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Back to the future
Do you ever wonder what our world would be like if one tiny detail was changed years ago? Imagine, if you will, that Mr. Peabody, the genius dog that built a time machine, looked at the dry eye world and the medicines we use. He’s pretty bright, that dog. After all, he figured out how to build a time machine. Let’s say he’s also smart enough to know that surface inflammation is a huge issue in dry eye and that one of the clinical signs we see on the eye is punctate corneal staining. Unlike the vast majority of docs, pharmacists and PPM administrators, Mr. Peabody took the time to read every word on the package insert of all of our topical anti-inflammatory drops and he noticed that one of them actually has an indication for the treatment of superficial punctate keratitis (SPK).
Armed with this knowledge, imagine our world if Mr. Peabody had climbed into his time machine and teleported himself back to 1998 and told the good folks at Bausch + Lomb about dry eye and billion dollar drugs to treat it. Do you think those good folks at B+L might have marketed a little gem they own any differently? Would our friends at Allergan have a billion dollar medicine today?
You’re probably asking: “What’s the point? Mr. Peabody’s just a cartoon, and that horse has left the barn.” (Apologies for mixing animal metaphors.)
We now have the ability to detect surface inflammation with InflammaDry (RPS). It’s vitally important that you learn how to prescribe Restasis (cyclosporine ophthalmic emulsion 0.05%, Allergan) and that you use it early and often. Sometimes patients need more. When you see SPK despite Restasis, or SPK that needs more urgent, acute treatment, don’t forget that you have at your disposal a medicine that once had a real, live, actual FDA indication for treating that surface inflammation: Lotemax (loteprednol etabonate, Bausch + Lomb).
Lotemax Gel is our option now. It is nothing less than brilliant at treating surface inflammation (and intraocular inflammation, for that matter) with little to no difference in efficacy when compared with all other “full-strength” topical steroids. It appears to have the same safety profile as Lotemax suspension. In our SkyVision hands, the stuff just flat out works and it’s very safe. It has a different package insert, though. Maybe Mr. Peabody will drop in and visit the folks at B+L and chat about that.
All he needs today is a plane ticket.
Disclosure: White is a consultant for Bausch + Lomb, Allergan, Nicox and Eyemaginations. He is on the speaker board for Bausch + Lomb, Allergan and TearLab.