or visit www.santeninc.com. At Santen, our single focus in ophthalmology enables research of novel therapies in glaucoma, uveitis, and dry eye/corneal disorders—therapies determined to challenge eye disease, one patient at a time. Inspiring ophthalmic medicines © 2012 Santen Pharmaceutical Co., Ltd. All rights reserved. SAN-272.00 07/12 33

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