A Survey of Ocular Medication

Health care has dramatically improved this past quarter century with the development of new and more effective drugs. After WW II, antibiotics were discovered and death rates declined. As bacteria have evolved; so have antibiotics. In addition, other pharmaceuticals have come along to fight viruses, most micro-organisms, allergies and even autoimmune disorders. These developments have dramatically improved the quality of our lives. Unfortunately, while there are many new and better drugs, there are still some practitioners that continue to use old, out dated, and in many cases ineffective drugs. Doctors have an obligation to change treatment modality as often as new drugs become available. What follows is a brief survey of contemporary drugs for the treatment of eye conditions. It should be understand that in 6-12 months this list will change.

A big player on this eye care stage is allergies. For many years we were stuck using cool compresses, oral antihistamines that put people to sleep and topical antihistamines. They were affective, but only treated the symptoms not the source of the problem. Today we have prescription eye drops that are antihistamines AND mast cell inhibitors. These drops treat the symptoms while decreasing the factors that cause the problem. In doing so we can rapidly improve patient comfort. The best drug is Patanol. It is a twice per day dosage medication and works with in 15 minutes of installation. In a recent development, the concentration has been increased and Pataday is now available which is the same drug that can be used ONCE per day. This increases patient compliance and keeps folks comfortable for 24 hours. None of the OTC drugs even come close to being as affective as Pataday.

Antibiotics are a big part of eye care. In the past, drugs like Bacitracin which were broad spectrum drugs were great. Today there is a 60 % resistance to it. Antibiotics need to evolve to keep up with the proliferation of resistant bacteria. We are currently on our 4th generatio
Fluoroquinolones. The two most prescribed are Vigamox ( 3 times per day) and Zymar ( 4 times per day). Both are presently very effective, and which ever is chosen by the eye doctor becomes a personal preference. All other topical antibiotics are a distant second in kill rates and bacterial resistance. It is important to avoid over using these drugs. Overuse can create new resistance at a fast rate, and their efficacy would be greatly reduced. .

Anti viral agents are relatively new to the field. Herpes Simplex Virus can be quite destructive to the eye, but fortunately Viroptic is available. It is quite toxic to the eye, but will kill the virus, and in most cases will save the eye from disaster. It must be used carefully and followed very closely. A newer anti viral is Valtrex which is commonly used to treat Herpes. It can be used as a long term therapy while Viroptic is strictly short term.

Anti inflammatories have changed quite a bit over time. In the past, steroids were the only game in town. They are still used, and are among the most effective drugs, but they do come with potential side effects. They can cause cataracts, glaucoma, reduce healing rates and will increase blood glucose levels. Careful follow-up is essential when undergoing steroid therapy. Pred Forte is still the gold standard for serious inflammations. Dexamethosone usually in combination with Tobramycin in a formulation called Tobradex is one of the most widely prescribed medicines. Soft steroids have recently made their entrance on to the market in the form of Lotemax. Soft steroids have adequate anti inflammatory properties with out the side affects of regular steroids. They are however, not as affective in serious swelling conditions.

New developments in inflammation is the advent of Non Steroidal Anti Inflammatory agents like Acular, Voltarin and now Xibrom. They are effective, bring new treatment options to the table and can be used long term. Xibromis often used post surgically, but retards healing. They also can be used topically to reduce some retinal swelling like Central Serous Retinopathy.

An old drug that has found a new use is Cyclosporin. It is an anti autoimmune drug that had seen a decreasing use. It has been found to increase tear production in the lacrimal gland by reducing swelling. In doing so, tear production increases after about 2-3 months of use. The new/old drug is called Restasis, Care must be exercised when using Restasis; it must be discontinued if an infection exists. Continued use will result in a major infection that.

These are the newest and best ocular drugs available today. While older medications have some value, it is essential that contemporary therapy be instituted. This will protect the patient, and control the proliferation of organism mutations.