EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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29 EW REFRACTIVE SURGERY December 2014 Contact information Greenbaum: thecannula@aol.com Editors' note: Dr. Greenbaum has no financial interests related to his comments. Reference Wilkins MR, MD, Allan BD, Rubin GS, et al, for the Moorfields IOL Study Group. Randomized Trial of Multifocal Intraocular Lenses versus Monovision after Bilateral Cataract Surgery. Ophthalmology. 2013;120 (12): 2449–2455. Dr. Greenbaum has monovi- sion patients from 20 years earlier whose friends still cannot believe that they do not need reading glasses. "They're patients for life and referrers for life," he said. While he certainly tells everyone about all of their choices, Dr. Greenbaum said he has not yet had anyone choose multifocal lenses over monovision. On the flip side, he has had re- ferrals from those who were unhap- py with the multifocal approach. "I have seen in consultation a dentist who could not practice, who had multifocal lenses put in and 'Vaseline vision' (as a result)," he said. "I have also seen patients who had a multifocal lens put in one eye and then had to have it removed and left [the original] doctor." How- ever, he has never had that experi- ence with the monovision approach. While nothing is for everyone, Dr. Greenbaum sees monovision as possibly rivaling the numbers attained with multifocal lenses. "I think there will be a portion of patients who will be afraid of multifocals because they hate their progressive glasses," he said. "Those folks will be more apt to want monovision because they are used to single vision lenses." It is important to offer full monovision to patients who choose this option. "There are lecturers going from meeting to meeting reporting that –2.75 in the non-dominant eye is too much, and that in the era of aspheric IOLs, –1.25 is sufficient. They should review the December 2013 Moorfields data using aspheric IOLs because –1.25 achieved 25% spectacle independence, and –2.75 achieved 91% spectacle indepen- dence," Dr. Greenbaum said. Eventually, however, these options will fall by the wayside, he thinks, should a liquid accom- modating lens to restore the full spectrum of vision become avail- able. Even though 25 years ago it was thought that this lens would be a reality soon, it remains just an enticing idea, Dr. Greenbaum said. In the meantime, he is certain that the cataract population will soon become more educated about the monovision option and all it has to offer, with many adopting this approach. EW © 2014 Novartis 9/14 SMB14119JAD For the treatment of elevated IOP UNLOCK TREATMENT POSSIBILITIES SIMBRINZA ® Suspension delivered 21-35% mean IOP reduction at Month 3 1-3 1-3 mm Hg greater than either component 4 Effi cacy proven in two pivotal Phase 3 randomized, multicenter, double-masked, parallel-group, 3-month, 3-arm, contribution- of-elements studies. Primary objective of studies was to compare IOP-lowering effi cacy of SIMBRINZA ® Suspension, brinzolamide, 1%, and brimonidine, 0.2%. IOP was measured at 8am, 10am, 3pm, and 5pm 1,2 The most frequently reported adverse reactions in a 6-month clinical trial in patients treated with SIMBRINZA ® Suspension occurring in approximately 3-7% of patients were eye irritation, eye allergy, conjunctivitis, blurred vision, dysgeusia (bad taste, conjunctivitis allergic, eye pruritus, and dry mouth 5 Only available beta-blocker-free fi xed combination 2,3 Learn more at myalcon.com/simbrinza INDICATIONS AND USAGE SIMBRINZA ® (brinzolamide/brimonidine tartrate ophthalmic suspension) 1%/0.2% is a fi xed combination indicated in the reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension. Dosage and Administration The recommended dose is one drop of SIMBRINZA ® Suspension in the affected eye(s) three times daily. Shake well before use. SIMBRINZA ® Suspension may be used concomitantly with other topical ophthalmic drug products to lower intraocular pressure. If more than one topical ophthalmic drug is being used, the drugs should be administered at least fi ve (5) minutes apart. IMPORTANT SAFETY INFORMATION Contraindications SIMBRINZA ® Suspension is contraindicated in patients who are hypersensitive to any component of this product and neonates and infants under the age of 2 years. Warnings and Precautions Sulfonamide Hypersensitivity Reactions —Brinzolamide is a sulfonamide, and although administered topically, is absorbed systemically. Sulfonamide attributable adverse reactions may occur. Fatalities have occurred due to severe reactions to sulfonamides. Sensitization may recur when a sulfonamide is readministered irrespective of the route of administration. If signs of serious reactions or hypersensitivity occur, discontinue the use of this preparation. Corneal Endothelium—There is an increased potential for developing corneal edema in patients with low endothelial cell counts. Severe Hepatic or Renal Impairment (CrCl <30 mL/min)—SIMBRINZA ® Suspension has not been specifi cally studied in these patients and is not recommended. Contact Lens Wear—The preservative in SIMBRINZA ® Suspension, benzalkonium chloride, may be absorbed by soft contact lenses. Contact lenses should be removed during instillation of SIMBRINZA ® Suspension but may be reinserted 15 minutes after instillation. Severe Cardiovascular Disease—Brimonidine tartrate, a component of SIMBRINZA ® Suspension, had a less than 5% mean decrease in blood pressure 2 hours after dosing in clinical studies; caution should be exercised in treating patients with severe cardiovascular disease. Adverse Reactions In two clinical trials of 3 months' duration with SIMBRINZA ® Suspension, the most frequent reactions associated with its use occurring in approximately 3-5% of patients in descending order of incidence included: blurred vision, eye irritation, dysgeusia (bad taste), dry mouth, and eye allergy. Adverse reaction rates with SIMBRINZA ® Suspension were comparable to those of the individual components. Treatment discontinuation, mainly due to adverse reactions, was reported in 11% of SIMBRINZA ® Suspension patients. Drug Interactions—Consider the following when prescribing SIMBRINZA ® Suspension: Concomitant administration with oral carbonic anhydrase inhibitors is not recommended due to the potential additive effect. Use with high-dose salicylate may result in acid-base and electrolyte alterations. Use with CNS depressants may result in an additive or potentiating effect. Use with antihypertensives/ cardiac glycosides may result in additive or potentiating effect on lowering blood pressure. Use with tricyclic antidepressants may blunt the hypotensive effect of systemic clonidine and it is unknown if use with this class of drugs interferes with IOP lowering. Use with monoamine oxidase inhibitors may result in increased hypotension. For additional information about SIMBRINZA ® Suspension, please see Brief Summary of full Prescribing Information on adjacent page. References: 1. Katz G, DuBiner H, Samples J, et al. Three-month randomized trial of fi xed-combination brinzolamide, 1%, and brimonidine, 0.2% [published online ahead of print April 11, 2013]. JAMA Ophthalmol. doi:10.1001/ jamaophthalmol.2013.188. 2. Nguyen QH, McMenemy MG, Realini T, et al. Phase 3 randomized 3-month trial with an ongoing 3-month safety extension of fi xed-combination brinzolamide 1%/brimonidine 0.2%. J Ocul Pharmacol Ther. 2013;29(3): 290-297. 3. Data on fi le, 2013. 4. SIMBRINZA ® Suspension Package Insert. 5. Whitson JT, Realini T, Nguyen QH, McMenemy MG, Goode SM. Six-month results from a Phase III randomized trial of fi xed-combination brinzolamide 1% + brimonidine 0.2% versus brinzolamide or brimonidine monotherapy in glaucoma or ocular hypertension. Clin Ophthalmol. 2013;7:1053-1060.