Clinical ocular pharmacology

777 Pages·2008·29.195 MB·English

by  Jimmy D. Bartlett OD DOS ScD, Siret D. Jaanus PhD LHD

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CLINICAL OCULAR PHARMACOLOGY,FIFTH EDITION ISBN:978-0-7506-7576-5
Copyright © 2008 by Butterworth-Heinemann, an imprint of Elsevier Inc.
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Notice
Knowledge and best practice in this field are constantly changing.As new research and experience
broaden our knowledge,changes in practice,treatment and drug therapy may become necessary or
appropriate.Readers are advised to check the most current information provided (i) on procedures
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dose or formula,the method and duration of administration,and contraindications.It is the
responsibility of the practitioner,relying on their own experience and knowledge of the patient,
to make diagnoses,to determine dosages and the best treatment for each individual patient,and to
take all appropriate safety precautions.To the fullest extent of the law,neither the Publisher nor the
Editors assume any liability for any injury and/or damage to persons or property arising out of or
related to any use of the material contained in this book.
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Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
To Cindy,Andrew, Kenton, and Harrison,
who have taught me about love and family,
and to my parents,
who taught me about the value of hard work.
J.D.B.
To Jaak, Maire, and Ilomai and her family
with more love and thanks than life and time can hold.
S.D.J.
Contributors
Diane T. Adamczyk, OD David D. Castells, OD
Director of Residency Education and Externships Associate Professor
State University of New York Illinois College of Optometry
State College of Optometry Chicago,Illinois
New York,New York
John G. Classé, OD, JD
John F. Amos, OD Professor
Dean School of Optometry
School of Optometry University of Alabama at Birmingham
University of Alabama at Birmingham Member of the Alabama Bar
Birmingham,Alabama Birmingham,Alabama
Howard Barnebey, MD Rachel A. Coulter, OD
Specialty Eyecare Centre Associate Professor
Bellevue,Washington College of Optometry
Former Clinical Associate Professor Nova Southeastern University
Department of Ophthalmology Fort Lauderdale,Florida
University of Washington
Seattle,Washington Timothy R. Covington, MS, PharmD
President and CEO
Jimmy D. Bartlett, OD, DOS, ScD Covington Healthcare Associates,LLC
Professor of Optometry Birmingham,Alabama
School of Optometry Professor of Pharmacy Practice
University of Alabama at Birmingham Harrison School of Pharmacy
Professor of Pharmacology Auburn University
University of Alabama School of Medicine Auburn,Alabama
Birmingham,Alabama
Mitchell W. Dul, OD, MS
David C. Bright, OD Associate Professor
Professor Chairman,Department of Clinical Sciences
Southern California College of Optometry Director,Glaucoma Institute of the University
Fullerton,California Optometric Center
Chief,Optometry Section State University of New York
Greater Los Angeles Healthcare System (VHA) State College of Optometry
Los Angeles,California New York,New York
Private Practice
Linda Casser, OD, FAAO Peekskill,New York
Director of Clinical Examinations
National Board of Examiners in Optometry
Charlotte,North Carolina
vii
viii CONTRIBUTORS
Arthur B. Epstein, OD, FAAO Kimberly A. Lambreghts, RN, OD
Clinical Adjunct Assistant Professor Associate Clinical Professor
Northeastern State University College of Optometry University of Houston
Tahlequah,Oklahoma College of Optometry
Private Practice Houston,Texas
North Shore Contact Lens & Vision Consultants,PC
Roslyn Heights,New York Nada Lingel, OD, MS
Distinguished Professor of Optometry
Richard G. Fiscella, RPh MPH Pacific University College of Optometry
Clinical Professor Forest Grove,Oregon
Department of Pharmacy Practice
Robert W. Lingua, MD
Adjunct Assistant Professor
Lingua Vision Surgical Group
Department of Ophthalmology
Fullerton,California
University of Illinois at Chicago
Chicago,Illinois
Blair B. Lonsberry, MS, OD, MEd, FAAO
Associate Professor
Marcela Frazier, OD, MPH
Clinic Director,Portland Vision Center
Assistant Professor
Pacific University College of Optometry
School of Optometry
Portland,Oregon
University of Alabama at Birmingham
Birmingham,Alabama Gerald G. Melore, OD, MPH
Assistant Clinical Professor
Denise Goodwin, OD, FAAO Pacific University
Associate Professor College of Optometry
Pacific University College of Optometry Forest Grove,Oregon
Forest Grove,Oregon
Cynthia Ann Murrill, OD, MPH
Susan P. Haesaert, OD Adjunct Faculty
Attending Optometrist Pacific University College of Optometry
Boston Veterans Administration Healthcare System Forest Grove,Oregon
Associate Professor of Optometry Pacific Cataract and Laser Institute
New England College of Optometry Tacoma,Washington
Boston,Massachusetts
Jerry R. Paugh, OD, PhD
Nicky R. Holdeman, OD, MD Associate Professor and Associate Dean for Research
Professor and Associate Dean for Clinical Education Southern California College of Optometry
Executive Director,University Eye Institute Fullerton,California
Chief of Medical Services
C. Denise Pensyl, OD, MS, FAAO
University Eye Institute
Chief,Optometry
University of Houston
Bakersfield VA Outpatient Clinic
Houston,Texas
Greater Los Angeles VA Healthcare System
Bakersfield,California
Siret D. Jaanus, PhD, LHD
Professor
Joan K. Portello, OD, MPH, FAAO
Southern California College of Optometry
Associate Professor
Fullerton,California
State University of NewYork
State College of Optometry
Alan G. Kabat, OD, FAAO
New York,New York
Associate Professor
Nova Southeastern University,College of Optometry
C. Lisa Prokopich, OD, BSc
Fort Lauderdale,Florida
Lecturer
Head,Ocular Health Clinic,Optometry
David M. Krumholz, OD, FAAO
School of Optometry
Associate Professor
University of Waterloo
State University of New York
Waterloo,Ontario,Canada
State College of Optometry
Head,Freeport Hospital Vision Centre
New York,New York
Kitchener,Ontario,Canada
CONTRIBUTORS ix
Christopher J. Quinn, OD, FAAO Michael E. Stern, PhD
President Vice President,Inflammation Research Program
Omni Eye Services Allergan,Inc.
Iselin,New Jersey Irvine,California
Kimberly K. Reed, OD, FAAO Tammy Pifer Than, MS, OD, FAAO
Associate Professor Adjunct Associate Professor
Nova Southeastern University School of Optometry
College of Optometry University of Alabama at Birmingham
Fort Lauderdale,Florida Birmingham,Alabama
Adjunct Faculty
Leo Paul Semes, OD Mercer University School of Medicine
Professor Macon,Georgia
School of Optometry Staff Optometrist
University of Alabama at Birmingham Carl Vinson VAMC
University Optometric Group Dublin,Georgia
Birmingham,Alabama
Michael D. VanBrocklin, OD
David P. Sendrowski, OD, FAAO Adjunct Faculty
Professor Pacific University College of Optometry
Southern California College of Optometry Forest Grove,Oregon
Fullerton,California Pacific Cataract and Laser Institute
Tacoma,Washington
Leonid Skorin, Jr., OD, DO, FAAO, FAOCO
Senior Staff Ophthalmologist Erik Weissberg, OD
Albert Lea Eye Clinic–Mayo Health System Associate Professor
Albert Lea,Minnesota New England College of Optometry
Clinical Assistant Professor of Ophthalmology Boston,Massachusetts
Department of Surgery
Chicago College of Osteopathic Medicine Suzanne M. Wickum, OD
Midwestern University Clinical Associate Professor
Downers Grove,Illinois University of Houston
Clinical Assistant Professor College of Optometry
Department of Neurology and Ophthalmology Houston,Texas
College of Osteopathic Medicine
Michigan State University Elizabeth Wyles, OD
East Lansing,Michigan Assistant Professor
Clinical Assistant Professor of Ophthalmology and Visual Illinois College of Optometry
Sciences Chicago,Illinois
University of Illinois Eye & Ear Infirmary
Chicago,Illinois Kathy Yang-Williams, OD, FAAO
Adjunct Professor Northwest Eye Surgeons,PC
College of Optometry Seattle,Washington
Pacific University
Forest Grove,Oregon Diane P. Yolton, PhD, OD
Professor Emeritus
David L. Standfield, OD Pacific University
Adjunct Faculty College of Optometry
Pacific University College of Optometry Forest Grove,Oregon
Forest Grove,Oregon
Pacific Cataract and Laser Institute
Chehalis,Washington
Condit F. Steil, PharmD, FAPhA, CDE
Associate Professor of Pharmacy Practice
McWhorter School of Pharmacy
Samford University
Birmingham,Alabama
Preface
There continues to be an explosion of research on issues that chapter content is “evidence based.”In this edition,
of pharmacologic relevance to primary eye care delivery. each contributing author has been carefully instructed to
New ophthalmic formulations are being developed,new ensure that evidence-based material is the cornerstone of
diagnostic methods introduced,and new medications and every chapter.This is consistent with past editions of this
delivery systems are available that were unheard of a book.However,because reference sources are so easily
decade ago.It is important that these new concepts be retrieved today through the internet and other electronic
introduced to students and practitioners alike.This new sources,we have elected in this edition to simply provide
fifth edition of Clinical Ocular Pharmacologyaddresses selected bibliographies rather than detailed annotated
these new concepts and provides “one-stop shopping”for references.The bibliographies are current and concise,
students,residents,and practicing clinicians who need a direct the reader to the most relevant source material,and
ready source of information regarding both the basic consist of salient major review articles,as well as impor-
pharmacology of ophthalmic drugs,as well as their utiliza- tant classic literature.Our intent,as in previous editions,
tion in clinical practice.In this edition,readers will find is to recognize the work of those individuals who have
that every chapter has been substantially updated from contributed to the knowledge base in ocular pharma-
our previous work, and several chapters have been cology and to ensure that our readers receive the most
completely rewritten. contemporary thought regarding pharmacologic concepts
New topics not previously discussed include several for both the diagnosis and therapeutic intervention in
novel drug delivery systems;the pharmacologic treatment primary eye care.
of retinal diseases,including age-related macular degenera- The updated book design elements you see in these
tion and diabetic retinopathy; and nutritional agents pages,together with the concise writing of our contribut-
relevant to ocular therapy.We have expanded coverage of ing authors and their streamlined reference formatting,
medications used to treat infections, allergies, and dry have resulted in a book that,although visibly smaller and
eyes.New information on ocular hypotensive drugs and more portable,retains its goal of providing the most clin-
an entirely new chapter on the contemporary medical ically relevant material and guidance to optometrists and
management of glaucoma offer new insights on treatment ophthalmologists who care for primary eye care patients.
of these extremely important diseases.
One of the most challenging tasks facing authors of Jimmy D. Bartlett, OD, DOS, ScD
contemporary medical and scientific books is to ensure Siret D. Jaanus, PhD, LHD
xi
Acknowledgments
We are deeply grateful for our contributing authors,both fourth edition,these editors skillfully guided the develop-
those who are new to this edition and those who have ment,organization,and presentation of their respective
contributed to previous editions.Without their enthusi- chapters.Their work has clearly improved the readability,
asm,commitment,and expert contributions,the prepara- accuracy, and conciseness of virtually all the material
tion of this book would have been impossible.The helpful represented in this edition.
suggestions from our colleagues and the expert advice Our editor,Christie Hart,Senior Developmental Editor
from peer referees, who offered insightful and useful at Elsevier,was steadfast in her commitment to this proj-
comments regarding each revised chapter, have clearly ect and in her efforts to coordinate and to ensure timely
improved the presentation and accuracy of the text.We contributions from all the authors and section editors.
are most appreciative of our administrative associates, We are extremely grateful to her for her tireless efforts
Debi Honeycutt, Donna Scott, and Karen Beeching, for on behalf of this edition.
their expert technical skills in preparing the voluminous Most of all,we must also thank our readers,who have
manuscript.We are extremely grateful for our section continually given us positive feedback regarding the useful-
editors—Richard Fiscella, Nicky Holdeman, and Lisa ness of this book.Our students,residents,and clinicians
Prokopich—who spent enumerable hours reviewing from many countries have offered insightful comments
draft manuscript and corresponding with authors and and positive encouragement that have led to the develop-
reviewers to achieve the desired end result.As in the ment of this new edition.
xiii
SECTION
I
Fundamental Concepts in
Ocular Pharmacology
There is no great danger in our mistaking the height of the sun,or the fraction of some astronomical computation;but here
where our whole being is concerned,’tis not wisdom to abandon ourselves to the mercy of the agitation of so many contrary
winds.
Hippocrates
1
1
Pharmacotherapy of the Ophthalmic Patient
Rachel A. Coulter, Jimmy D. Bartlett, and Richard G. Fiscella
Pharmacotherapyof the ophthalmic patient refers to the socioeconomic levels not covered by health insurance,
use of diagnostic drugs to facilitate the examination and obtaining prescribed medications may not be feasible.
diagnosis of patients undergoing comprehensive assess- This can result in the progression of chronic eye condi-
ment and to the use of therapeutic drugs for the treat- tions such as glaucoma.To control medication costs and
ment of patients with eye or vision problems. Patients to increase compliance with drug usage,patients should
requiring ophthalmic pharmacotherapy are individuals. be encouraged to comparison shop among pharmacies,
Individuals with eye problems may have unique medical especially for medications used for prolonged periods of
histories that can include any range or combination of time.Several studies have documented that prescription
systemic conditions from the common cold or asthma to drug prices vary considerably among pharmacies.
rheumatoid arthritis or diabetes. Individuals may take Patients may need guidance in choosing community phar-
medications that can interact with administered or macies that combine reasonable prices with necessary
prescribed ocular drugs.Individuals vary in their desire or services. Prescribing generic drugs when feasible may
need to overcome health problems.Some individuals may help to control the costs of therapy,especially for chronic
have socioeconomic disadvantages that make prescribed diseases such as glaucoma.
medications unaffordable.This chapter discusses funda- Studies have investigated the pharmacoeconomics of
mental issues that must be addressed if each ophthalmic drug therapy.The drug price may reflect only part of the
patient is to benefit fully from pharmacotherapy. medication “cost.”Other costs,such as those associated
with adverse drug effects,additional laboratory tests,and
office visits, may more realistically reflect the pharma-
INITIATING AND MONITORING OCULAR
coeconomics of therapy.For ophthalmic medications,the
PHARMACOTHERAPY
daily cost of medications also depends on the volume of
The decision to use or refrain from using drugs for diagno- the medication, the drop size, dosing regimen, compli-
sis or treatment is often straightforward.Topical anesthet- ance,and other factors.Publications have reviewed glau-
ics must be used for applanation tonometry.Mydriatics are coma and topical corticosteroid therapy and described
required for stereoscopic ophthalmoscopic examinations. more cost-effective treatment options not based solely on
Pharmacologic intervention is needed for patients who the actual medication cost.
have glaucoma. Other situations are less clear. Patients Long-term management of chronic eye conditions
with mild blepharitis may not need antibiotics. Patients depends on patient adherence to therapy. This involves
with dry eye syndrome who have intermittent symptoms an understanding of the ocular condition and a budgeted
but lack ocular surface abnormalities may not require medical care plan.Clinicians’best intentions and efforts
pharmacotherapeutic intervention. Simple reassurance toward therapy are unsuccessful if the medical and phar-
can be sufficient for some patients, the disease process macotherapeutic plan is not practical and reasonable to
may be left to run its natural course.The decision to use that particular patient.
diagnostic or therapeutic pharmaceutical agents should Patient education can impact the ability or willingness
be based on several factors:symptoms,signs,knowledge of patients to use prescribed medications. Studies of
of the natural history of the disease process,potential for patient preferences for eyedrop characteristics have
morbidity,and identification of any underlying ocular or determined that patients differ in how they value various
general medical contraindications. drop characteristics and are willing to pay or undergo
A frequently overlooked factor in prescribing drugs inconvenience for some attributes but not for others.A frank
for ophthalmic patients is affordability. Managed health discussion should include possible side effects, dosage,
care coverage has limitations. For patients at lower and cost to determine patient preference and achieve
3