Dr. Iwach, associate clinical professor of ophthalmology, University of California San Francisco, presented a snapshot of current medical, surgical, and practice management issues pertaining to glaucoma patient care. The symposium was held at Glaucoma 360°, which was presented in association with Ophthalmology Times.
In 2012, new chemical entities for treatment of glaucoma are showing promise, but most are in phase II clinical trials or earlier stages of development and so are not expected to come to market for at least several more years. Prostaglandin analogues are still the leading class of ocular hypotensive agents used in the medical management of glaucoma, and the number of prostaglandin analogue prescriptions written continues to rise.
Meanwhile, generic medications, which now include latanoprost, are taking on a more prominent role, causing an increasing burden on physician practices because of the time spent communicating with pharmacies and insurance companies, as well as a potential confusion for patients. Dr. Iwach cautioned that generics manufactured in other countries may not be equivalent to the products manufactured in the United States. In addition, there is an increasing problem with look-alike packaging for generic ophthalmic drops that can cause confusion for the patient who is being treated with a multi-medication regimen.
"These issues are creating new challenges. Therefore, I always ask my patients to bring in their bottles when they come in for a follow-up visit because I want to see what they are using and where it is from," said Dr. Iwach.
He added that he is particularly concerned if there seems to be a sudden loss of IOP control or the patient has developed side effects that can't readily be explained. If tolerability is an issue, clinicians should consider the possibility of a preservative allergy.
"In my experience, the preservative used in the formulation can make a difference for certain patients. Fortunately, there are a number of alternatives to choose from, including products containing preservatives other than benzalkonium chloride or that are preservative-free," Dr. Iwach said.
Data on glaucoma surgical procedures show a continued rise in the number of laser trabeculoplasty and tube procedures as trabeculectomy cases decrease.