Eyeworld

61 EW CORNEA March 2016 instill alcaftadine in their eyes, they often wake up itch-free the follow- ing morning. Udell, who was involved in review- ing some of the data on Pazeo, reported that there was longer action for some patients with mild to moderate allergic disease. "They might find that it is more effective on a once-a-day basis than Pataday," Dr. Udell said. However, Leonard Bielory, MD, professor of medicine, allergy and immunology, Rutgers University, and Thomas Jefferson University, Philadelphia, said, "I'm not clear how a higher concentration gets you to where you want to go based on the pharmacokinetics of the molecule. The half-life is the same." In some patients, it causes some irritation. Another dual acting agent is Lastacaft (alcaftadine, Allergan, Dublin). Dr. Abelson describes this as offering barrier protection and having antihistaminic qualities. "That explains the long duration of action of alcaftadine and its dramat- ic ability to prophylax," Dr. Abelson said. "If patients start taking it at the beginning of the season once a day, they're going to have a different season most likely." Dr. Abelson views Lastacaft as a new class. "I look at Lastacaft as the first of many agents in the upstream prevention of early adherence and damage caused by the pollen itself," Dr. Abelson said. "Everything we've done suggests that we try and keep as many of the mediators inside the mast cell as possible—that has been my thought for the last 20 years." Before the idea was to block these as they tried to bind to certain recep- tors. "We're now moving to the third phase, which is to try and head them off at the pass and not even get to the mast cell," Dr. Abelson said. Using confocal microscopy, Paul Gomes, MS, head of the ocular allergy group, Ora, Andover, Mass., noted that prophylactically Lastacaft prevents the allergic reaction from occurring. "Not only do you see the clinical benefit during the acute phase for itching and redness, but you also see what's happening during the late phase at the cellular level shutting down inflammation," Mr. Gomes said. Over the past 10 years, Dr. Abelson has become attuned to a condition known as morning congestion syndrome where patients wake up with swollen, red eyes. "It's some type of low-level inflammation that occurs from the result of the previous day, so the eye is going through an inflammatory process," he said, adding this seems to be more prevalent in allergy season. He finds that when patients That's all you need! One-size-fits-all punctum plug eliminates sizing and simplifies stocking Pre-stretched shape (on inserter) avoids dilation and facilitates insertion Expanded shape (once inserted) assures snug fit and virtually eliminates pop-out Soft collar prevents migration and provides patient comfort FCI-Ophthalmics.com 800.932.4202 Plug into FCI for Dry Eye Treatment and watch the SnugPlug insertion video. Visit PlugintoFCI.com for promotional pricing ™ For patients who wake up with swollen red eyes during the allergy season, prophylactic use of Lastacaft may help this from occurring the next morning. Source: Mark Abelson, MD continued on page 62

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