Eyeworld

EW FEATURE 112 Refractive options March 2015 material inside is an index-matched silicone oil just like that used during retina surgery. As a result there are no optical interfaces, Dr. Nichamin said. "It acts like a homogenous single optical element, and it takes very little fluid volume-wise to create significant lens shape— hence, accommodation," he said. "Pharmacologic and bench studies indicate one could get 5 D to 10 D of accommodation, which stimu- lated further development." To date, dozens of sighted eyes have been implanted with the FluidVision, he said. Investigators are seeing a minimum of 2 D to 2.25 D of accommodation. "All patients have distance vision comparable to modern-day monofocal lenses," Dr. Nichamin said, adding that this is in conjunction with 20/25 near vision. Dr. Packer pointed out that in- vestigators have shown more than 3 D to 5 D of accommodation in most eyes with the FluidVision. The lens is currently being im- planted through a 3.5 mm incision, so it is injectable into the capsular bag in a conventional manner, Dr. Nichamin said. "Now with addition- al experience gained both in South Africa and Europe, FDA trials are not far off," he predicted. There is another interesting lens in the works, Dr. Packer said— a triplet optic, which Pablo Artal, PhD, discussed at the 2014 European Society of Cataract & Refractive Sur- geons' annual meeting in London. "It's a sandwich with 2 con- vex lenses and a concave lens in the middle," Dr. Packer explained, adding that this involves different materials with different refractive indexes. Initial work, at least on the optical bench, show the lens to be responsive. "If you compress it 1 µm, you get a diopter of true accommodation," he said. With just a small amount of compression, 6 D of accommodation would be possible. Dr. Weinstock said some tech- nologies being studied are examin- ing where ultraviolet or femtosec- ond light can be applied to a lens material like an acrylic that can change the shape of the lens inside the eye. "All of these technologies are interesting, but our hands are still tied because there is nothing on the immediate horizon that is a viable physiologic replication of accom- modation in an IOL," Dr. Weinstock said. EW Editors' note: Dr. Nichamin has finan- cial interests with Bausch + Lomb and PowerVision. Dr. Weinstock has finan- cial interests with Alcon (Fort Worth, Texas), Bausch + Lomb, STAAR Sur- gical (Monrovia, Calif.), and Valeant Pharmaceuticals (Bridgewater, N.J.). Dr. Packer has financial interests with Alcon, Bausch + Lomb, PowerVision, and STAAR Surgical. Contact information Nichamin: ldnichamin@gmail.com Packer: mark@markpackerconsulting.com Weinstock: rjweinstock@yahoo.com out during accommodation and disaccommodation," Dr. Nichamin explained. "That fluid movement causes the central optic to change its curvature—it gets thicker during accommodation and thinner during disaccommodation." The outer shell of this lens is made of a proprietary hydrophobic acrylic, he noted, adding that the Joining continued from page 110 BRIEF SUMMARY OF PRESCRIBING INFORMATION INDICATIONS AND USAGE ILEVRO® Suspension is indicated for the treatment of pain and inflammation associated with cataract surgery. DOSAGE AND ADMINISTRATION Recommended Dosing One drop of ILEVRO® Suspension should be applied to the affected eye one-time-daily beginning 1 day prior to cataract surgery, continued on the day of surgery and through the first 2 weeks of the postoperative period. An additional drop should be administered 30 to 120 minutes prior to surgery. Use with Other Topical Ophthalmic Medications ILEVRO® Suspension may be administered in conjunction with other topical ophthalmic medications such as beta-blockers, carbonic anhydrase inhibitors, alpha-agonists, cycloplegics, and mydriatics. If more than one topical ophthalmic medication is being used, the medicines must be administered at least 5 minutes apart. CONTRAINDICATIONS ILEVRO® Suspension is contraindicated in patients with previously demonstrated hypersensitivity to any of the ingredients in the formula or to other NSAIDs. WARNINGS AND PRECAUTIONS Increased Bleeding Time With some nonsteroidal anti-inflammatory drugs including ILEVRO® Suspension, there exists the potential for increased bleeding time due to interference with thrombocyte aggregation. There have been reports that ocularly applied nonsteroidal anti-inflammatory drugs may cause increased bleeding of ocular tissues (including hyphemas) in conjunction with ocular surgery. It is recommended that ILEVRO® Suspension be used with caution in patients with known bleeding tendencies or who are receiving other medications which may prolong bleeding time. Delayed Healing Topical nonsteroidal anti-inflammatory drugs (NSAIDs) including ILEVRO® Suspension, 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. Corneal Effects 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 ILEVRO® Suspension 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. Contact Lens Wear ILEVRO® Suspension should not be administered while using contact lenses. 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 reflect the rates observed in practice. 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. Non-Ocular Adverse Reactions Non-ocular adverse reactions reported at an incidence of 1 to 4% included headache, hypertension, nausea/vomiting, and sinusitis. USE IN SPECIFIC POPULATIONS Pregnancy Teratogenic Effects. Pregnancy Category C: Reproduction studies performed with nepafenac in rabbits and rats at oral doses up to 10 mg/kg/day have revealed no evidence of teratogenicity due to nepafenac, despite the induction of maternal toxicity. At this dose, the animal plasma exposure to nepafenac and amfenac was approximately 70 and 630 times human plasma exposure at the recommended human topical ophthalmic dose for rats and 20 and 180 times human plasma exposure for rabbits, respectively. In rats, maternally toxic doses ≥10 mg/kg were associated with dystocia, increased postimplantation loss, reduced fetal weights and growth, and reduced fetal survival. Nepafenac has been shown to cross the placental barrier in rats. There are no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, ILEVRO® Suspension should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Non-teratogenic Effects. Because of the known effects of prostaglandin biosynthesis inhibiting drugs on the fetal cardiovascular system (closure of the ductus arteriosus), the use of ILEVRO® Suspension during late pregnancy should be avoided. Nursing Mothers ILEVRO® Suspension is excreted in the milk of lactating rats. It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when ILEVRO® Suspension is administered to a nursing woman. Pediatric Use The safety and effectiveness of ILEVRO® Suspension in pediatric patients below the age of 10 years have not been established. Geriatric Use No overall differences in safety and effectiveness have been observed between elderly and younger patients. NONCLINICAL TOXICOLOGY Carcinogenesis, Mutagenesis, Impairment of Fertility Nepafenac has not been evaluated in long-term carcinogenicity studies. Increased chromosomal aberrations were observed in Chinese hamster ovary cells exposed in vitro to nepafenac suspension. Nepafenac was not mutagenic in the Ames assay or in the mouse lymphoma forward mutation assay. Oral doses up to 5,000 mg/kg did not result in an increase in the formation of micronucleated polychromatic erythrocytes in vivo in the mouse micronucleus assay in the bone marrow of mice. Nepafenac did not impair fertility when administered orally to male and female rats at 3 mg/kg. PATIENT COUNSELING INFORMATION Slow or Delayed Healing Patients should be informed of the possibility that slow or delayed healing may occur while using nonsteroidal anti-inflammatory drugs (NSAIDs). Avoiding Contamination of the Product Patients should be instructed to avoid allowing the tip of the dispensing container to contact the eye or surrounding structures because this could cause the tip to become contaminated by common bacteria known to cause ocular infections. Serious damage to the eye and subsequent loss of vision may result from using contaminated solutions. Use of the same bottle for both eyes is not recommended with topical eye drops that are used in association with surgery. Contact Lens Wear ILEVRO® Suspension should not be administered while wearing contact lenses. Intercurrent Ocular Conditions Patients should be advised that if they develop an intercurrent ocular condition (e.g., trauma, or infection) or have ocular surgery, they should immediately seek their physician's advice concerning the continued use of the multi-dose container. Concomitant Topical Ocular Therapy If more than one topical ophthalmic medication is being used, the medicines must be administered at least 5 minutes apart. Shake Well Before Use Patients should be instructed to shake well before each use. U.S. Patent Nos. 5,475,034; 6,403,609; and 7,169,767. ALCON LABORATORIES, INC. Fort Worth, Texas 76134 USA © 2014 Novartis 7/14 ILV14057JAD

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