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.

See what your colleagues are thinking on OptometricPhysician® Blog.

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.

Arthur B. Epstein, OD, FAAO Chief Medical Editor artepstein@optometricphysician.com

 

Want to share your perspective? Write to Dr. Epstein at artepstein@optometricphysician.com. Please indicate if you would like your thoughts shared on OP-Blog and if they should be attributed or anonymous. The views expressed in this editorial are solely those of the author and do not necessarily represent the opinions of the editorial board, Jobson Publishing or any other entities or individuals.

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. Doctor-patient communication, 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.