Eyeworld

EW NEWS & OPINION April 2016 33 Allergy Formula and Bausch + Lomb. Dr. Loff sees an expanding market for SLIT use by ophthalmologists, dermatologists, ear nose and throat specialists, primary care doctors, and allergists. John Sheppard, MD, presi- dent, Virginia Eye Consultants, and professor of ophthalmology, mi- crobiology and molecular biology, Eastern Virginia Medical School, Norfolk, Virginia, tried offering SLIT in the office as a premium service. Dr. Sheppard decided to offer this for moderate to severe ocular allergy patients; his office is also using Doctors Allergy Formula with grow- ing volume, clinical utility, patient satisfaction, and universal provider acceptance. However, with SLIT not in the mainstream of an eye prac- tice, Dr. Sheppard's office stopped offering it. "We are no longer doing SLIT, but we remain keenly interested in the prospects for expanded patient adoption. It's just easier logistically right now to send patients on to the many qualified allergists around town, several of whom enthusias- tically endorse SLIT for their pa- tients," he said. EW References 1. Sikora JM, et al. Perception and practice of sublingual immunotherapy among practicing allergists in the United States: a follow-up survey. Ann Allergy Asthma Immunol. 2013;110:194–197. 2. Anolik R, et al. Patient initiation and per- sistence with allergen immunotherapy. Ann Allergy Asthma Immunol. 2014;113:101–107. 3. Calderon MA, et al. Sublingual immuno- therapy for allergic conjunctivitis: Cochrane systematic review and meta-analysis. Clin Exp Allergy. 2011;41:1263–1272. Editors' note: Dr. Loff has financial interests with Bausch + Lomb. The other physicians have no financial interests related to their comments. Contact information Bielory: drlbielory@gmail.com Cox: lindacox1955@gmail.com Loff: hloffmd@doctorsoptimalformula.com Miller: tmiller@sacent.com Sheppard: docshep@hotmail.com Of course, unpredictable insur- ance coverage also can be a down- side. Ironically, one potential ben- efit of SLIT—not having to come to a doctor's office for shots—also turns into a downside. "Despite the obvious convenience factor of home dosing, adherence to sublingual immunotherapy regimens is consis- tently below that of subcutaneous administration," said Dr. Miller, citing evidence from a 2014 study. 2 "Patients should be given instruc- tions on dosing, timing, and what to do if they have increased allergy symptoms or an illness." It's important to consider which patients may be best suited for SLIT based on their age, health condi- tions, the severity of their allergies, asthma state, and motivation, Dr. Miller said. Clinicians treating allergy patients also must think beyond SLIT and examine for other atopic disorders a patient might need to have treated, Dr. Bielory said. This could include eczema, rhinitis, and asthma. All eyes on SLIT for ocular allergy Most research regarding SLIT focuses on allergic rhinitis, but there is evi- dence that it can help eye symptoms as well as hay fever. A 2011 literature review from authors in the U.K. analyzed the effectiveness of SLIT to reduce ocular symptoms. They found that SLIT in- duced a significant decrease on total ocular symptom scores, individual symptom scores, and itchy and wa- tery eyes compared to placebo. 3 Howard Loff, MD, Jacksonville, Florida, founder of Doctors Allergy Formula (which was recently ac- quired by Bausch + Lomb, Bridgewa- ter, New Jersey), became interested in SLIT after seeing several studies on its efficacy. Although many patients with ocular allergy can be treated with avoidance or pharmaco- therapy, he does see a small market for SLIT in ophthalmology. For this reason, he's developed a protocol for using SLIT in ophthalmology that is separate from his work with Doctors Uniform epithelium removal in only 5 - 7 seconds Corneal Xlinking, PRK Advanced Surface Ablation Improved clinical outcomes of CXL and PRK with Amoils Epithelial Scrubber Minimize total procedure time Avoid alcohol damage to surrounding tissue No need for subsequent scraping T. 800.461.1200 www.innovativexcimer.com g e uent scraping er.com order online www.innovativexcimer.com in the S4OPTIK booth #2055 Visit AMOILS at the ASCRS www.innovativexcimer.com AMOILS

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