Off the Cuff: Solutions of the Future
After nearly two years of uncertainty, better news looms on the horizon for contact lens practitioners and patients. With the lens care recalls of the past two years fading into memory, what we've learned will undoubtedly help improve patient safety and product effectiveness. The FDA and ISO are presently working on new regulations for contact lens care product testing, regulations that will hopefully better account for the real-world challenges that our patients face.
So what will the contact lens care product of the future look like? Two areas are likely to get the attention of the FDA and ISO standards group.
Enhanced real world disinfection will almost certainly top the list. Multipurpose solutions will require stronger disinfecting capability. Dual disinfectant systems, similar to the combination in some MPS products currently available, will likely become necessary to meet new disinfection standards.
Biocompatibility is another hot area. With the use of new, more complex contact lens materials growing, the likelihood of lens-solution interaction has increased. As a result, material and biocompatibility testing will almost certainly be part of any new FDA testing protocols.
So what will this mean for us? More stringent requirements and enhanced products meeting these requirements will yield greater safety and a better contact lens experience for our patients. Until then, a good understanding of lens care products, contact lens material interactions and sound professional judgment will be critical in keeping our contact lens patients safe and sound.
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Doctor-Patient Communication, Health-Related Beliefs,
and Adherence and Persistency in Glaucoma
Retrospective databases and chart reviews in combination with prospective
patient surveys were used to determine drivers of patient adherence to topical
ocular hypotensive therapy.
A total of 300 patients with a new claim diagnosis for open-angle
glaucoma who initially were prescribed one of three prostaglandins
and 103 physicians participating in the same medical plans were
assessed. A structured interview addressing self-reported adherence,
experiences with medication, communication with the physician and
health-related beliefs associated with adherence behavior was
administered to surveyed patients. Phone interviews were conducted
with participating ophthalmologists.
Eight variables were associated independently with a lower medication
possession ratio: 1) hearing all of what you know about glaucoma from
your doctor (compared with some or nothing); 2) not believing that
reduced vision is a risk of not taking medication as recommended;
3) having a problem paying for medications; 4) having difficulty
adhering to medication regimen while traveling or away from home;
5) not acknowledging stinging and burning; 6) being non-white;
7) receiving samples; and 8) not receiving a phone call/visit reminder.
The multivariate model explained 21 percent of the variance.
These findings indicate that doctor-patient communications and
health-related beliefs of patients contribute to patient adherence.
Patient learning styles that are associated with less concern about
the future effects of glaucoma and the risks of not taking medications
are associated with lower adherence. Specifically, knowledge about
potential vision loss from glaucoma is a critical element that tends
to be missed by more passive, doctor-dependent patients, who tend
to be poorly adherent. These findings suggest that educational efforts
in the office may improve patient adherence to medical therapies.
SOURCE: Friedman DS, Hahn SR, Gelb L, et al.
health-related beliefs, and adherence in glaucoma results from
the Glaucoma Adherence and Persistency Study. Ophthalmol 2008;
Mar 3 [Epub ahead of print].
Infectious Keratitis in Keratoconus with Corneal Hydrops Without CL Wear
Infectious keratitis was diagnosed in a 58-year-old man, with spontaneous onset of pain,
redness, photophobia and decreased vision. He had no history of contact lens use or
any ocular allergy. Noncoagulase Staphylococci were cultured from the corneal scrapings,
and treatment was started with fortified antibiotics. Response to treatment was noted,
and the patient is awaiting keratoplasty.
This case report highlights the occurrence of infectious keratitis in a case
of keratoconus with corneal hydrops without any antecedent history of contact lens use.
SOURCE: Jhanji V, Sharma N, Agarwal T, Titiyal JS. Infectious keratitis in keratoconus with corneal hydrops without contact lens wear: A case report. Eye Contact Lens 2008;34(2):122-3.
Retinal Artery Occlusion in a Healthy Pregnant Patient
A 29-year-old pregnant woman presented with decreased vision in her left eye.
She had a pale retina, with macular edema consistent with branch retinal
artery occlusion (BRAO). An extensive workup was performed to determine an
etiologic factor. All test results were within normal limits except for her
factor VIII activity. Her visual acuity improved from finger counting to 20/30
over two months without treatment.
This case suggests that BRAO can occur in healthy patients without
any systemic or ocular disorders, despite an extensive evaluation.
SOURCE: Chung YR, Kim JB, Lee K, Lew HM. Retinal artery occlusion in a healthy pregnant patient. Korean J Ophthalmol 2008;22(1):70-1.
NEWS & NOTES
NEW STEROID FOR POST-OP OCULAR INFLAMMATION EARNS NDA ACCEPTANCE.
The FDA has granted priority review and accepted a New Drug Application
(NDA) from Sirion Therapeutics, Inc. for its investigational compound
Durezol (difluprednate ophthalmic emulsion) 0.05%, a twice-daily
steroid for treating postoperative ocular inflammation. Durezol is a
difluorinated derivative of prednisolone and has potent anti-inflammatory
activity. Its efficacy and safety in ocular inflammatory diseases has
been demonstrated in an extensive preclinical and clinical program in
Japan. Priority review is granted by the FDA to drugs that have the
potential to provide a significant improvement compared to marketed
products; the designation results in a review period of six months
from the date of receipt of the NDA. Data from two Phase III clinical
studies of Durezol in post-operative inflammation will be presented at
the American Society of Cataract and Refractive Surgery 2008 Symposium
and Congress in April 2008.
FUNGI MAY CAUSE SOME RETINOPATHIES.
A research team from the Centro de Biologia Molecular Severo Ochoa
(CSIC-UAM) working in collaboration with the Clinica Barraquer in
Barcelona, Spain, believe that fungi may be the cause of some retinopathies,
including some that currently have no known cause, such as acute zonal
occult outer retinopathy (AZOOR), multifocal choroiditis, serpiginous
choroiditis and idiopathic blind spot enlargement syndrome. The progressive
nature of these conditions causes most patients to lose vision gradually,
many until they are completely blind. Based on the observation that a
patient suffering form AZOOR was also infected by Candida famata, CSIC-UAM
researchers collaborated with the Clinica Barraquer to study other patients
with AZOOR or with serpiginous choroiditis. They analyzed blood samples
to discover whether antibodies against yeasts were present and to identify
fungal components such as proteins and DNA. The results of their study
indicated the existence of a disseminated mycosis in most patients, suggesting
that retinopathies including AZOOR and serpiginous choroiditis may be
caused by fungal infections. Future investigations by the research group
will include improvement of diagnosis techniques for fungal infections and
continued research into the causes of other retinopathies. The researchers
believe that these techniques will also be useful in analyzing the evolution
and effectiveness of possible antifungal treatments for patients in the study.