Eyeworld

53 EW FEATURE Contact information Gupta: preeya.gupta@duke.edu Hardten: drhardten@mneye.com Matossian: cmatossian@matossianeye.com more significant than we recognize," she said. Intense pulsed light therapy can also be used for ocular rosacea, Dr. Gupta said, with the side benefit that it will help facial rosacea as well. In patients with ocular rosacea, Dr. Gupta prescribes metronidazole gel for facial lesions and oral doxy- cycline or minocycline if the patient can tolerate it. Demodex mites are attracted to rosacea, and Dr. Gupta finds patients often experience both conditions at once. In these cases, she prescribes a tea tree oil solution (such as Cliradex, Bio-Tissue, Doral, Fla.), and Avenova eyelid cleanser (NovaBay Pharmaceuticals, Emeryville, Calif.). The clinicians interviewed for this article all refer to a dermatol- ogist if there is facial involvement of the rosacea and/or Demodex. Dermatologists will usually consider oral therapy with ivermectin to treat Demodex, Dr. Gupta said. Adding cataract surgery to the mix Although Dr. Matossian usually likes to try 1 treatment at a time in evaporative tear dysfunction patients, if they are prepping for cataract surgery, she'll try several things at once, including the Bruder mask, omega-3s, oral antibiotics, and a topical steroid. "I don't want to delay surgery for 3 to 5 months," she said. "I tend to use 3 or 4 prod- ucts and explain we want to get the ocular surface optimized." It's crucial to identify patients with meibomian gland dysfunction or related issues before cataract sur- gery because the surgery can worsen dry eye disease and symptoms, Dr. Gupta said. "If it's not treated, it creates an issue," she said. Patient education is key Patient education is crucial with any patient who has evaporative tear dysfunction. "It's critical for patients so that they understand the disease is progressive and the treatment approach is multifactorial and also chronic," Dr. Hardten said. Dr. Matossian likes to educate patients about other environmen- tal influences on evaporative tear dysfunction. She tells patients how a fan over the bed and air con- ditioning or heat vents blowing right on the face could exacerbate evaporative tear dysfunction. She also addresses the value of humid- ifiers, computer screen breaks, and adequate hydration. EW Editors' note: The physicians have no financial interests related to this article. February 2016 • Ocular surface disease INDICATIONS AND USAGE SIMBRINZA ® (brinzolamide/brimonidine tartrate ophthalmic suspension) 1%/0.2% is a fixed 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 five (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 specifically 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 SIMBRINZA ® Suspension 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. Study Design: A prospective, randomized, multicenter, double-blind, parallel-group study of 189 patients with open-angle glaucoma and/or ocular hypertension receiving treatment with a PGA. PGA treatment consisted of either travoprost, latanoprost, or bimatoprost. Patients in the study were randomized to adjunctive treatment with SIMBRINZA ® Suspension (N=88) or vehicle (N=94). The primary efficacy endpoint was mean diurnal IOP (IOP averaged over all daily time points) at Week 6 between treatment groups. Key secondary endpoints included IOP at Week 6 for each daily time point (8 am, 10 am, 3 pm, and 5 pm) and mean diurnal IOP change from baseline to Week 6 between treatment groups. 1 ADD SIMBRINZA ® Suspension to a PGA for Even Lower IOP 1 * Prescribe SIMBRINZA ® Suspension as adjunctive therapy to a PGA for appropriate patients SIMBRINZA ® Suspension should be taken at least five (5) minutes apart from other topical ophthalmic drugs Learn more at myalcon.com/simbrinza For additional information about SIMBRINZA ® Suspension, please see Brief Summary of full Prescribing Information on adjacent page. Reference: 1. Data on file, 2014. © 2015 Novartis 3/15 SMB15017JAD 5.6 † mm Hg additional mean diurnal IOP lowering observed from base - line when added to a PGA 1 Up to 7.1 mm Hg additional IOP reduction from baseline when added to a PGA 1 * PGA study-group treatment consisted of either travoprost, latanoprost, or bimatoprost. † Treatment difference (mm Hg) and P-value at Week 6 was -3.7, P<0.0001. IOP Time Points (mm Hg) 1‡ Treatment Arm 8 am 10 am 3 pm 5 pm PGA + SIMBRINZA ® Suspension (N=83) Baseline § 24.5 22.9 21.7 21.6 Week 6 19.4 15.8 17.2 15.6 PGA + Vehicle (N=92) Baseline § 24.3 22.6 21.3 21.2 Week 6 21.5 20.3 20.0 20.1 ‡ Least squares means at each Week 6 time point. Treatment differences (mm Hg) and P-values at Week 6 time points between treatment groups were: -2.14, P=0.0002; -4.56, P<0.0001; -2.84, P<0.0001; -4.42, P<0.0001. § Baseline (PGA Monotherapy). Mean Diurnal IOP (mm Hg) 1|| Treatment Arm PGA + SIMBRINZA ® Suspension (N=83) Baseline ¶ 22.7 Week 6 17.1 PGA + Vehicle (N=92) Baseline ¶ 22.4 Week 6 20.5 || Treatment difference (mm Hg) and P-value at Week 6 was -3.4, P<0.0001. ¶ Baseline (PGA Monotherapy).

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