MDNews - Greater Kansas

BETA-RECEPTOR BLOCKERS Timolol, one of the earliest eye drops prescribed to treat glaucoma, falls into this class. Drugs in this class also decrease the production of intraocular fluid, but also have the systemic risks of other beta blockers such as hypotension and bradycardia. It may affect a person's exercise tolerance, "like hitting that wall quicker during a workout," Dr. Campbell says. For patients with asthma or COPD, it can cause shortness of breath via bronchoconstriction. It may also increase depression symptoms. If it is necessary to prescribe a beta blocker for a patient with these underlying conditions, a cardioselective one such as carteolol is preferred. CARBONIC ANHYDRASE INHIBITORS This medication, which decreases production of intraocular fluid, is available in either eye drop form or pill form. Although drugs in this class contain nonantibiotic sulfonamides, only 10% of patients with a sulfa (antibiotic sulfonamide) allergy will have topical reactions because of the difference in metabolite form. However, those same patients cannot take acetazolamide in pill form, Dr. Campbell says. Other side effects with the pill form include kidney stones, upset stomach and frequent urination. PROSTAGLANDINS Drugs in this class increase intraocular f luid outflow and may cause changes to one's iris color and longer eyelashes. Because the drug may cause inflammation, Dr. Campbell will avoid prescribing drugs in this class for those with inflammatory eye diseases such as iritis, uveitis or macular edema, but it's less known whether it affects patients prone to inflammation elsewhere in the body. FINDING ALTERNATIVES Physicians who suspect a glaucoma medication may be causing a patient 's symptoms should refer the patient back to his or her optometrist or ophthalmologist to consider alternative glaucoma treatments, Dr. Campbell says. "It used to be hard to find alternatives, but now we can because we have so many classes and alterna- tives," Dr. Campbell says. She also advises that if allowed, hospitalized patients should use their outpatient prescribed glaucoma medications because hospital formularies are limited. This will help avoid glaucoma progres- sion during inpatient stays. Dr. Campbell is available for consultations on glaucoma medication interactions by contacting Grene Vision Group at 316-684-5158. n Clinical Trials Help Focus on Effective Glaucoma Surgeries W HEN K A NSA N DEBOR A H Foy underwent surgery at Grene Vision Group last year to remove a cataract and relieve glaucoma pressure, she was part of a select group of patients nationwide in a clinical study about the safety and efficacy of the surgical system used to treat her glaucoma. While those who practice medicine rely on clinical studies that help develop treatments and test the safety and effectiveness of drugs and therapies already approved by the FDA, not everyone who practices medicine participates in studies. But that's not the case at Grene Vision Group, a large, comprehensive provider of ophthalmology and optometry services that is headquartered in Wichita and has several locations throughout Kansas. In the past two years, Grene Vision Group glaucoma specialist Anita Campbell, MD, has participated in two studies related to the long-term benefits of the OMNI Surgical System. The OMNI system has become one of the latest tools used in the growing list of minimally invasive glaucoma sur- gery (MIGS) procedures that have been transforming glaucoma treatment. "It's not experimental so it reassures people that it's safe to be a part of. You're helping further science, but not putting your eye at risk," Dr. Campbell says about the efficacy studies for an FDA-cleared system. The OMNI system received FDA clearance in January 2018, and Dr. Campbell started using the system not long after it became commer- cially available. In the first study, which the OMNI manufacturer called Gemini, about 150 patients were enrolled, starting in March 2019, at several sites nationwide, including Grene Vision Group. The OMNI surgical device combines two MIGS procedures. It removes part of the trabecular meshwork to allow direct drainage of the fluid buildup causing a rise in the ocular pressure, and it also injects viscoelas- tic fluid farther into the Schlemm's canal to clear out the so-called pipes of the eye, which also improve pressure levels. It can be performed at the same time as cataract removal. Dr. Campbell invited eligible patients who were already scheduled for both cataract surgery and OMNI glaucoma surgery to join the Gemini study. They were receiving the same treatment that had been recommended. Foy was one of eight patients treated by Dr. Campbell who enrolled in the Gemini study. After failing an eye exam at her workplace, Foy had been referred for cataract removal surgery to Grene Vision Group. When the cataract surgeon realized Foy also was being treated with two differ- ent prescription eye drops to control her glaucoma, Foy was referred to Dr. Campbell for concurrent treatment of both ocular conditions. "I needed the surgery and the study didn't sound like a bad idea," Foy says. While study subjects receive additional follow-up care and some financial compensation, that didn't play a part in her decision to participate, Foy says. "I just wanted to see again." With the Gemini study concluded, Sight Sciences has started enroll- ing subjects in another study that will look at the long-term benefits of the OMNIi system when used stand-alone for glaucoma treatment, Dr. Campbell says. One patient who just joined the study said he was in a glaucoma drug study 25 years ago with another Grene Vision Group doctor and was excited to be asked to participate again, Dr. Campbell says. M D N E W S . C O M /// M D N E W S G R E AT E R K A N S A S ■ 2 0 2 0 1 5

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