Premium technologies lead the way to make patients like Benjamin Button
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With almost every exam these days, it seems like patients hate the dreaded phrase “due to your age.” I usually lighten up the verbiage and refer to it as the “A-G-E syndrome” that all of us encounter daily.
But more remarkably, I always joke to my patients as they tell me that I “never age” that I am really Benjamin Button. The Curious Case of Benjamin Button is a fantasy film from 2008 starring Brad Pitt as a man who ages in reverse and Cate Blanchett as the love interest throughout his life. Age reversal and/or prevention is a large determinant why many of our patients seek us out as premium surgeons in the first place.
We have great experience in eliminating glasses with refractive surgery and/or refractive cataract surgery with premium IOLs such as Vivity/PanOptix (Alcon), Symfony/Eyhance (Johnson & Johnson Vision), enVista toric (Bausch + Lomb) and Light Adjustable Lens (RxSight).
Most patients, to their surprise, ask why we created wrinkles after refractive cataract surgery, and we all know the answer: The wrinkles were already there hiding behind full-time spectacle wear. With great cosmetic technologies such as Botox, Latisse and Juvéderm (Allergan Aesthetics) and Xeomin (Merz), we have the magic to make those age-related blemishes vanish.
But there is a new kid in town called Upneeq (oxymetazoline hydrochloride ophthalmic solution 0.1%, RVL Pharmaceuticals), indicated for the treatment of acquired blepharoptosis in adults, administered with one drop topically once daily. Oxymetazoline is preservative free in this formulation, prepared with balanced salt solution and the hydrophilic polymer hypromellose. Hypromellose cross-links upon contact with the surface of the eye, acting to coat and protect the ocular surface. Oxymetazoline is a potent, direct-acting alpha-adrenergic receptor agonist, selectively targeting receptors in Muller’s muscle to cause contraction and raise the eyelid.
The Benjamin Button effect
Ptosis is typically age-related and progressive and often goes undiagnosed and untreated due to limited treatment options historically. There are medical concerns when the ptosis gets more advanced, such as visual field deficits and chronic headaches and brow aches, which typically lead to surgery. On the milder side, the ptotic concerns are mainly aesthetic, with patients complaining of “sleepy” appearance, asymmetrical appearance and enhanced frown lines from trying to raise their eyelids with their forehead musculature constantly.
In two clinical trials conducted by RVL, the pooled data at 6 weeks showed an average upper eyelid lift by marginal reflex distance 1 of 1 mm seen as early as 5 minutes after instillation and sustained to at least 6 hours after instillation on day 1 compared with vehicle. Superior visual field deficits were also improved statistically significantly compared with vehicle. The product was well tolerated with a good safety profile in the clinical trials and no effect on critical visual function (Snellen visual acuity, IOP) or vital signs.
In my practice, I use photographs in the exam lanes showing the benefit of Upneeq, which starts the process of patients asking about the product. We typically will place a drop topically in their eyes and have them sit for about 15 minutes; most patients will start to notice the improvement with greater benefit at about 2 hours. One patient drove back to my office to show us the benefit at 2 hours — she said she was the female version of Benjamin Button and that this drop had changed her life.
Recently, we have implemented sampling the product at the time of Botox or Xeomin injections, and most patients end up filling the prescription for Upneeq, enjoying the enhanced effect with their cosmetic injections. Adding a simple component to existing lifestyle questionnaires used in our refractive and refractive cataract surgery evaluations helps bring awareness to the ptosis problem and a viable treatment option for it.
In the end, what patient does not want to enjoy the benefits of being Benjamin Button? Any way to slow down the A-G-E syndrome that affects all of us, even as premium surgeons, is a friend of mine and Benjamin Button.
Stay safe and safe travels to all my colleagues headed to our first upcoming live meetings.
- References:
- Haenisch B, et al. Fundam Clin Pharmacol. 2010;doi:10.1111/j.1472-8206.2009.00805.x.
- Richards, HS, et al. Eye (Lond). 2014;doi:10.1038/eye.2013.264.
- Slonim CB, et al. JAMA Ophthalmol. 2020;doi:10.1001/jamaophthalmol.2020.3812.
- For more information:
- Mitchell A. Jackson, MD, can be reached at Jacksoneye, 300 N. Milwaukee Ave., Suite L, Lake Villa, IL 60046; email: mjlaserdoc@msn.com.
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