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Consider prescribing allergy eye drops to patients taking systemic allergy meds
Statistics are many things. Certainly, they are important. As a profession, we rely on statistics to evaluate a given patient’s risk for acquiring a certain disease as well as for selecting the appropriate treatment. Statistics can also be misleading. Witness the clinical study in which two treatment protocols are deemed statistically different, but prove to be very similar clinically. Occasionally, statistics can be shocking. Indeed, this was my response when recently reading some statistics on ocular allergy treatment.
It has long been accepted that approximately 20% of the U.S. population experience seasonal or perennial allergies. Of those, about 75% have ocular involvement. These numbers aren’t that surprising, but the prescription data is. While it’s estimated that Americans spend $9 billion annually on oral medications and nasal inhalers for allergy, they spend only $250 million on prescription ocular allergy medications. In essence, while 75% of allergy sufferers have ocular symptoms, they spend only about 3% of their treatment dollars on eye medications. How can such a disparity exist?
Patients misinformed about eye drops
In actuality, there are a number of plausible explanations for why allergy sufferers spend so little on prescription eye drops. First and foremost is the issue of self-medicating. Many patients simply address their ocular symptoms with over-the-counter eye drops, often unaware that more effective options exist. Second, patients might assume — erroneously so — that their prescription oral medication will provide the same symptomatic relief as eye drops. Finally, health care providers — optometrists, ophthalmologists, allergists, primary care physicians — might just be missing the point. However, while each of these reasons may be valid, they are not necessarily the best solution.
While OTC allergy eye drops have good public recognition, are widely available and are relatively cheap, they do have a number of shortcomings. As optometrists we’re all too familiar with their limited therapeutic efficacy, need for frequent dosing and propensity for ocular toxicity and rebound hyperemia.
With respect to our patients’ decisions, consider their predicament. They go to their primary care physician or allergist with a variety of systemic and ocular symptoms. They’re given a prescription oral antihistamine to be taken daily, and it helps, for the most part. However, from an ocular perspective we know things could be better.
Additive effect of therapeutics
There is now a compelling body of literature proving that mast-cell stabilizer/antihistamine eye drops have an additive effect with oral antihistamines in reducing ocular allergy symptoms. Furthermore, nasal inhalers used in conjunction with mast-cell stabilizer/antihistamine eye drops are often as effective in reducing allergy symptoms as oral antihistamines, but without the systemic side effects. Finally, the fact that practitioners might be underprescribing does not imply negligence on our part. Rather, it is often a matter of patients coming in for an examination when their allergies are asymptomatic or with a rather vague set of symptoms. Either way, asking a few simple questions often aids with the differential diagnosis and identifies those who might require allergy eye drops at other times of the year.
In reality, this isn’t about writing more prescriptions just for the sake of writing prescriptions. It is, however, about being as attentive to our patients’ needs as possible. My guess is that our patients will be happier and more loyal — statistically so.