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An Alternative Treatment

Decreased tear meniscus in dry eye.
As an alternative to steroids—or as an adjunctive therapy—topical cyclosporine can also be used to control inflammation in dry eye disease. While cyclosporine does not demonstrate the rapid anti-inflammatory effect of steroids, it carries fewer risks and is safe for long-term use.
Because of their complementary efficacy and safety profiles, many practitioners often begin dry eye treatment by prescribing both topical steroids and cyclosporine. Following the recommendation of the Asclepius Panel, the use of combination therapy is instituted with the topical corticosteroid, Lotemax (loteprednol etabonate ophthalmic suspension %, Bausch + Lomb) and Restasis (cyclosporine ophthalmic emulsion %, Allergan). 24 The Asclepius Panel recommends practitioners begin early treatment with an anti-inflammatory agent (such as Lotemax) four times a day to improve symptoms and to prevent disease progression. After two weeks, the frequency of the corticosteroid is reduced to twice daily and supplemented with Restasis twice a day. Treatment with loteprednol was stopped after day 60, while cyclosporine treatment is continued.

Betsy:
Some of the generic drops have become expensive because of consolidation. For example, generic pred forte drops used to be very inexpensive but now there are only two companies that make it and those two companies are owned by the same two large pharmaceuticals that own the branded medicines, hence the price of the generic is almost the same as the expensive branded options. The price of drugs does vary from one pharmacy to another and each insurance plan has its preferred drugs which cost much less for patients depending on the deals they have made with the manufactures. For example brand A might be priced well at one store because they have made a good deal with the manufacturer and made it their preferred drug while brand B would be expensive. Across town a different drug store chain might have a great price for B and a high price for A because they have make B their preferred drug and have a great volume price with the manufacturer.
Alas, it is hard to find a cost effective way to protect your eyes around cataract surgery.
God Bless,
Gary Foster

Q: Please, explain the use of calcium channel blockers in glaucoma treatment. Do they replace other medications such as beta-blockers or are they used in conjunction with other glaucoma medication? Is it more dangerous to the patient to use calcium channel blockers when the patient is being treated for other health problems such as heart disease?
A: Calcium channel blockers represent an entirely new approach to the treatment of glaucoma. Hopefully, the advent of these drugs marks only the beginning of a trend in finding new approaches to the treatment of glaucoma over the coming years.
  Previously, the only form of treatment of glaucoma has involved lowering intraocular pressure (IOP), even when IOP is normal to begin with. Although the evidence is not all in yet, calcium channel blockers have been reported to increase blood flow to the eye and to stabilize the visual field. Thus, instead of lowering IOP (although they appear to do this also), calcium channel blockers increase the resistance of the eye to glaucomatous damage. Because they represent an entirely new approach to the treatment of glaucoma, they do not replace other medications that are used in conjunction with them.
  There are different types of calcium channel blockers. Some primarily affect the strength with which the heart contracts, while others affect peripheral blood vessels, making them dilate so that more blood can pass through. The calcium channel blockers used in the treatment of glaucoma ideally would be those which increase blood flow to the brain, since the eye and the brain share a common blood supply.
  It remains to be determined just which patients will be helped and which will not be helped, or even perhaps harmed, by calcium channel blockers. Calcium channel blockers can also lower blood pressure, and a low blood pressure predisposes to glaucomatous damage. Therefore, we do not use these drugs at the present time in patients who have low blood pressure, but only in those with normal or high blood pressure. The patient's internist or family physician should be consulted with regard to the treatment plan.

Diagnosis Index entries containing back-references to :

  • Diabetes, diabetic (mellitus) (sugar) ICD-10-CM Diagnosis Code Type 2 diabetes mellitus without complications
      2016 2017 2018 Billable/Specific Code Questionable As Admission Dx
    • with
      • retinopathy ICD-10-CM Diagnosis Code Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema
          2016 2017 2018 Billable/Specific Code
        • with macular edema
    • type 2 ICD-10-CM Diagnosis Code Type 2 diabetes mellitus without complications
        2016 2017 2018 Billable/Specific Code Questionable As Admission Dx
      • with
        • retinopathy ICD-10-CM Diagnosis Code Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema
            2016 2017 2018 Billable/Specific Code
          • with macular edema

New ophthalmic steroid

new ophthalmic steroid

Diagnosis Index entries containing back-references to :

  • Diabetes, diabetic (mellitus) (sugar) ICD-10-CM Diagnosis Code Type 2 diabetes mellitus without complications
      2016 2017 2018 Billable/Specific Code Questionable As Admission Dx
    • with
      • retinopathy ICD-10-CM Diagnosis Code Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema
          2016 2017 2018 Billable/Specific Code
        • with macular edema
    • type 2 ICD-10-CM Diagnosis Code Type 2 diabetes mellitus without complications
        2016 2017 2018 Billable/Specific Code Questionable As Admission Dx
      • with
        • retinopathy ICD-10-CM Diagnosis Code Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema
            2016 2017 2018 Billable/Specific Code
          • with macular edema

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