Do You Have an After-Hours Plan for Drug Rx’s?

HOT TOPIC

Scleral Lens Used as Drug Delivery System in Dry Eye Trial

A new study published in the journal Clinical Ophthalmology seems poised to open some eyes in the eye care community. In the open-label, prospective, noncomparative clinical trial, cyclosporine ophthalmic emulsion 0.05% (Restasis, AbbVie), was used in the reservoir of a PROSE scleral lens (BostonSight) for the treatment of dry eye disease. (For those unaware, a PROSE treatment uses a specialized scleral lens to treat patients with corneal irregularities and ocular surface disease.)

BostonSight

The study’s research lead, Daniel Brocks, MD, chief medical officer at BostonSight, said that, ultimately, they anticipate their research in this area will lead to additional ocular management strategies to improve ocular health and the lives of patients.

The study instructed the nine participants (18 eyes) who completed the study to instill one drop of preservative-free cyclosporine 0.05% into the PROSE reservoir and to then fill the rest of the reservoir with regular preservative-free saline. After applying the PROSE lens and wearing it for 6 hours, the lens was removed, and the protocol was repeated for at least another 4 hours of wear. Baseline, 1-week, and 1-month sign and symptom data were collected.

The results showed an Ocular Surface Disease Index score improvement by an average of 3.83 from baseline. The study researchers concluded that using the PROSE lens as a drug delivery system for nonpreserved cyclosporine 0.05% was well-tolerated with regard to both ocular symptoms and ocular surface signs. (Read more here.)

My Two Cents

I’ve often wondered about this in my clinic; however, I’ve been hesitant to pull the trigger on recommending my patient add anything other than a preservative-free saline or a drop or two of preservative-free artificial tears to their lens reservoir (to increase the viscosity). I have colleagues who regularly recommend the addition of serum tears into the scleral lens bowl and have contemplated this many times for some of my toughest patients, but I haven’t gotten comfortable with that sitting in a warm bowl of saline against a likely compromised ocular surface all day. Cyclosporine would be a wonderful option to consider. Not only that, but topical antibiotics could be another potential consideration to add into the bowl for some of our toughest ulcers!

OUTSIDE THE LANE

Elton John Update

Some time ago, I profiled Elton John’s “severe” eye infection that was giving him some problems. Recently, Rolling Stone Magazine provided us an update on his status. According to the article, the infection has caused the music mastermind to lose sight in his right eye for 4 months. Over the summer, Sir Elton John contracted the infection while in the south of France. In a September Instagram update, he updated his fans and stated that it would take some time before sight returned to his affected eye.

@eltonjohn

In a recent interview with Good Morning America, Elton John provided more details on how he has been affected, including those related to the release of his new album. He said, “It’s been a while since I’ve done anything … There’s hope and encouragement that it will be okay, but I’m kind of stuck at the moment. Going into the studio and recording, I don’t know … .” He cited his loss of vision as preventing him from reading lyrics or viewing much.

My Two Cents

The other day while grocery shopping, I glanced at the tabloids in the checkout line, and I wondered how Sir Elton’s eye was. Hopefully when this whole situation is behind him, he’ll come out with exactly what kind of “infection” he had so we can better educate our patients on how eye issues can affect anyone and that they’re not worth taking lightly.

CAN YOU RELATE

Sometimes, you get a nasty ulcer in clinic and sometimes they’re really nasty. The other day I had one show up in my chair. This patient was one of those borderline arrogant patients who “never had a problem sleeping in my contacts” and always seems to know better than their money-hungry eye doctor. You all know the exact patient I’m talking about. In fact, I bet you’re already thinking of one.

Well, this patient comes to my clinic after seeking “pink eye” care from everywhere but his normal eye doctor (a wonderful local corporate OD). He had seen an urgent care clinic (or three), and they instructed him to come see me. I was contacted on a Saturday night through our emergency line and, although he wasn’t one of our patients, I decided to hop in and see him anyway. Thus far, he had been prescribed erythromycin gel twice daily and gentamycin twice daily. Below is his cornea, which, as you can see was looking a little rough. I was thinking those old antibiotics probably aren’t up to the task. What would you do in this situation?

Even in a large city such as Baton Rouge, Louisiana, we don’t have a 24-hour pharmacy (anymore). Our clinic has run into this problem before and, thanks to new developments in the eye care space, we have a “break glass in case of emergency” protocol.

When I saw this patient, I knew exactly what needed to be done immediately (and yes, a corneal culture is appropriate). I grabbed one of our clinic’s bottles of tobramycin 1.5% + vancomycin 5% compounded antibiotic formulation (Fortisite, Harrow), a drop created by the compounding pharmacy ImprimisRx. After instructing the patient on its use, I contacted a cornea specialist and scheduled the patient for an urgent referral.

If you’re practicing medical optometry, is this something that you’ve thought of? What happens if you see a patient after hours and are unable to get a medication they desperately need? Do you have difficulty getting medications compounded at local pharmacies? Think about carrying Fortisite in your clinic for such an emergency. And no, Harrow/ImprimisRx did not pay me to write this! 😉