Ординатура / Офтальмология / Английские материалы / Clinical Ocular Pharmacology 5th edition_Bartlett, Jaanus_2008

viii CONTRIBUTORS

Arthur B. Epstein, OD, FAAO

Clinical Adjunct Assistant Professor

Northeastern State University College of Optometry

Tahlequah, Oklahoma

Private Practice

North Shore Contact Lens & Vision Consultants, PC

Roslyn Heights, New York

Richard G. Fiscella, RPh MPH

Clinical Professor

Department of Pharmacy Practice

Adjunct Assistant Professor

Department of Ophthalmology

University of Illinois at Chicago

Chicago, Illinois

Marcela Frazier, OD, MPH

Assistant Professor

School of Optometry

University of Alabama at Birmingham

Birmingham,Alabama

Denise Goodwin, OD, FAAO

Associate Professor

Pacific University College of Optometry

Forest Grove, Oregon

Susan P. Haesaert, OD

Attending Optometrist

Boston Veterans Administration Healthcare System

Associate Professor of Optometry

New England College of Optometry

Boston, Massachusetts

Nicky R. Holdeman, OD, MD

Professor and Associate Dean for Clinical Education Executive Director, University Eye Institute

Chief of Medical Services University Eye Institute University of Houston

Houston,Texas

Siret D. Jaanus, PhD, LHD

Professor

Southern California College of Optometry

Fullerton, California

Alan G. Kabat, OD, FAAO

Associate Professor

Nova Southeastern University, College of Optometry

Fort Lauderdale, Florida

David M. Krumholz, OD, FAAO

Associate Professor

State University of New York

State College of Optometry

New York, New York

Kimberly A. Lambreghts, RN, OD

Associate Clinical Professor

University of Houston

College of Optometry

Houston,Texas

Nada Lingel, OD, MS

Distinguished Professor of Optometry

Pacific University College of Optometry

Forest Grove, Oregon

Robert W. Lingua, MD

Lingua Vision Surgical Group

Fullerton, California

Blair B. Lonsberry, MS, OD, MEd, FAAO

Associate Professor

Clinic Director, Portland Vision Center

Pacific University College of Optometry

Portland, Oregon

Gerald G. Melore, OD, MPH

Assistant Clinical Professor

Pacific University

College of Optometry

Forest Grove, Oregon

Cynthia Ann Murrill, OD, MPH

Adjunct Faculty

Pacific University College of Optometry

Forest Grove, Oregon

Pacific Cataract and Laser Institute

Tacoma,Washington

Jerry R. Paugh, OD, PhD

Associate Professor and Associate Dean for Research Southern California College of Optometry

Fullerton, California

C. Denise Pensyl, OD, MS, FAAO

Chief, Optometry

Bakersfield VA Outpatient Clinic

Greater Los Angeles VA Healthcare System

Bakersfield, California

Joan K. Portello, OD, MPH, FAAO

Associate Professor

State University of NewYork

State College of Optometry

New York, New York

C. Lisa Prokopich, OD, BSc

Lecturer

Head, Ocular Health Clinic, Optometry

School of Optometry

University of Waterloo

Waterloo, Ontario, Canada

Head, Freeport Hospital Vision Centre

Kitchener, Ontario, Canada

There continues to be an explosion of research on issues of pharmacologic relevance to primary eye care delivery. New ophthalmic formulations are being developed, new diagnostic methods introduced, and new medications and delivery systems are available that were unheard of a decade ago. It is important that these new concepts be introduced to students and practitioners alike. This new fifth edition of Clinical Ocular Pharmacology addresses these new concepts and provides “one-stop shopping” for students, residents, and practicing clinicians who need a ready source of information regarding both the basic pharmacology of ophthalmic drugs, as well as their utilization in clinical practice. In this edition, readers will find that every chapter has been substantially updated from our previous work, and several chapters have been completely rewritten.

New topics not previously discussed include several novel drug delivery systems; the pharmacologic treatment of retinal diseases, including age-related macular degeneration and diabetic retinopathy; and nutritional agents relevant to ocular therapy. We have expanded coverage of medications used to treat infections, allergies, and dry eyes. New information on ocular hypotensive drugs and an entirely new chapter on the contemporary medical management of glaucoma offer new insights on treatment of these extremely important diseases.

One of the most challenging tasks facing authors of contemporary medical and scientific books is to ensure

that chapter content is “evidence based.” In this edition, each contributing author has been carefully instructed to ensure that evidence-based material is the cornerstone of every chapter. This is consistent with past editions of this book. However, because reference sources are so easily retrieved today through the internet and other electronic sources, we have elected in this edition to simply provide selected bibliographies rather than detailed annotated references. The bibliographies are current and concise, direct the reader to the most relevant source material, and consist of salient major review articles, as well as important classic literature. Our intent, as in previous editions, is to recognize the work of those individuals who have contributed to the knowledge base in ocular pharmacology and to ensure that our readers receive the most contemporary thought regarding pharmacologic concepts for both the diagnosis and therapeutic intervention in primary eye care.

The updated book design elements you see in these pages, together with the concise writing of our contributing authors and their streamlined reference formatting, have resulted in a book that, although visibly smaller and more portable, retains its goal of providing the most clinically relevant material and guidance to optometrists and ophthalmologists who care for primary eye care patients.

Jimmy D. Bartlett, OD, DOS, ScD

Siret D. Jaanus, PhD, LHD

We are deeply grateful for our contributing authors, both those who are new to this edition and those who have contributed to previous editions. Without their enthusiasm, commitment, and expert contributions, the preparation of this book would have been impossible. The helpful suggestions from our colleagues and the expert advice from peer referees, who offered insightful and useful comments regarding each revised chapter, have clearly improved the presentation and accuracy of the text. We are most appreciative of our administrative associates, Debi Honeycutt, Donna Scott, and Karen Beeching, for their expert technical skills in preparing the voluminous manuscript. We are extremely grateful for our section editors—Richard Fiscella, Nicky Holdeman, and Lisa Prokopich—who spent enumerable hours reviewing draft manuscript and corresponding with authors and reviewers to achieve the desired end result. As in the

fourth edition, these editors skillfully guided the development, organization, and presentation of their respective chapters.Their work has clearly improved the readability, accuracy, and conciseness of virtually all the material represented in this edition.

Our editor, Christie Hart, Senior Developmental Editor at Elsevier, was steadfast in her commitment to this project and in her efforts to coordinate and to ensure timely contributions from all the authors and section editors. We are extremely grateful to her for her tireless efforts on behalf of this edition.

Most of all, we must also thank our readers, who have continually given us positive feedback regarding the usefulness of this book. Our students, residents, and clinicians from many countries have offered insightful comments and positive encouragement that have led to the development of this new edition.

Pharmacotherapy of the ophthalmic patient refers to the use of diagnostic drugs to facilitate the examination and diagnosis of patients undergoing comprehensive assessment and to the use of therapeutic drugs for the treatment of patients with eye or vision problems. Patients requiring ophthalmic pharmacotherapy are individuals. Individuals with eye problems may have unique medical histories that can include any range or combination of systemic conditions from the common cold or asthma to rheumatoid arthritis or diabetes. Individuals may take medications that can interact with administered or prescribed ocular drugs. Individuals vary in their desire or need to overcome health problems. Some individuals may have socioeconomic disadvantages that make prescribed medications unaffordable. This chapter discusses fundamental issues that must be addressed if each ophthalmic patient is to benefit fully from pharmacotherapy.

INITIATING AND MONITORING OCULAR PHARMACOTHERAPY

The decision to use or refrain from using drugs for diagnosis or treatment is often straightforward.Topical anesthetics must be used for applanation tonometry. Mydriatics are required for stereoscopic ophthalmoscopic examinations. Pharmacologic intervention is needed for patients who have glaucoma. Other situations are less clear. Patients with mild blepharitis may not need antibiotics. Patients with dry eye syndrome who have intermittent symptoms but lack ocular surface abnormalities may not require pharmacotherapeutic intervention. Simple reassurance can be sufficient for some patients, the disease process may be left to run its natural course.The decision to use diagnostic or therapeutic pharmaceutical agents should be based on several factors: symptoms, signs, knowledge of the natural history of the disease process, potential for morbidity, and identification of any underlying ocular or general medical contraindications.

A frequently overlooked factor in prescribing drugs for ophthalmic patients is affordability. Managed health care coverage has limitations. For patients at lower

socioeconomic levels not covered by health insurance, obtaining prescribed medications may not be feasible.

This can result in the progression of chronic eye conditions such as glaucoma. To control medication costs and to increase compliance with drug usage, patients should be encouraged to comparison shop among pharmacies, especially for medications used for prolonged periods of time. Several studies have documented that prescription drug prices vary considerably among pharmacies. Patients may need guidance in choosing community pharmacies that combine reasonable prices with necessary services. Prescribing generic drugs when feasible may help to control the costs of therapy, especially for chronic diseases such as glaucoma.

Studies have investigated the pharmacoeconomics of drug therapy. The drug price may reflect only part of the medication “cost.” Other costs, such as those associated with adverse drug effects, additional laboratory tests, and office visits, may more realistically reflect the pharmacoeconomics of therapy. For ophthalmic medications, the daily cost of medications also depends on the volume of the medication, the drop size, dosing regimen, compliance, and other factors. Publications have reviewed glaucoma and topical corticosteroid therapy and described more cost-effective treatment options not based solely on the actual medication cost.

Long-term management of chronic eye conditions depends on patient adherence to therapy. This involves an understanding of the ocular condition and a budgeted medical care plan. Clinicians’ best intentions and efforts toward therapy are unsuccessful if the medical and pharmacotherapeutic plan is not practical and reasonable to that particular patient.

Patient education can impact the ability or willingness of patients to use prescribed medications. Studies of patient preferences for eyedrop characteristics have determined that patients differ in how they value various drop characteristics and are willing to pay or undergo inconvenience for some attributes but not for others.A frank discussion should include possible side effects, dosage, and cost to determine patient preference and achieve