Eyeworld

EW GLAUCOMA 88 symptomatic," Dr. Cantor said. "This interferes with therapy in a number of ways, particularly with patients' compliance and willingness to use therapy." For patients who are affected by OSD, Dr. Fechtner stressed that it's important to diagnose and treat any underlying condition, such as mei- bomian gland disease, as well as to consider medication options. "For those patients where BAK is a con- sideration, we have available alterna- tives in virtually all of our major classes now," Dr. Fechtner said. Options in the United States include brimonidine with Polyquad (Alcon, Fort Worth, Texas), preservative-free timolol, and travoprost with SofZia (Alcon). "We also have laser trabecu- loplasty, which could be a good fit for patients who have ocular surface disease," Dr. Fechtner said. "It is quite effective and should be consid- ered early in our therapeutic regi- men." Generic medication Further complicating the situation has been the recent approval of generic latanoprost. Just 3 months after entry into the marketplace, there's already over 80% market penetration for generic latanoprost, according to Dr. Cantor. While these must meet regulatory standards, there is room for some variation. "While they have the same thing, there is a range of concentrations, and how you cook up these formula- tions can have an impact not only on how well they're tolerated but also how effective they are," Dr. Cantor said. At present there are approxi- mately five different generic formu- lations and soon there will be as many as eight, Dr. Cantor estimated. Unfortunately on any given month the pharmacy may use a different generic formulation. "You may find your patient using a different bot- tle," he said. "There are subtle things about the formulations that can af- fect comfort, tolerability, and effi- cacy despite the regulatory guidance." Dr. Fechtner pointed out that there are other factors such as PH, the tonicity, and the presence of par- ticulates that may differ in generics. "We don't have comparative clinical trials to reassure us that these gener- ics will perform in the patient the same even though we trust that they are manufactured to the FDA's re- quirements," Dr. Fechtner said. He worries that patients may be coerced by their pharmacy benefits manager to switch to the less expensive generic medication. Dr. Fechtner also pointed out that there's no other branded glaucoma medication that contains more BAK than latanoprost. Overall, Dr. Cantor stressed the importance of keeping each individ- ual patient in mind. "I think that it boils down to making sure that the therapy that you're using is individ- ualized to that patient, works well, and is tolerated so that you can re- move any obstacles and barriers to compliance," he said. "Certainly one of those obstacles is how a drop feels." EW Editors' note: Dr. Cantor has financial interests with Alcon, Allergan (Irvine, Calif.), Merck (Whitehouse Station, N.J.), and Pfizer (New York). Dr. Fechtner has financial interests with Alcon and Allergan. Dr. Stewart has no financial interests related to his com- ments. Contact information Cantor: 317-274-8485, lcantor@iupui.edu Fechtner: 973-972-2030, fechtnrd@umdnj.edu Stewart: williamstewart@prnorb.com February 2011 October 2011 OCULUS Pentacam ® Please visit us at the AAO 2011 in Orlando, FL Booth No. 2543 • Date: Sunday, October 23 • Location: Peabody Hotel • Time: 6:15 – 8:00 am • Presenters: Michael Belin, David Hardten, Marc Michelson and Paolo Vinciguerra Space is limited. Register now at www.pentacamseminar.com OCULUS is offering a customer appreciation discount on selected products at the 2011 AAO. To get your discount, go to www.oculusvoucher.com to print your AAO discount voucher in 3 easy steps. This event is not affi liated with the offi cial program of the American Academy of Ophthalmology's Annual Meeting. Toll free 1-888-519-5375 www.oculususa.com sales@oculususa.com www.pentacam.com Pentacam Breakfast Seminar ASCRS Eyeworld USA - Pentacam Br1 1 07.09.2011 12:50:49 Navigating continued from page 87 84-88 Glaucoma_EW October 2011-DL2_Layout 1 9/29/11 4:11 PM Page 88

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