Eyeworld

EW FEATURE 48 Corneal lamellar surgical procedures April 2015 by EyeWorld Staff specialist may have samples of prescription medications, whereas I doubt that any OTC medication would be found in the sample closet. Therefore, it is much easier to start therapy with a branded prescrip- tion sample, and if it is successful, continue with a prescription," Dr. Mah said. However, if patients are seen by an ophthalmologist and have not tried OTC medications, they may be required to try them before an insurance company will allow for a prescription medication. "Sometimes, due to the ever- present insurance formularies, generics or OTC products must be tried before the successfully used sample can be continued," Dr. Mah explained. Protocols Dr. Mah's protocol is to provide a sample and coupons, if they are available. "If the patient would like to try an OTC or generic, I try to advise a branded OTC product and explain my reasons for using branded medications over generics," he says. Dr. Hovanesian said that it often takes some experimentation to find just the right therapy. His protocol for prescription medications is to try a generic first, due to cost. "When patients fail on those therapies, we may consider steroids or prescription antihistamines or other therapies for allergies," he said. EW Editors' note: Drs. Hovanesian and Mah have financial interests with Alcon (Fort Worth, Texas), Allergan (Irvine, Calif.), and Bausch + Lomb (Bridgewater, N.J.). Contact information Hovanesian: drhovanesian@harvardeye.com Mah: Mah.Francis@Scrippshealth.org Over-the-counter versus prescription allergy medications: ASCRS members weigh in Global Trends in Ophthalmology ™ Copyright © 2015 Global Trends in Ophthalmology and the American Society of Cataract & Refractive Surgery. All rights reserved. "The challenge is that patients may not get what we recommend and instead choose a redness reliev- er, which can cause tachyphylaxis, and they can end up with more redness and discomfort than they had in the beginning. In patients who have challenging allergies that are not controlled by OTC products, it may be appropriate to prescribe a specific therapy because different therapies work better for different people," he said. Clinical Survey results In the 2014 ASCRS Clinical Survey, ASCRS members were asked the fol- lowing question: How important do you believe it is to use prescription ocular allergy drops versus over-the- counter alternatives for ocular aller- gy? See Figure 1 for the full results. Non-U.S. respondents believe it is very important to use prescription ocular allergy drops versus OTC al- ternatives for ocular allergy at a rate more than 7 times greater than U.S. respondents, 39.1% to 5.4%. The difference in responses between U.S. and non-U.S. doctors was statistical- ly significant. "This difference may be due to the fact that the U.S. has better OTC options than other countries," said Francis Mah, MD, Scripps Health, La Jolla, Calif. "Also, unlike in the U.S. where there are FDA regulations for OTC medications, it may be that other countries do not regulate as well. For example, pharmacists may incorpo- rate more concerning ingredients, such as steroids, in other countries," he said. Dr. Mah added that many patients who are being seen by oph- thalmologists for ocular allergy have already tried OTC products without success. "Therefore, a correct diagno- sis and proper therapy would be critical. Many times, an eyecare U.S. physicians are more likely to suggest OTC medications than non-U.S. physicians, survey finds A lthough many of today's over-the-counter (OTC) allergy medications were previously available in branded prescriptions only, many have recently become generic. However, some ophthal- mologists still prefer to prescribe the name-brand medications so they know exactly what their patients are using. "For first-line therapy for mild cases of allergy, OTC medications often are suitable and inexpensive," said John Hovanesian, MD, Har- vard Eye Associates, Laguna Hills, Calif. Figure 1: Survey participants were asked "How important do you believe it is to use prescription ocular allergy drops versus over-the- counter alternatives for ocular allergy?" Source: ASCRS

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