Thursday, May 10, 2012

OTC news: Optive Plus (UK only)


Allergan announces that OPTIVE PLUS® eye drops have been launched in the UK to treat moderate to severe dry eye symptoms in three different ways, including a new lipid enhancing technology to prevent the tears that keep the eye moist from evaporating. 

Abstract: Dry eye & hypertensive medication

Dry eye disease (DED) is a frequent problem in ophthalmology, causing considerable morbidity. DED is a multifactorial disease and requires a comprehensive approach in identifying the potential contributing factors. Often, clinicians overlook the fact that systemic medications are a cause of dry eye. We report two patients who developed symptoms and signs of DED secondary to systemic antihypertensive medication that improved following cessation of systemic medication.

Scott Med J. 2012 May;57(2):121.
Sagili S, Malhotra R.
Corneo Plastic Unit, Queen Victoria Hospital, East Grinstead, UK.

Abstract: Nerve growth factor (review)

For those following NGF it might be worthwhile tracking down a copy of this literature review (abstract only below).

PURPOSE OF REVIEW:To review the experimental and clinical data on the effects of nerve growth factor (NGF) in corneal physiopathology and to discuss the future development of NGF therapy for corneal diseases.
NGF plays a key role in the modulation of immune reaction, trophic support, healing of ocular surface, corneal sensitivity and tear film function. These properties of NGF make this neurotrophin a potential therapeutic agent for several corneal diseases. In this review, experimental evidence of the mechanisms of action of NGF on the ocular surface and clinical data on topical NGF use are described and discussed. This review includes the studies performed on corneal diseases such as neurotrophic keratitis, peripheral ulcerative keratopathy, dry eye and corneal surgery. Moreover, experimental studies that extended the NGF action on herpes virus corneal infection and ocular surface stem cell differentiation and proliferation are also reviewed.
Since the first clinical use of topical NGF therapy in patients with neurotrophic keratitis, the ocular surface healing and immune-modulating actions of NGF have been extensively studied and demonstrated in the past two decades, opening new perspectives for its use in clinical practice in patients with infective and noninfective diseases of the ocular surface.

Curr Opin Ophthalmol. 2012 Apr 25. [Epub ahead of print]
Department of Ophthalmology, University of Rome Campus Bio-Medico, Rome, Italy.

Abstract: Dry eye, depression, PTSD

Contrary to what many patients might be thinking (hoping?) when they click on it, this particular study is analyzing depression and PTSD as the chickens rather than eggs in the dry eye coop. But it's very interesting nonetheless.

I don't think I've ever seen a dry eye report on this many people, even the insurance database types. Interesting that nearly as many men as women in this study had a dry eye diagnosis... certainly in line with our anecdotal experiences on DryEyeTalk, and contradicting the conventional position of dry eye being a menopausal women's problem or an old age thing - I love seeing literature debunking this. And I really appreciated that in the conclusions they recommend doctors being (gasp!) proactive about finding out whether people with psychiatric diagnoses have dry eye.

Purpose: To study the scope of dry eye syndrome (DES) in veterans on a national level and to evaluate the relationship between psychiatric diagnoses and DES. 
Design: Case-control study. Setting: Patients were seen in a Veterans Affairs (VA) eye clinic between 2006 and 2011. Patient population: Patients were divided into cases and controls with regard to their dry eye status (cases = ICD-9 code for DES plus dry eye therapy; controls = patients without ICD-9 code plus no therapy).
Main outcome measures: The prevalence of DES and the influence of psychiatric diagnoses on the risk of DES.  
Results: A total of 2 454 458 patients were identified as either a dry eye case (n = 462 641) or control (n = 1 991 817). Overall, 19% of male patients and 22% of female patients had a diagnosis of DES, with female sex imparting an increased risk of DES at each decade compared to male sex (odds ratio [OR] 1.22-2.09). Several conditions were found to increase DES risk, including post-traumatic stress disorder (OR 1.92, 95% CI 1.91-1.94) and depression (OR 1.92, 95% CI 1.91-1.94) (analyses adjusted for sex and age). The use of several systemic medications was likewise associated with an increased risk of DES, including antidepressant medications (OR 1.97, 95% CI 1.79-2.17) and antianxiety medication (OR 1.74, 95% CI 1.58-1.91). Multivariate analysis (adjusted for age and sex) revealed that for psychiatric diagnoses, both the use of medication and the diagnosis remained significant risk factors when considered concomitantly, although the magnitude of each association decreased.
Conclusions: DES is a disease associated with depression and post-traumatic stress disorder, and is prevalent among male and female veterans receiving eye care services. The association could be driven by underlying disease physiology or medications used to treat psychiatric conditions. Regardless of the causal link, this suggests that individuals with a known psychiatric diagnosis should be questioned about dry eye symptoms and, if applicable, referred to an eye care physician.

Am J Ophthalmol. 2012 Apr 26. [Epub ahead of print]

Galor A, Feuer W, Lee DJ, Florez H, Faler AL, Zann KL, Perez VL.

Miami Veterans Administration Medical Center, Miami, Florida; Bascom Palmer Eye Institute, University of Miami, Miami, Florida.

Abstract: MRSA infection in a bandage lens patient


: The aim was to report a case of methicillin-resistant Staphylococcus aureus (MRSA) keratitis possibly associated with the use of a silicone hydrogel soft contact lens in a patient with dry eye.
: This is a case report.
: A 61-year-old woman who wore a silicone hydrogel lens as therapy for filamentary keratitis with severe dry eye presented with pain and redness in her left eye. She developed severe keratitis with ulceration and hypopyon. The MRSA grew in the culture, and intensive systemic and topical antibiotics resolved the corneal keratitis.
: The MRSA may cause infectious keratitis associated with silicone hydrogel contact lens therapy.

Eye Contact Lens. 2012 May;38(3):200-2.
Department of Ophthalmology (S.K, N.M, T.S, M.T, H.W., K.N.), Osaka University Graduate School of Medicine, Suita, Japan; and Department of Ophthalmology (Y.H.), Toho University Sakura Medical School, Chiba, Japan.

Abstract: Artificial tears & dessication

This is an interesting study in concept, however, all of the drops studied (drops available in Europe, not the US) are based on the polymers povidone and/or polyvinyl alcohol, which are not all that common in the US, where carboxymethylcellulose & the like predominate.

For reference, the actives in the named brands in this study are:

LACRIMAL = pva, povidone
ARUFIL = povidone
SICCAPROTECT = dexpanthenol, pva
VIDISEPT = povidone
WET COMOD = povidone

Background: A large number of artificial tears is widely used to treat dry eye symptoms. To test the efficacy of these drugs independent of individual parameters in vitro models are required. As described previously, we employed a reproducible in vitro cell culture system to evaluate the desiccation protection capability of some artificial tears. In the present paper data is presented of another set of pharmaceutical agents.

Material/Methods: Conjunctival epithelial cell line Chang 1-5c-4 (series 1) and the corneal cell line 2.040 pRSV-T (series 2) were cultured under standard conditions. Confluent cells were wetted for 20 min with artificial tears (Arufil® Uno, Arufil®, Lacrimal®, Lacophthal® sine, Siccaprotect®, Tears Again®, Vidisept® EDO, Vistil®, Wet Comod®) or PBS as a control. After exposure to a constant air flow for 0, 15, 30 and 45 minutes respectively, cells were incubated with the vital dye alamarBlue. Subsequently, absorption of the oxidised form of the dye was assessed using an ELISA-Reader.

Results: Cell best survival rates in series 1 after 15 min were found for Lacrimal® (0.89), Wet Comod® (0.84) compared to PBS (0.66) and in series 2 for Vidisept® EDO (0.57) and Lacrimal® (0.56) compared to PBS (0.01). After 45 min highest survival was seen in series 1 for Lacrimal® (0.46) and Lacophthal® sine (0.36) compared to PBS (0.33) and in series 2 for Lacrimal® (-0.06) and Arufil (-0.16) compared to PBS (-0.23).

Conclusions: Both cell lines tested showed different susceptibility towards desiccation and the artificial tears showed differences in preventing cells from desiccation.

Med Sci Monit. 2012 Apr 23;18(5):BR188-192.
Tost F, Keiss R, Großjohann R, Jürgens C, Giebel J.
Department of Ophthalmology, University Medicine, Greifswald, Germany.