EyeWorld India June 2013 Issue

55 EWAP CORNEA June 2013 Donnenfeld said. “Once they are educated and understand their disease, they are much more compliant and are more likely to achieve a therapeutic result.” When it comes to dealing with burning and stinging resulting from Restasis, Dr. Mah addresses this possibility from the start. “I’m very proactive about that, but a lot of patients come in and say, ‘I didn’t like the burning sensation,’” he said. “When you talk to these people, they were never told about the sensation.” As long as they understand that this is normal, they are usually willing to continue, he finds. Likewise, Dr. Donnenfeld stresses to patients how commonplace burning and stinging can be. “Burning and stinging are normal in about 17% of patients who take Restasis, and these improve over time so that by three months after starting Restasis, the burning and stinging almost always goes away,” Dr. Donnenfeld said. Dr. Mah also offers patients some tips to help minimize the burning sensation. “I usually tell patients to put the Restasis in the refrigerator,” Dr. Mah said. “Typically that cold drop stings less.” If that doesn’t help, he recommends using artificial tears or a palliative lubricating eye drop first, waiting five minutes and then putting the Restasis in afterward. To help patients respond more quickly to Restasis as well as minimize burning, Dr. Donnenfeld adds a topical corticosteroid to the treatment. “I’ve been very impressed by a new mediation, a loteprednol gel that has a vehicle that stays in the tear film longer,” he said. He recommends using this twice a day for one month in conjunction with Restasis therapy. “This makes patients respond more quickly and it eliminates the burning in a significant way,” Dr. Donnenfeld said. Restasis is not something that should be reserved just for the worst dry eye cases, Dr. Mah said. He has found success using this on patients earlier on in therapy when their symptoms first arise and they first begin to use artificial tears. Ironically, keeping track of artificial tear amounts can help patients to monitor their progress on Restasis. For example, Dr. Mah tells patients to continue using their artificial tears at the same dosages that they have been prior to starting Restasis and to take note if they begin using less over time. He finds it helpful to follow up with patients on this, especially in cases where patients are questioning their progress on the medication. “Many times patients will say, ‘I do think that I’m using less artificial tears than before,’” he said. “That’s an indication that their dry eyes are improving.” Of course even with the best support system in place to help patients, Restasis may not work for everyone. Dr. Donnenfeld pointed out that some may not actually have aqueous deficiency dry eye. “A lot of patients who come in with ‘aqueous deficiency’ dry eye are given Restasis when in actuality they have meibomian gland dysfunction,” he said. “The lack of response to Restasis is related to the fact that we were treating the wrong disease and that all dry eye is not the same,” he concluded. EWAP Editors’ note: Dr. Donnenfeld has financial interests with Allergan and Bausch+Lomb (Rochester, NY, USA). Dr. Mah has financial interests with Allergan. Contact information Donnenfeld : 516-446-3525, ericdonnenfeld@gmail.com Mah : 858-554-9093, mah.francis@scrippshealth.org