Article Date: 8/1/2001

Practice Pulse
Tips, Trends, and News You Can Use

GLAUCOMA TREATMENT TRENDS
Experts Share Their Views at AOA

"Have prostaglandins really changed the way we're treating glaucoma," Murray Fingeret, O.D., F.A.A.O., asked an audience of about 25 well-known doctors, many of them glaucoma experts, who'd gathered at the American Optometric Association's annual meeting in Boston this past June.

"I'm finding that patients have a quicker response to prostaglandins," explained Dr. Leland Carr. "With these drugs, I no longer need to wait 2 1/2 to 3 months to see results."

Dr. Chris Quinn concurred. "I've noticed positive results in patients who were non-responders with both Travatan and Lumigan," he said. "At least half the time I'm seeing a response to indicate that the medications are working."

From left to right: Joining the symposium on glaucoma were Dr. Bobby Christensen, Dr. George Comer, Dr. Marc Bloomenstein, Dr. Robert DiMartino and Dr. Barry Eiden.

Dr. Fingeret, who presented at the Alcon-sponsored symposium with Howard Barnebey, M.D., and Robert Wooldridge, O.D., also relayed some positive experiences he's had in treating patients with the prostaglandin travoprost ophthalmic solution 0.004% (Travatan), which has been shown to have an increased effect in African American patients. "I've had a number of black glaucoma patients who've been ready to move on to surgery because we haven't been able to control their IOPs on another product," said Dr. Fingeret. "Travatan lets us delay surgery in many of these patients."

Dr. Jimmy Bartlett, a clinical investigator for Travatan, said that he's awaiting results from a blind study where the patient's diurnal IOPs decreased from 18 mm Hg to 11 mm Hg. He's not sure to which medication the patient reacted.

Did You Know?

In 2000, the market for glaucoma was $2.3 billion. By 2011, that amount is projected to nearly double to $4 billion.

Dr. Bartlett added that when he's trying a new glaucoma drug on a patient, a general rule of thumb he follows is to stop the patient's current medication, observe a wash-out period and then switch to the new drug. He uses this tactic because "I don't think that we need to just keep adding on medications. Patients like only having to take one drug -- not two or three."

Dr. Bruce Onofrey explained that he often used prostaglandins with other glaucoma medications. "I like beta-blockers when they're used rationally and in combination with prostaglandins," he said.

"However," he added, "I think a lot of doctors jump right into high-dose beta-blockers in both eyes without titrating. That's something to steer clear of."

 

Did You Know?

 

O.D.s write 8% to 15% of all prescriptions written for any type of medication; M.D.s write 85% to 92% of all Rxs. However, in the past 2 years, O.D. prescribing has jumped 20%

Dr. Fingeret said he also uses beta-blockers with prostaglandins. "I'll use a beta-blocker in the morning as an add on to Travatan, which I'll prescribe at night," he said.

Dr. Barnebey summed up the discussion with a look at future research objectives.

"Now, what we need to determine is which prostaglandin in combination with another type of glaucoma medication will give us the most efficacious treatment."

In other presentations, Dr. Barnebey gave an update on research results with Travatan and Dr. Wooldridge presented patient cases along with Dr. Fingeret.

THIRTY-DAY EXTENDED WEAR ALMOST REALITY
Focus Night and Day Lenses Approved
By Terri B. Goshko, Senior Associate Editor

Focus Night and Day lenses by CIBA Vision may soon become the first 30-day contact lenses approved in the United States. Advisors to the FDA recently recommended the lenses be approved for extended wear because they allow much higher levels of oxygen to reach the cornea than standard soft lenses. The FDA isn't legally bound to accept its panels' recommendations, but it generally does so. The decision could come as early as this fall.

The panel's vote was based on clinical data from more than 600 clinical trial participants demonstrating that the lenses gave 20/30 visual acuity or better in 99% of treated eyes when worn for 27 to 28 nights.

"CIBA Vision is now one step closer to bringing this revolutionary product to the U.S. market," said Stuart Heap, president of CIBA's global lens business. "Practitioner response to the performance of Focus Night and Day has been overwhelmingly positive. There's a strong market demand for 30 night continuous wear contact lenses in the United States, and we're eager to complete the final regulatory requirements."

Joe Barr, O.D., M.S., of Ohio State University College of Optometry in Columbus agrees. "This is a landmark accomplishment. Al-
though silicone lenses have been approved for 30 days before, the development of silicone hydrogel lens technology, overcoming the bulk and surface challenges and providing research evidence of safety and effectiveness are breakthroughs."

P. Douglas Becherer, O.D., F.A.A.O., chairman of the American Optometric Association (AOA) Contact Lens and Cornea Section, says that the new wearing schedule would represent "a controllable and healthy way to address convenience for patients and a good alternative to refractive surgery. Like any modality, if handled properly, it will be great."

This is also welcome news to Neil Gailmard, O.D., chief optometric editor of Optometric Management. "Panel approval of a 30-day extended wear lens by the FDA is a very promising development for optometrists," he says. "This new generation of materials will offer fewer complications than lenses we used in the 1980s, and we gain a whole new perspective on the safety of these lenses when they're viewed as an alternative to LASIK."

Some concerns remain about the potential for side effects, such as corneal ulcers, but the company is expected to conduct post-marketing studies to determine whether the incidence is higher. The most common reported adverse events were irritation, poor fitting and dryness.

Bausch & Lomb has submitted clinical data to the FDA for approval of PureVision soft contact lenses for 30-day wear. They're approved for this wearing schedule in Europe. Johnson & Johnson is also expected to seek approval of its extended-wear lenses.

MAKING SURE ALL'S FAIR
Low Vision Bill in the Works

As you know, macular degeneration, diabetic retinopathy, cataracts and glaucoma can all cause low vision. So as the population ages, it's more important than ever to care for patients' low vision needs. But when it comes to reimbursement, there's a noticeable lack of coverage.

Currently, Medicare covers low vision evaluations nationally, but many beneficiaries then lack coverage for prescribed therapy. The coverage for vision rehabilitation therapy depends on where beneficiaries live. Only 26 states currently cover therapy services, through either written or unwritten local Medicare carrier policies.

Representatives Michael Capuano (D-Mass.) and Mark Foley (R-Fla.) introduced the Medicare Vision Rehabilitation Services Act of 2001 H.R. 2484 to the House of Representatives. Actively backed by the American Academy of Ophthalmology, the bill was introduced to fill gaps in coverage for Medicare beneficiaries with low vision from various medical conditions.

As already allowed in states with coverage, this bill permits vision rehabilitation therapy in a doctor's office by either the doctor or a staff member directly supervised by him or her. Other appropriate settings, such as clinics and rehabilitation agencies, are also included. The legislation serves a critical need for seniors whose impairment isn't correctable by conventional refraction, medication or surgery.

NEW APPROVALS

Cleaner Lenses in the Blink of an Eye

The number-one reason for contact lens dropouts is discomfort. With that fact in mind, Allergan, Inc., developed a new product to make contact lens wear more comfortable for a longer amount of time. The company recently introduced Complete Blink-n-Clean Lens Drops. The contact lens wearer applies a few drops three to four times a day in each eye to enjoy cleaner, clearer lenses during wear. According to Allergan, the new product's formulation helps to prevent protein film buildup and remove particulate material that can cause irritation and discomfort.

Complete Blink-n-Clean Lens Drops contains hydroxypropyl methylcellulose (HPMC), which enhances wettability to help prevent attachment of debris to the surface of the lens. Designed for use with soft contact lenses, the product is ideal for extended wear materials and is sold in 20-mL bottles for a 1-month supply.

FDA Approves Implant for Glaucoma Treatment

In anticipation of FDA approval for its new glaucoma device, Staar Surgical Co. has trained more than 300 physicians to use its AquaFlow Collagen Glaucoma Drainage Device for patients who have open-angle glaucoma. Well the wait is finally over. Staar Surgical has received Premarket Approval from the FDA for the AquaFlow, which is a biocompatible, collagen-based device that's implanted into the eye to drain excess eye fluid and reduce intraocular pressure. Once a flap of outer eye tissue is folded back, the AquaFlow device is sutured above the trabecular meshwork and the outer flap is folded into place. According to Staar Surgical, the new AquaFlow swells five to 10 times its original size and is absorbed within 6 to 9 months, creating a new drainage pathway. The company reports that in most cases, AquaFlow surgery eliminated the need for glaucoma medications.

No Rub, No Preservative Lens Solution

Last month, CIBA Vision launched AOSEPT Clear Care Cleaning and Disinfecting Solution. This no rub lens care solution with no added preservatives combines the convenience of one-bottle systems with the disinfecting and cleaning power of peroxide. AOSEPT Clear Care has a built-in cleaner, as well as hydrogen peroxide to penetrate the lens for a deep cleaning. CIBA says that patients will find the solution's no-rub, 5-second pre-rinse lens cleaning process easier to use than many one-bottle solutions. In addition, every package comes with a free disposable lens case to encourage healthy habits through automatic disposal of old lens cases.

Aberrometer Receives FDA Clearance

The FDA recently cleared Bausch & Lomb's Zywave aberrometer for sale in the United States. The Zywave is a diagnostic device that enables examination of the eye's entire optical system. It uses wavefront technology to determine the unique features of each eye and identify abnormalities throughout the entire optical system. Bausch & Lomb reports that it's conducting a U.S. clinical study on 80 eyes using its Zyoptix system, which integrates information gathered by the Orbscan II and the Zywave, enabling surgeons to design individually tailored treat-
ments for their patients. The company plans to use these three devices to create a "platform of personalized vision solutions" that will range from customized contact lenses to customized laser-assisted in situ keratomileusis.

Individualized RGP Solution

Alcon Laboratories, Inc. recently introduced its new, Unique-pH Multi-Purpose Solution for rigid gas permeable (RGP) contact lens wearers. According to the company, the solution provides a soothing cushion upon lens insertion. As the pH level in Unique-pH increases to match the patient's tear pH, viscosity also increases, cushioning the lens. Unique-pH also maintains visual acuity immediately after lens insertion.

ON A MISSION
Vistakon's Plans to Educate Consumers

In June, Vistakon, a division of Johnson & Johnson Vision Care, Inc., announced plans to roll out its "Innovation Platform," a series of programs that promote optimal eye health, stimulate growth in the eyecare industry and elevate the role of the eyecare professional (ECP). The Platform priorities include growth of the contact lens business; product innovation and improvement; increasing eyecare awareness; superior customer value; and ongoing corporate responsibility.

Two new educational programs, the Science of Sight Experience and the Acuvue Eye Health Advisor Program, help increase eyecare awareness. While the goal of both pro-
grams is to reach consumers, the Science of Sight Experience reaches out directly to consumers, whereas the Acuvue Eye Health Advisor Program gives ECPs the tools to reach the consumer from the office.

O.D. NOTEBOOK 
PEOPLE AND PROMOTIONS

Rodenstock promotions. John Potocny has been named president, sales and marketing operations for Rodenstock North America, responsible for all sales and marketing activities for the U.S. and Mexico, including business development. Potocny reports to James Cox, who is the president/ CEO of Rodenstock North America.

Jan Minton has been named Rodenstock North America Frames Division's Territory Sales Manager for Tennessee and North Carolina.

Rodenstock North America Frames Division's Regional Director, Pam Wood, recently announced Sheila Snelling as territory sales manager for Cincinnati and Northern Kentucky and Tom Christner as the territory sales manager for Georgia and South Carolina.

Adelle Erdman, director of Marketing, Frames Division, announced Sabrina Lilly as the new product manager in the Frames Division.

Prominent California O.D. passes away. Robert Miles Wold, O.D., M.S. died on July 8th of cancer. He was 58. Dr. Wold received his Doctor of Optometry degree from Pacific University in 1964 and earned his M.S. in Physiological Optics from Pacific in 1966. He practiced privately in Los Altos, Calif. from 1965 to 1969, at which time he joined a group practice in Chula Vista, Calif.

Dr. Wold was president of The College of Optometrists in Vision Development, past president of the San Diego County Optometric Society and the American Optometric Foundation. He also received the first Young Optometrist of the Year award from the California Optometric Association in 1970. Dr. Wold lectured extensively in the United States and in Canada. He edited two books, co-authored two, wrote one and also published more than 120 professional articles.

COMPANY NEWS

Marchon wins four awards. Marchon Creative Services was awarded four Best On Long Island (BOLI) awards at the "BOLI 28" awards show hosted by the Long Island Advertising Club in May. Marchon was nominated for a total of 16 awards in 10 categories. Winning entries include the "Marchon Trade Catalog 2000" (Best Trade Catalog); "Marchon Holiday Promotion Campaign" (Best Sales Promotion Campaign); "Marchon Holiday Tree Ad" (Best Business-to-Business, Print, 2 Colors or More); and the "Marchon Showroom Invitation" (Best Direct Mail/Single Mailing).

OSI battles Go2Contacts. Ocular Sciences, Inc. is suing Go2Contacts.com because of alleged "bait-and-switch" tactics. OSI says that the Canada-based Internet company has advertised the availability of Ocular's Biomedics 55 contact lenses on its site, despite the fact that Go2Contacts is unable to obtain OSI lenses because of OSI's policy of selling only to authorized distributors and eyecare practitioners.

OSI claims that when customers ordered Biomedics 55 lenses, Go2Contacts shipped a different company's lens instead, claiming that the two are "virtually the same."

The lawsuit sets forth claims for relief based on unfair trade practices; false and deceptive advertising, including "bait-and-switch;" and intentional interference with contracts between OSI and its customers.


Optometric Management, Issue: August 2001