EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78712
April 2012 Ocular allergies February 2011 Combination drops are first-line therapy for allergies by Jena Passut EyeWorld Staff Writer M any ocular allergy suffers first try to quash symptoms by self-medicating with over-the-counter drops, but different classes of med- ications, especially combination an- tihistamine/mast cell stabilizers, are quite effective treating the irritating condition, according to several prac- titioners who spoke to EyeWorld. More than 90% of patients with ocular allergy symptoms are affected by either seasonal allergic conjunc- tivitis (SAC) or perennial allergic conjunctivitis (PAC), with swelling and itching being hallmark symp- toms. Drop therapies available today attempt to stave off allergic conjunc- tivitis by focusing on the character- istic mast cell degranulation that is associated with the condition. Mast cell stabilizers help prevent the re- lease of numerous pro-allergy media- tors, while antihistamines block histamine from binding at its recep- tors after it already has escaped from the mast cell, according to Mark B. Abelson, M.D., associate clinical professor of ophthalmology, Harvard Medical School, Boston. There is tremendous overlap of symptoms with dry eye disease, Dr. Abelson said. "Once your tear volume is de- creased you have less of a diluent eyewash and barrier protection ef- fect of the normal tears, and the ep- ithelial surface breaks down and the junctional complexes between the cells fall apart," he said. E-cadherins and other keratins are broken down in a SAC patient's conjunctiva, which may explain why the epithelium in these patients is less able to protect against aller- gens, said Paul Gomes, M.S., vice president of allergy research, Ora, Andover, Mass., an independent ophthalmic drug and device development firm founded by Dr. Abelson. Both Mr. Gomes and Dr. Abelson have been heavily involved in developing combination therapies for allergy suffers, especially over the past 15 years, Dr. Abelson said. "There have been studies [with] biopsies of conjunctival tissue of allergy patients out of season com- pared to normal patients that show a degradation or a decrease in those junctional proteins that keep the epithelium barrier tight," Mr. Gomes said. "We've also done studies for the most recent antihistamine to be approved to show that antihista- mines have the ability to prevent degradation of those type of pro- teins. We are looking at other therapies to prevent that from happening." Before drops, ophthalmologists have to manage more than just the eyes of the patient, according to Terrence P. O'Brien, M.D., Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami. "We have to approach the pa- tient both from a systemic point of view and ocular point of view be- cause the eyes are obviously con- nected to the rest of the body," he said. "Some doctors view this as a nuisance to handle, but the impact on quality of life is substantial." SAC often is accompanied by rhinitis, or runny nose. "Patients usually focus on the nasal symptoms, even though the eye symptoms can make them mis- erable, too," Andrea Leonardi, M.D., neurosciences department, ophthalmology unit, University of Padua, Italy, said. Many ophthalmologists like Drs. Abelson, O'Brien, and Leonardi agree that avoidance is a key first step, but when that's not enough, there are a number of drugs in a doctor's arma- mentarium, including antihista- mines and mast cell stabilizers. continued on page 58 Practice Makes Perfect KITARO®Kits. The Revolutionary Training Tool to Practice Cataract Surgery The KITARO WetLab system has a high-quality artificial cornea & cataract lens allowing you to practice: • Creating Appropriate Incisions • Filling the Anterior Chamber • Performing CCC • Executing Hydrodissection & Hydrodelineation • Grooving & Splitting the Nucleus • Emulsification & Aspiration • Removing the Cortex • IOL Implantation The KITARO DryLab system allows you to quickly improve your cataract surgical skills including: • Continuous Curvilinear Capsulorhexis • Nucleus Dividing • Phacoemulsification • Wound Construction & IOL Insertion EW SECONDARY FEATURE 57 Visit FCI-Ophthalmics.com/ Cataract#Kitaro & watch the KITARO Training video. Most practitioners agree that combination drops are the go-to therapy for SAC (pictured here) Source: Andrea Leonardi, M.D. FCI-Ophthalmics.com 800.932.4202 Call us at 800-932-4202 to receive promotional pricing on your first KITARO WetLab & DryLab Kit. NEW