Eyeworld

EW FEATURE 58 January 2011 potential recurrent rebound inflam- mation," he said. With this ap- proach, Dr. Holland has found that recurrences are markedly reduced. Dr. Holland also recommends that clinicians watch out for a flare dose—in other words, if a dose is ta- pered and the patient becomes symptomatic again, that patient should be kept above that lower dose for a few months to avoid re- currences. Other forms of HSV include en- dothelialitis, which presents with herpetic precipitates and edema and requires anti-viral treatment along with steroids; and HSV iritis, which requires anti-viral medication. New alternatives In addition to the introduction of Zirgan in the U.S. market, the use of more versus less potent steroids has also made a difference in HSV treat- ment, Dr. Holland said. The new steroid Durezol (difluprednate oph- thalmic suspension 0.05%, Sirion Therapeutics, Tampa, Fla.) is the most potent available in the United States, and he prefers to start pa- tients with this and then taper down to a "softer" steroid such as Lotemax (loteprednol, Bausch & Lomb). "In the past, all steroids were the same. Now, we have 'designer' steroids, and we have choices," Dr. Holland said. A number of other new agents are on the horizon for HSV, Dr. Mah said. Researchers and clinicians alike are hoping for single agents that can tackle both adenovirus and HSV. Such agents would be "phenome- nal" and could potentially be on the market in 2 to 5 years, considering that some agents of this kind are currently in phase 2 clinical trials, he said. Research into broader issues re- lated to HSV, such as the disease la- tency and whether a vaccine would be effective, is particularly valuable and farther reaching for other forms of HSV in the body, Dr. Mah said. A study published in January 2010 in the Future Microbiology on mucosal treatments for HSV also supports the idea of disease preven- tion. "The pathology of recurrent disease and the concerns regarding chronic inflammation again support the goal of protecting against pri- mary infection; such protection would prevent latent seeding of the sensory ganglia and subsequent re- current corneal disease," wrote Chris L. McGowin, Ph.D., LSU Health Sciences Center, Department of Medicine, Section of Infectious Diseases, New Orleans; and Richard B. Pyles, Ph.D., Department of Pedi- atrics, University of Texas Medical Branch at Galveston. Although there has not been much research into immunomodu- lation for ocular HSV, this could be another treatment option, the inves- tigators wrote. "…[S]timulation of the host mucosal immune system has proven to be a viable approach for prophylaxis and treatment of genital HSV-2 infections, and good rationale exists for continued inves- tigation [in ocular HSV]," Drs. Mc- Gowin and Pyles wrote. The investigators' report also ad- dresses the promising role and po- tential challenges of vaccines for HSV. EW Editors' note: Dr. Holland is a consult- ant for Abbott Medical Optics (AMO, Santa Ana, Calif.), Alcon, Allergan (Irvine, Calif.), and other ophthalmic companies. Dr. Mah is a consultant for Alcon and Allergan. Drs. McGowin and Pyles received research support from the Gulf South STI/Topical Microbicides Cooperative Research Center. Contact information Holland: 859-331-9000, eholland@holvision.com Mah: 412-647-2211, mahfs@upmc.edu McGowin: cmcgow@lsuhsc.edu continued from page 57 EyeWorld Factoid In 2008, Harvey V. Fineberg, M.D., Ph.D., suggested that in the last 15 years, optometric employment in ophthalmic practices was up 100% Source: Harvey V. Fineberg, M.D., Ph.D., American Academy of Opthalmology annual meeting, 2008

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