Two of the major causes of blindness in the United States are glaucoma and age-related macular degeneration (AMD), which often can be controlled with medication.
Two of the major causes of blindness in the United States are glaucoma and age-related macular degeneration (AMD). However, medications are available for both conditions that substantially limit their effects, especially when treatment is started early.
In glaucoma, the fluid inside the eye doesn't drain normally, so excess pressure builds up within the eye. As this goes on, the structure of the eye is damaged, resulting in blurred vision, a narrowed field of sight and eventual blindness. While anyone can develop glaucoma, those at highest risk include African Americans over age 40, those with a family history of glaucoma, and anyone over age 60.
It is important for patients to receive regular checkups, including a dilated eye exam.
EARLY DIAGNOSIS IS CRITICAL
The early stages of glaucoma typically affect peripheral vision, and patients don't experience any symptoms. Even though they have increased eye pressure, they don't feel it.
"By the time people come in because they are actually noticing vision problems, at that point they have sustained major damage to the optic nerve," Dr. Iwach says.
Once the early stages of glaucoma are identified during a routine eye exam, ophthalmologists do have effective medications to reduce pressure within the eye. Beta-blockers used to be the first line treatment for glaucoma, and they are still used under certain circumstances.
"The problem with beta-blockers is they are systemic medications, which tend to exacerbate asthma and chronic obstructive pulmonary disease, limit the maximal heart rate, and lead to depression," says Mark Packer, MD, an ophthalmologist in private practice in Eugene, Ore., and an associate clinical professor at Oregon Health Sciences University.
Starting in the mid-1990s, prostaglandin analogs, which do not affect systemic bodily functions, became the first line choice for treatment of glaucoma.
"They offer once-a-day dosing, which is by far the most convenient and also has the highest compliance rate," Dr. Packer says. "In addition, the absence of systemic side effects is of great importance."
Treatment for glaucoma starts out with one of the prostaglandin analogs, and if needed a second medication may be added.
"Treatment of glaucoma is all about the target pressure," says Dr. Packer. "Let's say that some damage has occurred at the current pressure, so as a starting point, we think the pressure should be 20% lower. Generally speaking, we first try a prostaglandin and then try other medications to see their effect. The period for maximal efficacy is usually about two to four weeks, and then we check the pressure in the eye again."
"This disease is potentially blinding, and yet it has no symptoms in its early stages," says Dr. Packer. "The treatment regimen is complex. Sometimes the patient has to do the first drop, than wait five minutes to do the second drop. Patients with arthritis may have problems squeezing the bottle."
Drug compliance programs should be considered for glaucoma patients.
David Calabrese of OptumRx Talks New Role, Market Insulin Prices and Other Topics 'On His Mind'
April 13th 2023In this month’s episode of the "What's On Your Mind podcast," Peter Wehrwein, managing editor of MHE connects with the now Chief Clinical Officer of OptumRx Integrated Pharmacies, David Calabrese. In this conversation, David touches on his transition in January as OptumRx’s former chief pharmacy officer and market president of health plans and PBMs to his new role as Chief Clinical Officer where he now focuses more on things such as specialty pharmacy to home delivery — with an overall goal of creating whole-patient care. Throughout the conversation, Calabrese also touched on the market’s hot topic of insulin prices and behavioral health services within the OptumRx community, among other topics.
Listen
Upended: Can PBM Transparency Succeed?
March 6th 2024Simmering tensions in the pharmacy benefit management (PBM) industry have turned into fault lines. The PBMs challenging the "big three" have formed a trade association. Purchaser coalitions want change. The head of the industry's trade group says inherent marketplace friction has spilled over into political friction.
Read More
Briana Contreras, editor of Managed Healthcare Executive, spoke with Nancy Lurker, CEO and president of EyePoint Pharmaceuticals. Nancy shared a bit about EyePoint and how the organization’s innovative therapies are addressing patient needs through eye care, and most importantly, she addressed C-Suite positions like the CEO role. Nancy shared advice for those seeking to reach the CEO level, especially toward women in healthcare and other roles, and what it takes to run a biopharma company.
Listen
The deliberate disconnection of Change Healthcare to ring fence a cyberattack entered its seventh day today. Prescribers are finding ways to get pharmacy claims processed, and UnitedHealth Group says disruption to the dispensing of prescriptions has been minimal. But independent pharmacies want more information and protection from financial consequences from pharmacy benefit managers.
Read More