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E W NEWS & OPINION 16 and make the redness of the eyes worse. Meanwhile, antihistamine decongestant eye drops, Dr. Blaiss p ointed out, have to be given fairly frequently. "They don't have any major effect on inflammation, and allergic conjunctivitis is not only a condition of histamine but also inflammatory cells such as eosinophils, which lead to the chronic conditions that patients are suffering with," he said. However, Dr. Blaiss does find that OTC options that have both mast cell stabilizing and antihista- m ine activity such as ketotifen eye drops may be a helpful starting point for some patients, and if the condition is mild enough, may even suffice. Christopher E. Starr, MD, asso- ciate professor of ophthalmology, Weill Cornell Medical Center, New York, said that OTC products have been somewhat underwhelming in his experience. "A fair number of patients will come in and say 'I took t his OTC allergy drop and it didn't help and it actually made my eyes worse,'" he said. "Or they stopped it and the eye became red and in- flamed and they have to keep using it." As a rule, Dr. Starr reserves oral antihistamines for use in conjunc- tion with topical medication for those with severe allergies. "For pure allergic conjunctivitis, I almost never use oral medication by itself," h e said. "I find the best treatment for ocular allergic conjunctivitis is a topical medication that gets to the eye with high concentration. If they have concurrent nasal or systemic allergic symptoms then oral medica- tion is added." Standing prescriptions For his seasonal allergic patients Dr. Starr relies on newer once-a-day drops such as Pataday (olopatadine, A lcon) and Lastacaft (alcaftadine, Allergan, Irvine, Calif.). "I think that reducing the number of drops a day is always a good thing for patient compliance," he said. That said, in more severe cases he finds once-a- day use may not be enough. "I have found that in the summertime if I take a drop of Lastacaft or Pataday in t he morning, sometimes by 3 or 4 in the afternoon the ocular itching re- turns," he said. "There's no harm in taking that extra drop if necessary." In patients who he knows will encounter seasonal allergies yearly, he gives a standing prescription for these medications with a lot of re- fills. He also advises them to put a reminder in their smartphones alert- ing them two weeks before their symptoms arise. "That's usually a good time to preload the eye with antihistamine mast cell stabilizers because you want to stabilize the mast cells before they react to the allergy, not after it has happened," Dr. Starr said. Dr. Epstein agrees that patients may benefit from taking drugs such as Lastacaft or Pataday more than once a day. "It feels good to put these drops in your eyes, so I'm not sure that once-a-day dosing is doing anyone any favors," he said. "I al- most always tell my patients to use drops like Pataday twice a day just because they feel good and there's no downside to it." Dr. Blaiss usually relies on Lastacaft for seasonal ocular allergy patients. He cited recent studies showing that during a 16-hour time frame patients did better on Lastacaft than on Pataday. "There may be some increased potency," he said. For some patients during peak season, these agents might not pro- vide complete 24-hour coverage. "Therefore twice-a-day preparations may be better for some of these pa- tients," Dr. Blaiss said. If they have failed once-a-day-treatment he may instead put them on a twice-a-day product like Bepreve (bepotastine besilate ophthalmic solution 1.5%, Bausch + Lomb, Rochester, N.Y.). February 2014 The power of one Two types of incisions – one module The Ziemer FEMTO LDV Z Models are FDA cleared and CE marked and available for immediate delivery. The FEMTO LDV Z6 is FDA cleared and CE marked for creation of corneal incisions in patients undergoing cataract surgery. For some countries, availability may be restricted due to local regulatory requirements; please contact Ziemer for details. CLEAR CORNEAL & ARCUATE INCISIONS • Custom-designed incisions • Topographically matched • Added precision and reproducibility • Intrastromal incisions possible Exclusively available for the FEMTO LDV Z6 www.femtoldv.com ARCUA CLEAR CORNEAL & INCISIONS TE RCUA AT CLEAR CORNEAL & INCISIONS CLEAR CORNEAL & Intrastromal incisions possible • Added precision and reproducibility • opographically matched T • Custom-designed incisions • Intrastromal incisions possible Added precision and reproducibility opographically matched Custom-designed incisions Intrastromal incisions possible Added precision and reproducibility opographically matched Custom-designed incisions incisions in patients undergoing cataract surgery. For some countries, availability may be restricted due to local regulatory r The Ziemer FEMTO LDV Z Models are FDA cleared and CE marked and available for immediate delivery. The FEMTO LDV Z6 is FDA clear www E y e W o r l d _ n ov ov 2 0 1 3 _ F E M T O _ L EyeWorld_nov2013 FEMTO L incisions in patients undergoing cataract surgery. For some countries, availability may be restricted due to local regulatory r The Ziemer FEMTO LDV Z Models are FDA cleared and CE marked and available for immediate delivery. The FEMTO LDV Z6 is FDA clear .com .femtoldv www L D V _ C o r n e a l _ I n s c i s i o n s _A Ad _ 1 0x 1 3 i . i n d d 1 LDV Corneal nscisions Ad 10x13i.indd 1 incisions in patients undergoing cataract surgery. For some countries, availability may be restricted due to local regulatory r The Ziemer FEMTO LDV Z Models are FDA cleared and CE marked and available for immediate delivery. The FEMTO LDV Z6 is FDA clear equirements; please contact Ziemer for details. incisions in patients undergoing cataract surgery. For some countries, availability may be restricted due to local regulatory r ed and CE marked for creation of corneal The Ziemer FEMTO LDV Z Models are FDA cleared and CE marked and available for immediate delivery. The FEMTO LDV Z6 is FDA clear equirements; please contact Ziemer for details. ed and CE marked for creation of corneal 0 08 . 1 1 . 1 3 08 11.13 Ocular continued from page 14 13-25 News_EW February 2014-DL2-ALT-OIS-ad_Layout 1 1/30/14 10:07 AM Page 16