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Prevention ‘best treatment’ for zoster ophthalmicus
KOLOA, Hawaii — The ocular manifestations of herpes zoster involve a wide range of corneal disease with the estimated worldwide cost for treatment reaching $1 billion, according to a speaker.
Individual treatment cost is $1,800 but treatment for post-herpetic neuralgia, a possible consequence, is $7,200 in the U.S., Jay S. Pepose, MD, said at Hawaiian Eye 2020.
“The cost of treating post-herpetic neuralgia is exorbitant, and there really is not a great treatment,” Pepose said. “The best treatment is prevention, by far.”
Recurrence rate of zoster keratouveitis is common following cataract surgery. Vision can be decreased due to corneal opacity, ocular surface disease or uveitis. For patients who present with diffuse corneal edema on day 1 after cataract surgery, Pepose considers giving prophylaxis with antivirals.
Overall prevention, however, can take the form of vaccination to prevent shingles in adults.
The Shingrix adjuvanted subunit zoster vaccine (GlaxoSmithKline) is the preferred vaccine and is 97% effective in preventing shingles and 91% effective against post-herpetic neuralgia, he said.
“So, the best thing you could do for every single patient who is 50 or older in your office is say, ‘Have you been vaccinated?’” Pepose said. – by Patricia Nale, ELS
Reference: Pepose JS. Anterior segment manifestations and treatment of herpes zoster. Presented at: Hawaiian Eye 2020; Jan. 18-24, 2020; Koloa, Hawaii.
Disclosure: Pepose reports financial disclosures with Acufocus, Allergan, Bausch + Lomb, Dompé, Genentech, Johnson & Johnson Vision, Kala, Keeler, MG Therapeutics, Mimetogen, Novartis, Ocunexis, Okogen, Stuart Pharmaceuticals, Sun Pharmaceuticals and TearLab.