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Vision Health Spotlight: Page 2 of 2
Preservative-Free Treatment for Elevated Intraocular Pressure
Open-angle glaucoma is the most common form of glaucoma, a disease that is the second leading cause of blindness in the United States. While glaucoma is a risk at any age, as a patient’s age increases, so does his or her risk of developing this disease. On February 10, 2012, the FDA approved tafluprost 0.0015% ophthalmic solution (Zioptan), a prostaglandin drop used to treat elevated eye pressure in patients with open-angle glaucoma or ocular hypertension. Ocular hypertension is generally considered to be an intraocular pressure reading >21 mm Hg and is a risk factor for glaucoma.
While numerous classes of medication are available to treat glaucoma, prostaglandin drops are often a first-line treatment for open-angle glaucoma because they are effective in lowering intraocular pressure and cause fewer adverse effects than other treatments, resulting in good compliance. Unlike other prostaglandins on the market, Zioptan does not contain a preservative. This formulation was introduced to reduce preservative-related side effects and improve patient compliance. Studies have shown this agent to be as efficacious as preservative-containing formulations, but to be more comfortable during long-term treatment and to offer improved compliance and tolerability, particularly among patients who experienced ocular surface damage after using other prostaglandin analogs. Reports have also shown Zioptan to produce less severe incidences of ocular hyperemia and to reduce incidences of irritation and itching.
Possible side effects of Zioptan include darkening of the iris, darkening of the eyelid, and eyelash growth. To access Zioptan’s full prescribing information visit www.merck.com/product/usa/pi_circulars/z/zioptan/zioptan_pi.pdf. To read a recently published literature review on tafluprost visit www.dovepress.com/tafluprost-once-daily-for-treatment-of-elevated-intraocular-pressure-i-peer-reviewed-article-OPTH.
Ophthalmic Drugs Should Factor Into the Polypharmacy Equation in Nursing Homes
The incidence of glaucoma increases with age, and with life expectancy on the rise, glaucoma is becoming more prevalent worldwide. Although a variety of glaucoma treatments are available, local pharmacotherapy (ie, glaucoma eye drops) is the primary treatment option, especially for elders. While glaucoma eye drops are generally considered safe, there may be associated systemic risks, particularly among frail nursing home residents who are receiving multiple medications. Because there are limited data about the use of ophthalmic drugs in combination with other medications, Matthias Huber, Institute of Clinical Pharmacology and Toxicology, Charite, Universitätsmedizin Berlin, Germany, and colleagues assessed prescribing practices for antiglaucoma agents among a group of German nursing home residents on polypharmacy regimens. Their findings were published in the January 2013 issue of Drugs and Aging (www.ncbi.nlm.nih.gov/pubmed/23184270).
Huber and colleagues’ study assessed the health insurance records of 8685 German nursing home residents aged 65 to 106 years. These residents collectively had 88,695 drug prescriptions, with the average resident receiving 6.0 ± 3.3 drugs. Of these patients, 6% (n=520) had glaucoma, but only 341 received antiglaucoma drugs. The most frequently prescribed antiglaucoma ophthalmics were beta blockers (n=219), followed by prostaglandin analogues (n=101) and carbonic anhydrase inhibitors (n=86).
The investigators found that local antiglaucoma therapy (ie, drops) was concomitantly prescribed with systemic pharmacotherapy to 338 nursing home residents. In addition, residents receiving an ophthalmic agent were on average receiving 6.5 ± 3.2 prescriptions for systemic agents. When assessing prescribing practices, Huber and colleagues noted several scenarios that increased the risk of potential drug-drug interactions, particularly with regard to cardiac function. These scenarios included prescribing opthalmic beta blockers along with an antihypertensive (71.9%), including a systemic beta blocker (20.2%); prescribing an ophthalmic beta blocker along with cardiac glycosides or calcium antagonists (14%); and coprescribing ophthalmic parasympathomimetics along with cardiac glycosides or calcium antagonists (13%).
Based on the their findings, the authors conclude that the use of ophthalmic drugs in combination with other agents, as often occurs in nursing homes, “may modify the efficacy and safety of local and systemic therapies.” As a result, they note that “individualized pharmacotherapy that integrates anti-glaucoma drug therapy into the overall treatment rationale in nursing home residents is necessary.”