Eyeworld

WHERE DO YOU GO FOR NSAID EFFICACY? 1. IMS Health, IMS National Prescription Audit™, February 2010 to January 2011 © 2011 Alcon, Inc. 3/11 NPF11500JAD Go to the #1 dispensed NSAID drop among ophthalmologists 1 INDICATIONS AND USAGE: NEVANAC ® ophthalmic suspension is a nonsteroidal, anti-infl ammatory prodrug indicated for the treatment of pain and infl ammation associated with cataract surgery. DOSAGE AND ADMINISTRATION: One drop of NEVANAC ® ophthalmic suspension should be applied to the affected eye(s) three-times-daily beginning 1 day prior to cataract surgery, continued on the day of surgery and through the fi rst 2 weeks of the postoperative period. IMPORTANT SAFETY INFORMATION: CONTRAINDICATIONS: Hypersensitivity to any of the ingredients in the formula or to other NSAIDs. WARNINGS AND PRECAUTIONS: • Increased bleeding time due to increased thrombocyte aggregation • Delayed healing • Corneal effects including keratitis ADVERSE REACTIONS: Most common adverse reactions (5% to 10%) are capsular opacity, decreased visual acuity, foreign body sensation, increased intraocular pressure, and sticky sensation. EyeWorld May 2011 13)-$'(:.LQJLQGG 30 It just depends on the patient's spe- cific needs. "Someone with bad rheumatoid arthritis or Sjogren's disease who has a very dry eye is a person who would be on a gel during the day and an ointment at bedtime, or maybe even an ointment during the day because of the severity of the dry eye condi- tion," said Dr. Lane. Other treatment options In addition to prescribing artificial lubricants, Dr. Donnenfeld is a big believer in oral nutritional supple- ments, specifically TheraTears Nutri- tion. "It's been shown in a peer-re- viewed article published in Cornea by James P. McCulley, M.D., that it dramatically improves dry eye signs and symptoms after just a few months of therapy," said Dr. Donnenfeld. "That's been my find- ing as well, that it improves tear quality and meibomian gland oil se- cretions." Dr. Donnenfeld recommends 2 grams of omega-3s a day, which is essentially three pills. "There's an epidemic of omega- 3 deficiency diseases because of our dietary habits, so I think nutritional supplements are important to dis- cuss with patients," Dr. Donnenfeld said. "Patients love a holistic ap- proach to disease, and I have my pa- tients stay on omega-3 supplements indefinitely. It lowers their choles- terol and improves their skin and hair. It's a very good thing that we should all do for ourselves and our patients." Most importantly, though, is catching and treating DES before it progresses, especially if the patient is relatively young. Although early dry eye isn't viewed as a serious problem, it can quickly develop into one. For this reason, Dr. Donnenfeld has be- come a strong advocate of initiating cyclosporine therapy early in the management of DES patients, as studies have shown that the earlier you treat these patients, the better they do in the long run and the more comfortable and happy they are. "As a group, ophthalmologists need to be more proactive about treating patients earlier and more ag- gressively with immunomodula- tion," he said. "I think we aren't giving our patients the best treat- ment unless we offer the therapies that are going to reverse the process of dry eye and prevent progression." Tears as retail income Compliance, even with remember- ing to take supplements, is rarely an issue for DES patients, as the treat- ment usually makes them feel better. But one way to ensure that patients walk out with the correct supple- ment or over-the-counter (OTC) tear is to sell the tears in your practice. Dr. Lane has been doing this not only as a convenience to his pa- tients, but for retail income as well. "Selling OTC drugs and other OTC-type products makes good sense to me," Dr. Lane said. "That way patients have exactly what you want them to have. You don't have to worry about what a pharmacy stocks or if the pharmacist will rec- ommend something you don't want." Dr. Lane suggests pricing OTC items such as contact lens solutions, artificial tears, and vitamins for ocu- lar health competitively with major retailors like Wal-Mart and Target. He buys these items directly from the companies that supply them, thus eliminating the middleman. "If you have them right there in your office to sell at a reasonable price, it becomes a major conven- ience for the patients," Dr. Lane said. "If they find they need more in the future, they have the choice of coming back to your office or going to a retailer. But they'll still have the box in hand and be able to match it up so they buy the right thing." Improvements to come Significant developments to dry eye lubricants have been few and far be- tween in recent years, but that does- n't stop Drs. Lane and Donnenfeld from looking to the future. Both doctors would love to see longer- lasting tears that don't blur vision. Dr. Lane hopes that one day, drops will be both preservative free and reusable, but that's currently a pie- in-the-sky possibility. "The tears we use today are so much better than the tears we used 5 or 10 years ago," said Dr. Donnenfeld. "There has been tremendous improvement in the technology." EW Editors' note: Dr. Donnenfeld has fi- nancial interests with AMO, Allergan, and Advanced Vision Research. Dr. Lane has financial interests with Alcon. Contact information Donnenfeld: eddoph@aol.com Lane: sslane@associatedeyecare.com OCULAR SURFACE April 2011 ©2005, 2007 Alcon, Inc. 3/11 NPF11500JAD NEVANAC® (nepafenac ophthalmic suspension) 0.1%, topical ophthalmic Initial U.S. Approval: 2005 Revised: 9/2007 BRIEF SUMMARY 1 INDICATIONS AND USAGE NEVANAC® ophthalmic suspension is indicated for the treatment of pain and inammation associated with cataract surgery. 2 DOSAGE AND ADMINISTRATION 2.1 Recommended Dosing One drop of NEVANAC® should be applied to the aected eye(s) three-times-daily beginning 1 day prior to cataract surgery, continued on the day of surgery and through the rst 2 weeks of the postoperative period. 2.2 Use with Other Topical Ophthalmic Medications NEVANAC® may be administered in conjunction with other topical ophthalmic medications such as beta-blockers, carbonic anhydrase inhibitors, alp ha-agonists, cycloplegics, and mydriatics. 3 DOSAGE FORMS AND STRENGTHS Sterile ophthalmic suspension: 0.1% 3 mL in a 4 mL bottle 4 CONTRAINDICATIONS NEVANAC® is contraindicated in patients with previously demonstrated hypersensitivity to any of the ingredients in the formula or to other NSAID. 5 WARNINGS AND PRECAUTIONS 5.1 Increased Bleeding Time With some nonsteroidal anti-inammatory drugs including NEVANAC®, there exists the potential for increased bleeding time due to interference with thrombocyte aggregation. There have been reports that ocularly applied nonsteroidal anti-inammatory drugs may cause increased bleeding of ocular tissues (including hyphemas) in conjunction with ocular surgery. It is recommended that NEVANAC® ophthalmic suspension be used with caution in patients with known bleeding tendencies or who are receiving other medications which may prolong bleeding time. 5.2 Delayed Healing Topical nonsteroidal anti-inammatory drugs (NSAIDs) including NEVANAC®, may slow or delay healing. Topical corticosteroids are also known to slow or delay healing. Concomitant use of topical NSAIDs and topical steroids may increase the potential for healing problems. 5.3 Corneal Eects Use of topical NSAIDs may result in keratitis. In some susceptible patients, continued use of topical NSAIDs may result in epithelial breakdown, corneal thinning, corneal erosion, corneal ulceration or corneal perforation. These events may be sight threatening. Patients with evidence of corneal epithelial breakdown should immediately discontinue use of topical NSAIDs including NEVANAC® and should be closely monitored for corneal health. Postmarketing experience with topical NSAIDs suggests that patients with complicated ocular surgeries, corneal denervation, corneal epithelial defects, diabetes mellitus, ocular surface diseases (e.g., dry eye syndrome), rheumatoid arthritis, or repeat ocular surgeries within a short period of time may be at increased risk for corneal adverse events which may become sight threatening. Topical NSAIDs should be used with caution in these patients. Postmarketing experience with topical NSAIDs also suggests that use more than 1 day prior to surgery or use beyond 14 days post surgery may increase patient risk and severity of corneal adverse events. 5.4 Contact Lens Wear NEVANAC® should not be administered while using contact lenses. 6 ADVERSE REACTIONS Because clinical studies are conducted under widely varying conditions, adverse reaction rates observed in the clinical studies of a drug cannot be directly compared to the rates in the clinical studies of another drug and may not reect the rates observed in practice. 6.1 Ocular Adverse Reactions The most frequently reported ocular adverse reactions following cataract surgery were capsular opacity, decreased visual acuity, foreign body sensation, increased intraocular pressure, and sticky sensation. These events occurred in approximately 5 to 10% of patients. Other ocular adverse reactions occurring at an incidence of approximately 1 to 5% included conjunctival edema, corneal edema, dry eye, lid margin crusting, ocular discomfort, ocular hyperemia, ocular pain, ocular pruritus, photophobia, tearing and vitreous detachment. Some of these events may be the consequence of the cataract surgical procedure. 6.2 Non-Ocular Adverse Reactions Non-ocular adverse reactions reported at an incidence of 1 to 4% included headache, hypertension, nausea/vomiting, and sinusitis. See full prescribing information for NEVANAC®. ALCON LABORATORIES, INC. Fort Worth, Texas 76134 USA Deciphering continued from page 44 032-047 Feature_EW April 2011-DL_Layout 1 4/10/11 8:04 AM Page 46

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