Eyeworld

EW NEWS & OPINION 24 November 2016 the recommendation. "This indi- cates that subspecialty training and bias affects therapeutic choices," Dr. Palestine said. In a meta-analysis, the Amer- ican Uveitis Society supported the use of TNF antagonists as first-line therapy for ocular Behçet's disease, the study authors said. Many times, subspecialty train- ing does not address the co-manage- ment of diseases with multi-system involvement, and specialists on both sides of the fence may not be aware of common practices from other specialties, Dr. Palestine said. To help address this, the University of Colorado now has a joint rheu- matology/ophthalmology clinic; it also has rheumatology fellows rotate through ophthalmology as part of their training. Another issue found from the study results is the role of cost and prior authorization, both of which had a statistically significant effect on the choice of biologic therapy. These medications are expensive and are often rejected by third-par- ty payers more than non-biologic immunomodulatory agents. The results do not surprise Esen Akpek, MD, Bendann Family Professor of Ophthalmology and Rheumatology; director, Ocular Sur- face Disease and Dry Eye Clinic; and associate director, Johns Hopkins Jerome L. Greene Sjögren's Syn- drome Center, Wilmer Eye Institute at Johns Hopkins, Baltimore. "Many doctors don't want to prescribe med- ications that require prior authori- zation," she said. "Many ophthal- mologists do not ordinarily prescribe immunomodulators or biologics. We usually ask rheumatology col- leagues to prescribe our choice of medication." EW Reference 1. Palestine AG, et al. Rheumatologists and ophthalmologists differ in treatment decisions for ocular Behçet disease. J Clin Rheumatol. 2016;22:316–319. Editors' note: The physicians have no financial interests related to their comments. Contact information Akpek: esakpek@jhmi.edu Palestine: ALAN.PALESTINE@ucdenver.edu Rheumatologists did not select a local steroid implant as a first- or second-line therapy, which may reflect the lack of exposure to this option outside of ophthalmolo- gy. However, the steroid implant options are the only FDA-approved treatment for posterior uveitis, including Behçet's disease, the au- thors wrote. One insight gleaned from the research is that specialists may not always follow published recommen- dations in their treatment choices. "It is likely that training and experi- ence have a strong influence in ther- apeutic choices for both rheumatol- ogists and ophthalmologists. There are most likely also regional differ- ences that could not be addressed in our study," the authors wrote. Treatment continued from page 22 Only the HOLOS IntraOp ™ Wavefront Aberrometer continuously streams patient refractive data. Meaning you'll get a non-stop look at your procedure as it changes. And see cataract surgery in a whole new light. With HOLOS, precision doesn't pause —and neither will you. Really real time. HOLOS.com ©2016 Clarity Medical Systems Inc. PN 100331 Rev B 10/16 Exclusive IOL Predictor NOW AVAILABLE

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