Eyeworld

49 EW FEATURE November 2015 • Glaucoma medical treatment non-adherence. "We found some of these predictors to include younger patients, patients who are African American, those with worse health status, people who have been on Harbin said, who sometimes think that they are invincible. However, he added that non-adherence is usu- ally seen in older patients. There are also people for whom the expense could be a problem, he said. In studies he has worked on, Dr. Boland and colleagues were able to determine some of the predictors of glaucoma treatment for less time, and people who admitted decreased adherence," he said. There are different kinds of non-adherent patients, Dr. Feldman said. There are those who don't take their medications at all, and these are relatively easy to identify since the physician likely won't see any of the typical side effects with the drops, and the patients also tend to not show up for appointments. The patients who are more difficult to diagnose are those who take medications intermittently. It's OK to miss a few doses, but Dr. Feldman said the issue is that he needs to be able to identify what regimen they are on in order to help them. Sometimes a patient has taken his or her drops right before coming into the office, so the pressure will be somewhat controlled and the physician may see some side effects of the drops, he said. When they are not controlled on a medication, you have to figure out what they're actually doing. Determining which patients are non-adherent One of the easiest ways to tell that a patient is not adherent with their therapy is when they start to miss appointments, Dr. Harbin said. Missed visits and not taking drops properly often go hand-in-hand, he said. Another key factor is if the pressure is not controlled when you think it should be, he said. "It's amazing how much you have to hound patients for key details of what they're doing." Each time a pa- tient comes in for an appointment, try to have him or her bring in the medication, he added. This will help the physician to see if the drops are being used. "We spend a lot of time making sure that they're taking what we think they're taking," Dr. Harbin said. Sometimes it's tempting to just look at the last note on the patient's chart and ask if they are still taking the same drops—but you really have to hone in on the patient. Dr. Feldman said a discussion with the patient is important. You can also do an in-office trial and see how they are doing with their drops. INDICATIONS AND USAGE ZYLET® (loteprednol etabonate 0.5% and tobramycin 0.3% ophthalmic suspension) is a topical anti-infective and corticosteroid combination for steroid-responsive infl ammatory ocular conditions for which a corticosteroid is indicated and where superfi cial bacterial ocular infection or a risk of bacterial ocular infection exists. Ocular steroids are indicated in infl ammatory conditions of the palpebral and bulbar conjunctiva, cornea and anterior segment of the globe such as allergic conjunctivitis, acne rosacea, superfi cial punctate keratitis, herpes zoster keratitis, iritis, cyclitis, and where the inherent risk of steroid use in certain infective conjunctivitides is accepted to obtain a diminution in edema and infl ammation. They are also indicated in chronic anterior uveitis and corneal injury from chemical, radiation or thermal burns, or penetration of foreign bodies. The use of a combination drug with an anti-infective component is indicated where the risk of superfi cial ocular infection is high or where there is an expectation that potentially dangerous numbers of bacteria will be present in the eye. The particular anti-infective drug in this product (tobramycin) is active against the following common bacterial eye pathogens: Staphylococci, including S. aureus and S. epidermidis (coagulase-positive and coagulase- negative), including penicillin-resistant strains. Streptococci, including some of the Group A-beta-hemolytic species, some nonhemolytic species, and some Streptococcus pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Enterobacter aerogenes, Proteus mirabilis, Morganella morganii, most Proteus vulgaris strains, Haemophilus infl uenzae, and H. aegyptius, Moraxella lacunata, Acinetobacter calcoaceticus and some Neisseria species. IMPORTANT SAFETY INFORMATION • ZYLET® is contraindicated in most viral diseases of the cornea and conjunctiva including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, and varicella, and also in mycobacterial infection of the eye and fungal diseases of ocular structures. IMPORTANT SAFETY INFORMATION (continued) • Prolonged use of corticosteroids may result in glaucoma with damage to the optic nerve, defects in visual acuity and fi elds of vision. Steroids should be used with caution in the presence of glaucoma. If this product is used for 10 days or longer, intraocular pressure should be monitored. • Use of corticosteroids may result in posterior subcapsular cataract formation. • The use of steroids after cataract surgery may delay healing and increase the incidence of bleb formation. In those diseases causing thinning of the cornea or sclera, perforations have been known to occur with the use of topical steroids. The initial prescription and renewal of the medication order should be made by a physician only after examination of the patient with the aid of magnifi cation such as a slit lamp biomicroscopy and, where appropriate, fl uorescein staining. • Prolonged use of corticosteroids may suppress the host response and thus increase the hazard of secondary ocular infections. In acute purulent conditions, steroids may mask infection or enhance existing infections. If signs and symptoms fail to improve after 2 days, the patient should be re-evaluated. • Employment of corticosteroid medication in the treatment of patients with a history of herpes simplex requires great caution. Use of ocular steroids may prolong the course and exacerbate the severity of many viral infections of the eye (including herpes simplex). • Fungal infections of the cornea are particularly prone to develop coincidentally with long-term local steroid application. Fungus invasion must be considered in any persistent corneal ulceration where a steroid has been used or is in use. • Most common adverse reactions reported in patients were injection and superfi cial punctate keratitis, increased intraocular pressure, burning and stinging upon instillation. Please see Brief Summary of Prescribing Information for ZYLET® on adjacent page. ®/™ are trademarks of Bausch & Lomb Incorporated or its affi liates. © 2015 Bausch & Lomb Incorporated. All rights reserved. Printed in USA. US/ZYL/15/0013 continued on page 50

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