Danica Yang, OD, MS, FAAO, will be filling in for me this week. Read more about her below.


Give your lids a lift!

Have you been visited recently by a rep with pamphlets and samples of an eye drop called Upneeq?

What is it?

Upneeq (oxymetazoline hydrochloride ophthalmic solution, 0.1%; RVL Pharmaceuticals) is a new eye drop indicated for the treatment of patients with acquired blepharoptosis who do not want to pursue surgical repair.

The active ingredient sounds familiar …

The active ingredient is oxymetazoline hydrochloride. You may recall that at lower concentrations, oxymetazoline is more commonly known as a decongestant found in the nasal spray Afrin. As an alpha-adrenergic agonist, oxymetazoline contracts the Müller muscle and lifts the upper eyelid.

How effective is it?

An analysis of two randomized, double-masked trials found that oxymetazoline, 0.1% once daily significantly increased the superior visual field by four points on the Leicester Peripheral Field Test and increased the marginal reflex distance 1 (the distance from the upper lid margin to the central pupillary reflex) by 0.5 mm when compared with the control. Participants in this study used the drop once daily for 6 weeks and observed effects within 2 hours of drop instillation.

How do patients get it?

The drug is available exclusively through RVL Pharmacy. Once a prescription is received by RVL, the pharmacy contacts the patient and sends them the medication.

How much does it cost?

The drug is estimated to cost between $90 and $120 for a 30-day supply. There is no insurance coverage at this time.

Are there any contraindications?

Yes. While the study showed no effect on vital signs, caution should be taken with patients with cardiovascular disease, orthostatic hypotension, and uncontrolled hypertension or hypotension. Upneeq may also be contraindicated in patients taking beta-blockers or alpha-adrenergic receptor antagonists. In addition, watch narrow angles carefully, as the medication can increase the risk of angle closure.

The take home:

Oxymetazoline, 0.1% appears effective and safe for the nonsurgical treatment of acquired blepharoptosis. It can be used daily or only for special events for patients who want a temporary boost to their lids. There is one caveat: Follow-up time in the two large studies was only 6 weeks. Longer studies are still needed to determine long-term safety and efficacy for this new therapy.


Is there anything new for migraines?

New data on the efficacy of topically applied beta-blockers for the treatment of migraines has come out.

Tell me about the study.

In a randomized crossover clinical trial, 50 patients with a history of migraines received either timolol maleate ophthalmic solution, 0.5% or placebo eye drops for 3 months. All patients were instructed to use their assigned eye drop at the first sign of a migraine. After a 1-month washout period, the patients were switched to the other treatment for another 3 months with the same protocol.

What did they find?

The study found that 233 of the 284 migraines treated with timolol (82%) were associated with a 4-point reduction in pain score, or to zero, at 20 minutes compared with 38 of the 271 migraines treated with placebo (14%). This was found to be statistically significant (P<.001).

How does this differ from previous research?

A previous randomized, crossover study in 10 participants with a shorter follow-up and shorter washout period found no statistically significant difference between timolol maleate, 0.5% and a placebo drop.



The approximate reimbursement for PPE costs per patient visit. Effective September 8, you may bill the CPT code 99072 for “additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency as defined by law, due to respiratory-transmitted infectious disease.” (via) (via)


Danica Yang, OD, MS, FAAO

Dr. Yang practices full-scope optometry in Brooklyn, New York. She completed her degree in optometry at SUNY College of Optometry with a joint Master of Vision Science. Dr. Yang specializes in myopia control and enjoys finding new ways to educate patients and parents about the condition through lectures, writing, and conducting clinical research. She became a Fellow of the American Academy of Optometry this year and is excited to continue her professional journey in the field of eye care.

Have a great week!