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UntitledMAY 15, 2005
A l l t h e C l i n i c a l N e w s i n S i g h t
Punctal plugs plus topical agent maximize dry eye relief
Combination offers improvement with less reliance on artificial tears
By Cheryl Guttman
scores in the three groups ranged from 2 to 2.3 at Dual approach
baseline (possible score range, 0 to 4). All groups “Management of dry eye has received increased at- showed a modest benefit after 1 month (mean Fort Lauderdale, FL—A dual treatment approach
tention recently, and with the introduction of sev- change range, –0.2 to –0.3), and there was no fur- combining punctal plugs with use of topical cy- eral new therapeutic modalities, including new ar- ther improvement throughout the course of the closporine ophthalmic emulsion 0.05% (Restasis, tificial tear products, topical cyclosporine, and new study in the patients using punctal plugs. How- Allergan) affords dry eye sufferers greater improve- punctal plugs, the question arises what is the best ever, patients using cyclosporine alone or in com- ment in their signs and symptoms than monother- first-line intervention for patient care,” Dr. Roberts bination with punctal plugs achieved greater re- apy with either modality alone, said Calvin W.
said.“While topical cyclosporine is being used more ductions in conjunctival staining after 3 months and more for the treatment of moderate dry eye, and further benefit by study conclusion when mean Dr. Roberts, clinical professor of ophthalmol- our study results indicate clinicians should not aban- changes from baseline were –0.9 and –1, respec- ogy, Weill Medical College of Cornell University, don punctal plugs nor consider punctal plugs and New York, reported the results of a parallel com- cyclosporine as mutually exclusive. Those modali- Mean frequency of artificial tear instillation at parison study in which 30 consecutive patients ties are complementary, work by different mecha- baseline ranged from 5.5 to 6.0 times daily across with bilateral dry eye symptoms and 2+ conjunc- nisms of action, and act synergistically to maximize the three treatment groups. By 1 month, patients tival staining with lissamine green were randomly relief of the signs and symptoms of dry eye.” who had punctal plugs placed reduced their usage assigned to receive topical cyclosporine twice a day, At baseline, mean Schirmer scores ranged from by about two instillations a day whether or not punctal plugs to the lower lids only, or combina- 2.5 to 2.7 mm across the three groups. At the 1- they also were using cyclosporine whereas patients tion treatment. Responses were evaluated after 1, using cyclosporine monotherapy had minimal 3, and 6 months by assessing Schirmer test results (5 minutes with anesthesia), conjunctival staining However, the group receiving the punctal plugs ‘Our study
scores, and frequency of use of artificial tears for alone achieved no additional reduction in artifi- symptom relief. He presented the results at the As- results indicate
cial tear use over the next several months while sociation for Research in Vision and Ophthalmol- those using cyclosporine had progressively greater clinicians
ogy annual meeting here earlier this month.
benefit. After 6 months, mean reductions in the After just 1 month, punctal plugs were associ- should not
frequency of artificial tear instillation were –3.2 in ated with marked improvement in Schirmer scores the cyclosporine group and –3.8 in the combina- abandon punctal plugs nor
and decreased frequency of artificial tear use, but that intervention had little effect on conjunctival consider punctal plugs and
Dr. Roberts chose the Parasol Punctal Occluder
staining. Onset to efficacy took longer with cy- (Odyssey Medical) for punctal plug placement in
cyclosporine mutually exclusive.’
closporine monotherapy, but all three measures this study based on his positive experience with of efficacy eventually improved with its use. How- that product in clinical practice. The Parasol Punc- Calvin W. Roberts, MD
ever, patients in the combination group enjoyed tal Occluder was easy to fit in all patients and well- the benefits of both modalities with improvements tolerated throughout the study. OT
that occurred early and that were equal or supe- month visit, mean Schirmer scores had increased rior to those associated with either of the to 7 mm in the punctal plug group and 7.1 mm among patients receiving combination therapy, buthad decreased to 1.2 mm in the cyclosporine group.
At study conclusion, however, mean Schirmer scores Take-Home Message
were comparable in the punctal plug and combi- Calvin W. Roberts, MD
nation groups (6.3 and 6.5 mm, respectively) and Results of a prospective, parallel comparison study were slightly inferior in patients using cyclosporine support combined treatment with punctal plugs Dr. Roberts received no industry financial support for this plus topical cyclosporine (Restasis, Allergan) for Mean lissamine green conjunctival staining study. He is a consultant to Allergan, and has no financial management of moderately severe dry eye.
Reprinted from OPHTHALMOLOGY TIMES, May 15, 2005 Copyright Notice Copyright by Advanstar Communications Inc. Advanstar Communications Inc. retains all rights to this article. This article may only be viewed or printed (1) for personal use. User may not
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Disease monger (Krankheitshändler)/ British Medical Journal British Medical Journal (BMJ) Bd. 324, S. 886, 2002 Selling sickness: the pharmaceutical industry and disease mongering Ray Moynihan , journalist a , Iona Heath , general practitioner b, David Henry , professor of clinical pharmacology c . a) Australian Financial Review , GPO Box 506, Sydney, 2201, Austr