Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
COVER STORY Treatment on a Budget Clinicians must help guide cost-conscious patients in their use of over-the-counter drops for the treatment of ocular allergy. BY DAVID A. GOLDMAN, MD A s unemployment rates stay high and more people lose insurance coverage, an increasing number of patients are asking their physicians for cheaper alternative medications. The prevalence of ocular allergy is at least four times that of nasal allergy symptoms,1 and some of the least expensive antiallergy drops are available over the counter. In a majority of cases, they cost less than generic prescription medications. The question is, do they work? In short, the answer is yes, but not all over-the-counter (OTC) drops are created equal. It is the duty of eye care professionals to steer patients in the right direction. There are well over a dozen OTC antiallergy drops, but they are mainly composed of one or two similar active ingredients. PHENIRAMINE MALEATE/NAPHAZOLINE Pheniramine maleate/naphazoline is the common ingredient in products such as Naphcon-A (Alcon Laboratories, Inc., Fort Worth, TX) and Opcon-A (Bausch + Lomb, Rochester, NY). The combination of an antihistamine and a vasoconstrictor can increase patients’ ocular comfort and decrease hyperemia. Multiple clinical studies have proven the efficacy of this combination.2,3 Unfortunately, rebound hyperemia and chemosis are frequent. Furthermore, a reactive conjunctivitis can occur that may take months to resolve.4 KETOTIFEN FUMARATE Ketotifen fumarate is the common ingredient in the majority of OTC antiallergy drops, including Zaditor (Novartis Pharmaceuticals Corporation, East Hanover, NJ), Alaway (Bausch + Lomb), Zyrtec Itchy Eye (Pfizer Inc., New York, NY), and Claritin Eye (Schering-Plough Corporation, Kenilworth, NJ). A second-generation H1antihistamine/mast cell stabilizer, ketotifen effectively treats the signs and symptoms of ocular allergy. It has been found to be more efficacious at reducing ocular 54 ADVANCED OCULAR CARE MARCH 2010 A sampling of the antiallergy drops that are available over the counter. itching and redness than fluorometholone acetate in the treatment of seasonal allergic conjunctivitis.5 In a comparative study, 0.025% ketotifen fumarate was superior to 0.1% olopatadine hydrochloride for the relief of the signs and symptoms of vernal conjunctivitis.6 In a study of patients’ preferences regarding the treatment of allergic conjunctivitis, however, individuals preferred olopatadine drops to ketotifen drops, because they found the former more efficacious and comfortable.7 Since the completion of this study, Alcon Laboratories, Inc., has released olopatadine hydrochloride ophthalmic solution 0.2% as a once-daily, dosed, antiallergy drop (Pataday). Although the q.d. dosing certainly lends itself to better compliance, it can come at a significant financial cost to patients. ALTERNATIVE REMEDIES Similasan Allergy Eye Relief (Similasan Corporation, Highlands Ranch, CO) is a homeopathic eye drop with active ingredients listed as apis, euphrasia, and sabadilla. COVER STORY Some patient-reported anecdotes of clinical success notwithstanding, there are no clinical studies proving any benefit to this product. SUMMARY OTC drops can be very effective for treating the signs and symptoms of ocular allergy, and they can be especially helpful to patients who have been hit hard by the current US economy. Although naphazoline/pheniramine maleate combination drops have proven beneficial in clinical trials, more evidence supports the use of ketotifen fumarate drops, which do not share the potential problem of rebound hyperemia and chemosis. Unfortunately, not all patients with allergic conjunctivitis will respond to drops containing ketotifen fumarate. At the very least, however, these OTC medications provide an inexpensive and readily available starting point for patients with allergic conjunctivitis. ■ David A. Goldman, MD, is an assistant professor of clinical ophthalmology at Bascom Palmer Eye Institute in Palm Beach Gardens, Florida. He is a consultant to Alcon Laboratories, Inc.; Allergan, Inc.; Aton Pharma, Inc.; Inspire Pharmaceuticals, Inc.; and Sirion Therapeutics. Dr. Goldman may be reached at (561) 515-1543; [email protected]. 1. Singh K,Bielory L.Ocular allergy:a national epidemiologic study.J Allergy Clin Immunol.2007;119(1):S154-S154. 2. Dockhorn RJ,Duckett TG.Comparison of Naphcon-A and its components (naphazoline and pheniramine) in a provocative model of allergic conjunctivitis.Curr Eye Res.1994;13(5):319-324. 3. Greiner JV,Udell IJ.A comparison of the clinical efficacy of pheniramine maleate/naphazoline hydrochloride ophthalmic solution and olopatadine hydrochloride ophthalmic solution in the conjunctival allergen challenge model.Clin Ther. 2005;27(5):568-577. 4. Soparkar CN,Wilhelmus KR,Koch DD,et al.Acute and chronic conjunctivitis due to over-the-counter ophthalmic decongestants.Arch Ophthalmol.1997;115(1):34-38. 5.Borazan M,Karalezli A,Akova YA,et al.Efficacy of olopatadine HCI 0.1%,ketotifen fumarate 0.025%,epinastine HCI 0.05%, emedastine 0.05% and fluorometholone acetate 0.1% ophthalmic solutions for seasonal allergic conjunctivitis:a placebocontrolled environmental trial [published online ahead of print July 9,2008].Acta Ophthalmol.2009;87(5):549-554. 6. Hida WT,Nogueira DC,Schaefer A,et al.Comparative study between 0.025% ketotifen fumarate and 0.1% olopatadine hydrochloride in the treatment of vernal keratoconjunctivitis [in Portuguese].Arq Bras Oftalmol.2006;69(6):851-856. 7. Leonardi A,Zafirakis P.Efficacy and comfort of olopatadine versus ketotifen ophthalmic solutions:a double-masked,environmental study of patient preference.Curr Med Res Opin.2004;20(8):1167-1173. Our comprehensive publishing group covers the globe...from anterior to posterior.