Optometric Management

FEB 2017

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F E B R U A R Y 2 0 1 7 • O P T O M E T R I C M A N A G E M E N T . C O M 55 DEPARTMENTS THERAPEUTIC FOCUS I T'S ESTIMATED that nearly 30 million American adults have reported symptoms consistent with dry eye disease (DED), making this one of the most common ocular conditions. e question thus arises: What are you doing to treat these patients? OVERVIEW Last year, the FDA approved lifitegrast ophthalmic solution 5% (Xiidra, Shire) for the treat- ment of the signs and symptoms of DED. is b.i.d. eye drop works by inhibiting the binding of two molecules: ICAM-1, which is overexpressed in the tissues of those with DED, and LFA-1, an integrin receptor on the surface of T-cells. When ICAM-1 and LFA-1 bind together, they stimulate the recruitment and activation of T-cells and cytokine release, mar- kers of inflammation in the ocu- lar tissues. Xiidra binds to LFA-1, preventing this interaction, and, theoretically, preventing the in- flammation associated with DED. As we know, from both clini- cal experience and research, DED does not necessarily pres- ent in a clear clinical manner. Signs and symptoms can vary among patients, making treat- ment a confounding process. e mechanism of action for Xiidra addresses the underlying culprit in almost all types of DED — in- flammation — making it applica- ble to virtually all DED patients in bringing them relief. PROCEDURE Before prescribing Xiidra, I in- struct patients on proper use, and briefly discuss the success shown in the studies required for ap- proval by the FDA. In four clinical studies, a reduc- tion in dryness — measured via an eye dryness score — was observed with Xiidra at six and 12 weeks. In two of the four studies, an im- provement in dryness was seen with Xiidra at two weeks. At week 12, a rate reduction of inferior cor- neal staining score was observed in three of the four studies. A patient script example: "is drop is for twice-daily usage, one drop in each eye, both morn- ing and evening. Of all the stud- ies used to approve Xiidra, most show that symptom relief was realized within weeks of start- ing, but every patient is different. I will be seeing you back in six to eight weeks for us to follow up on treatment outcome." In addition, prepare patients for possible adverse reactions, includ- ing instillation site irritation, al- tered taste sensation and reduced VA. is conversation sets the stage for appropriate expectations. PRACTICE BENEFITS / TRAINING As I've grown my DED patient base, my clinic has enjoyed an in- crease of referrals due to patient satisfaction in treatment, espe- cially because of Xiidra. Our Shire representative provided training on the product, helping our staff members to understand insurance coverage/co-pays and making sure both the clinic and patients have all the tools they need to be suc- cessful. Phone and online resourc- es are also on hand for doctors and patients alike to access informa- tional support, if necessary. DED IN YOUR CHAIR Remember, if an estimated 30 million Americans are reporting symptoms consistent with DED, it's very likely these patients are in front of you every day in your practice. Offer them a new option for treatment, bring them relief, and excel at patient care with the newest technology in prescrip- tion eye care. OM TREAT SIGNS AND SYMPTOMS XIIDRA WORKS TO PREVENT THE INFLAMMATION ASSOCIATED WITH DED GINA M. WESLEY, O.D., M.S., F.A.A.O. DR. WESLEY practices at Complete Eye Care of Medina, a Vision Source practice, which she opened in 2008. She was honored as Minnesota's Optometrist of the Year in 2011. Email drwesley@cecofme dina.com, or visit tinyurl.com/OMcom ment to comment on this article.

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