Article Date: 10/1/2008



Incomplete Coverage

To the Editor,
While Dr. Puchalski gave a thorough overview of different antibiotic classes ("The Bugs vs. The Drugs: A Guide to Antibiotics," OM, July 2008), the information about levofloxacin ophthalmic solution 1.5% was incomplete.

Levofloxacin 1.5%, available commercially as Iquix, has a broad spectrum of activity against both gram-negative and gram-positive organisms. The author correctly highlighted the drug's gram-negative activity, which is very important, particularly against the most virulent cause of corneal ulcers. Iquix is the only newer-generation fluoroquinolone approved for the treatment of corneal ulcers.

However, the author failed to mention levofloxacin's equally important gram-positive coverage. Iquix has been shown to be active both in vitro and in clinical infections against the most common gram-positive pathogens affecting the eye, including Staphylococcus aureus, S. epidermidis, and Streptococcus pneumoniae.

Like moxifloxacin and gatifloxacin, levofloxacin inhibits both topoisomerase IV and DNA gyrase, two enzymes necessary for bacterial replication. And finally, Iquix has been tested and is approved for use in children age six and older, rather than only in adults, as the article stated. For further information, readers can visit

Art Shedden, MD
Medical Director,
Vistakon Pharmaceuticals

Models and Care

To the Editor,
"Primary care is the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal healthcare needs, developing a sustained partnership with patients and practicing in the context of family and community."

Donaldson M, Yordy K, Vanselow N, eds. Institute of Medicine. Defining primary care: an interim report. Washington, DC: National Academy Press, 1994:16.

I read your editorial ("O.D. to O.D.," OM, June 2008) with interest and concurrence. However, I would go a step further. As I've stated in the Journal of the American Optometric Association (Defining Primary Care, Jan. 1997), optometry has the responsibility to provide "integrated, accessible comprehensive, coordinated, continuous vision and eyecare services in the context of family and community (culturally appropriate), or at least to assure access to such care through referrals." I'm pleased we provide enhanced access to care, including medical eyecare services. However, as you state, it also concerns me that to choose a model rather than recognize a practitioner's ability to provide additional services often results in limiting the perception of the practitioner's abilities to provide comprehensive services. Many O.D.s don't focus on non-medical vision care, developmental vision, binocular vision, functional vision for sports, computer usage and activities of daily living, etc. The demand for these services has never been greater. There is no better recent illustration of the connection between functional vision, neurological science and the medical model of care than veterans who've experienced post-traumatic vision disorder (PTVD) during the Iraqi conflict. As you say, there's no right or wrong choice for an individual O.D., only personal choice. However, providing every service you can rather than limiting the practice to one model or another may be the wisest of choices for both the practitioner and the visual health and well being of all Americans.

Norma K. Bowyer, O.D.

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Optometric Management, Issue: October 2008