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Nijm L, Matossian C, Rhee MK, Stephens JD, Rosselson ME, Majmudar PA, Gollamudi SR, Patel RH, Bauskar A, Montieth A, Vantipalli S, Gibson A, Metzinger JL, Goldstein MH, Gurses Ozden R. Early Real-World Patient and Staff Experience with an Intracanalicular Dexamethasone Insert. Clin Ophthalmol 2024; 18:1391-1401. [PMID: 38784434 PMCID: PMC11114144 DOI: 10.2147/opth.s448973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/26/2024] [Indexed: 05/25/2024] Open
Abstract
Purpose To evaluate both the early experience of real-world patients treated with dexamethasone ophthalmic insert (0.4 mg; DEXTENZA®), hereafter referred to as DEX, after cataract surgery as well as staff/practice integration of DEX relative to eyedrops. Patients and Methods This was a cross-sectional survey study of 23 cataract practices in the United States. Respondents were patients and practice staff who had experience with DEX following cataract surgery. Both patients and practice staff completed an online survey. Descriptive statistics summarized the survey responses to portray the experience of the respondents. Results Surveys were completed by 62 patients and 19 practice staff. Almost all patients (93%) were satisfied or extremely satisfied with DEX. Patients highly preferred DEX (93%) to topical steroid drops (7%) based on past experiences with topical steroid drops. Most practice staff (95%) were satisfied or highly satisfied with DEX, reporting a 45% reduction in time spent educating patients on postoperative drop use and a 46% decrease in time spent addressing calls from pharmacies regarding postoperative medications. Conclusion Incorporating the DEX insert into clinical practice in cataract surgery practices can improve patient adherence, while potentially providing significant savings to practices in terms of time spent educating patients and responding to patient and pharmacy call-backs.
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Affiliation(s)
- Lisa Nijm
- Warrenville EyeCare and LASIK, Warrenville, IL, USA
- University of Illinois Eye and Ear Infirmary, Chicago, IL, USA
| | | | | | | | | | | | | | - Ravi H Patel
- Eye Associates of Central Texas, Round Rock, TX, USA
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Reich S, Lopez M, Leff J, Herman J. DEXTENZA versus Topical Steroid or Antihistamine Therapy for Treatment of Allergic Conjunctivitis. Clin Ophthalmol 2024; 18:473-480. [PMID: 38375441 PMCID: PMC10875166 DOI: 10.2147/opth.s440840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/19/2024] [Indexed: 02/21/2024] Open
Abstract
Purpose To compare clinical outcomes and patient preference for the dexamethasone intracanalicular insert (DEX) versus topical loteprednol (LOT) or olopatadine (OLO) for the treatment of allergic conjunctivitis in a real-world model of allergen exposure. Methods This was a prospective comparative trial. Adults with testing-confirmed bilateral allergic conjunctivitis received DEX in the more symptomatic eye and either LOT 2 times daily or OLO once daily for 30 days in the fellow eye. The primary outcome was patient preference for treatment. Clinical outcomes included ocular itching and hyperemia, lid swelling, and watering/tearing. Safety outcomes included intraocular pressure (IOP). Results Thirty patients participated and completed the study. All received DEX in the eye with worse symptoms and 15 received LOT and the other 15 received OLO in the other eye. Patients preferred DEX (10/15; 66.7%) over LOT (4/15; 26.7%), with one patient having no preference (p = 0.0103). Patients had no preference between DEX (8/15; 53.3%) and OLO (6/15; 40%), with one patient having no preference (p = 0.1044). In the DEX/LOT cohort, ocular itching and hyperemia improved more with DEX than LOT (p ≤ 0.009), while in the DEX/OLO cohort, the DEX eyes showed greater improvement in conjunctival hyperemia (p < 0.0001) but not itching (p = 0.074). No between-group differences were seen in eyelid swelling or tearing/watering in either cohort. Mean change in IOP was similar between the DEX and LOT eyes (p = 0.4921), and mean IOP rose more in the DEX eyes than the OLO eyes (by <1 mmHg; p = 0.0403). Conclusion Overall, this real-world study demonstrated that the dexamethasone intracanalicular insert was as effective as a topical antihistamine/mast cell stabilizer and more effective than topical steroids in relieving the signs and symptoms of allergic conjunctivitis. This insert should be considered as an alternative to topical therapy for the treatment of allergic conjunctivitis.
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Affiliation(s)
- Shani Reich
- Clinical Research Center of Florida, Pompano Beach, FL, USA
| | - Maria Lopez
- New England Eye Center/Tufts Medical Center, Boston, MA, USA
| | - Jacqueline Leff
- Touro Osteopathic School of Medicine, Touro University, New York, NY, USA
| | - Jordan Herman
- Clinical Research Center of Florida, Pompano Beach, FL, USA
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Hovanesian J, Singh IP, Bauskar A, Vantipalli S, Ozden RG, Goldstein MH. Identifying and addressing common contributors to nonadherence with ophthalmic medical therapy. Curr Opin Ophthalmol 2023; 34:S1-S13. [PMID: 36951648 DOI: 10.1097/icu.0000000000000953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
PURPOSE OF REVIEW To discuss common reasons for nonadherence and review existing and emerging options to reduce nonadherence with ocular medical therapy and optimize therapeutic outcomes. RECENT FINDINGS Nonadherence can arise from patient-related issues (e.g. physical, cognitive) and healthcare-related issues (e.g. cost, access to care). Multiple strategies have been developed and evaluated to overcome these barriers to adherence. Identifying nonadherence and its cause(s) facilitates the development of strategies to overcome it. SUMMARY Many common causes of nonadherence can be mitigated through a variety of strategies presented.
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Affiliation(s)
| | - I Paul Singh
- The Eye Centers of Racine and Kenosha, Racine, Wisconsin
| | - Aditi Bauskar
- Ocular Therapeutix, Inc., Bedford, Massachusetts USA
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Jee KJ, Ling J, Bafna S, Chester T, Augustine J, Wiley WF. Prospective, Randomized, Fellow Eye-Controlled Study of Postoperative Pain and Inflammation Control with an Intracanalicular Dexamethasone 0.4 mg Ophthalmic Insert Following Small Incision Lenticule Extraction. Clin Ophthalmol 2022; 16:3895-3904. [PMID: 36444207 PMCID: PMC9700473 DOI: 10.2147/opth.s390815] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/11/2022] [Indexed: 06/15/2024] Open
Abstract
PURPOSE To compare postoperative anterior chamber inflammation, pain, and patient preference following small incision lenticule extraction (SMILE) in eyes treated with a dexamethasone 0.4 mg intracanalicular insert (DEX) or topical prednisolone acetate (PRED). PATIENTS AND METHODS In this prospective, randomized, fellow eye-controlled trial, 20 patients underwent same-day, bilateral SMILE. One randomly-selected eye of each patient received DEX placed immediately postoperatively, and the fellow eye received topical PRED tapered over 2 weeks. Postoperative evaluations were performed on day 1, week 1, month 1, and month 3. Primary outcomes included postoperative pain, incidence of anterior chamber cell and flare, and patient preference of steroid therapy. RESULTS No eyes in either group had any clinically evident cell or flare at any postoperative time point. Mean pain scores (0-10 by subjective report) and incidence of any pain were statistically similar at all postoperative visits. Uncorrected distance visual acuity improved in all eyes, 91% of which achieved 20/25 or better. No eyes lost any lines of corrected distance visual acuity. Three eyes developed a steroid-related rise in intraocular pressure, all of which resolved with 2 of the 3 eyes requiring topical therapy. At 1 week, 1 month, and 3 months, 70%, 65%, and 53% of patients preferred DEX over PRED therapy, respectively. CONCLUSION The DEX insert was preferred by more patients and controlled postoperative inflammation and pain comparably to topical PRED in eyes undergoing SMILE. There were no statistically significant differences in visual outcomes between the two groups.
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Lu AQ, Rizk M, O'Rourke T, Goodling K, Lehman E, Scott IU, Pantanelli SM. Safety and efficacy of topical vs intracanalicular corticosteroids for the prevention of postoperative inflammation after cataract surgery. J Cataract Refract Surg 2022; 48:1242-1247. [PMID: 35537939 PMCID: PMC9622372 DOI: 10.1097/j.jcrs.0000000000000963] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/28/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To compare the safety and efficacy of topical prednisolone and intracanalicular dexamethasone ophthalmic insert for the prevention of postoperative inflammation after cataract surgery. SETTING Penn State College of Medicine, Hershey, Pennsylvania. DESIGN Retrospective consecutive case series. METHODS Patients scheduled for elective phacoemulsification cataract surgery with a plan to receive inflammation prophylaxis with topical prednisolone (prednisolone acetate 1 mg/1 mL) between January 2018 and November 2019 or intracanalicular dexamethasone (Dextenza, 0.4 mg) between December 2019 and March 2021 were screened. Patients were seen 1 day, 1 week, and 4 to 16 weeks postoperatively. Medical records were also reviewed for any urgent messages between visits. Primary end points were proportion of eyes with (1) breakthrough inflammation requiring escalation of anti-inflammatory therapy and (2) intraocular pressure (IOP) increase ≥10 mm Hg at 4 to 16 weeks of follow-up. Secondary end points included incidence of intraoperative complications, cystoid macular edema, and infectious sequelae. RESULTS 358 patient charts (358 eyes) were screened. Of these, 262 eyes of 262 patients met the criteria for inclusion in the study; 131 eyes received topical drops, and 131 eyes received the intracanalicular insert. Among eyes that completed follow-up, 9 eyes (6.9%) in the drops group and 12 eyes (9.2%) in the insert group experienced breakthrough inflammation necessitating treatment ( P = .50). 2 eyes in the drops group and 1 eye in the insert group had elevated IOP. CONCLUSIONS Postoperative inflammation prophylaxis with the intracanalicular insert may be associated with similar rates of breakthrough inflammation and IOP elevation as topical drops.
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Ibach MJ, Zimprich L, Wallin DD, Olevson C, Puls-Boever K, Thompson V. In Clinic Optometrist Insertion of Dextenza (Dexamethasone Ophthalmic Insert 0.4mg) Prior to Cataract Surgery: The PREPARE Study. Clin Ophthalmol 2022; 16:2609-2615. [PMID: 35992569 PMCID: PMC9384970 DOI: 10.2147/opth.s374405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/04/2022] [Indexed: 01/13/2023] Open
Abstract
Purpose Methods Results Conclusion ![]()
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Affiliation(s)
- Mitchel J Ibach
- Ophthalmology, Vance Thompson Vision, Sioux Falls, SD, USA
- Correspondence: Mitchel J Ibach, Vance Thompson Vision, 3101 W. 57th St, Sioux Falls, SD, 57108, USA, Tel +1 605-361-3937, Fax +1 605-371-7035, Email
| | - Larae Zimprich
- Ophthalmology, Vance Thompson Vision, Sioux Falls, SD, USA
| | - Doug D Wallin
- Ophthalmology, Vance Thompson Vision, Sioux Falls, SD, USA
| | - Collin Olevson
- Medical School, University of South Dakota School of Medicine, Vermillion, SD, USA
| | | | - Vance Thompson
- Ophthalmology, Vance Thompson Vision, Sioux Falls, SD, USA
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Matossian C, Stephens JD, Rhee MK, Smith SE, Majmudar PA, Gollamudi SR, Patel RH, Rosselson ME, Bauskar A, Montieth A, Silva FQ, Vantipalli S, Gibson A, Metzinger JL, Goldstein MH. Early Real-World Physician Experience with an Intracanalicular Dexamethasone Insert. Clin Ophthalmol 2022; 16:2429-2440. [PMID: 35968052 PMCID: PMC9365058 DOI: 10.2147/opth.s372440] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Ravi H Patel
- Eye Associates of Central Texas, Round Rock, TX, USA
| | | | | | | | | | - Srilatha Vantipalli
- Ocular Therapeutix, Inc., Bedford, MA, USA
- Correspondence: Srilatha Vantipalli, Ocular Therapeutix, Inc, 24 Crosby Drive, Bedford, MA, 01730, USA, Tel +1 413-230-7242, Email
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Dierker DS, Hauswirth SG. Thermal Pulsation with or without Dexamethasone Intracanalicular Insert for Meibomian Gland Dysfunction: A Prospective, Masked Trial. Clin Ophthalmol 2022; 16:1477-1485. [PMID: 35585875 PMCID: PMC9109882 DOI: 10.2147/opth.s359719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/28/2022] [Indexed: 11/23/2022] Open
Abstract
Significance Meibomian gland dysfunction (MGD) is among the most common causes of dry eye disease worldwide. Few studies have compared treatment options, and the basis for an evidentiary approach to MGD management is lacking. We have conducted a non-randomized trial evaluating the additive benefit of a recently developed therapy. Purpose To compare the efficacy of thermal pulsation therapy alone or combined with the dexamethasone intracanalicular insert (Dextenza) on the signs and symptoms of MGD. Methods This was a prospective, patient-masked, sham-controlled, non-randomized trial. All subjects underwent thermal pulsation therapy using the LipiFlow system. The dexamethasone intracanalicular insert was placed in the inferior canaliculus of the more symptomatic eye (DEX group), while sham punctal dilation of the fellow eye was performed to preserve patient masking (SHAM group). Key outcomes were improvement in meibum expressibility at 1, 4, and 12 weeks and patient treatment preference at week 12. Results Nineteen subjects underwent thermal pulsation therapy and received the DEX insert. Meibomian gland expressibility scores improved significantly in both groups at 1, 4, and 12 weeks, with significantly greater improvement in DEX eyes than SHAM eyes at 12 weeks (P=0.027). Improvement from baseline in TBUT was significant at all time points in DEX eyes and only at week 4 in SHAM eyes, with significantly greater improvement in DEX eyes over SHAM eyes at week 12 (P=0.028). Mean best-corrected visual acuity and intraocular pressure remained unchanged from baseline throughout follow-up in both groups, and no adverse events were noted. Combined therapy with DEX was preferred by 61% of subjects. Conclusion This study demonstrated a significant benefit of combining thermal pulsation therapy with the dexamethasone intracanalicular insert on signs of MGD including TBUT and meibomian gland expressibility score. Consequently, a majority of patients preferred combination therapy to thermal pulsation therapy alone.
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Affiliation(s)
- Damon S Dierker
- Eye Surgeons of Indiana, Indianapolis, IN, USA
- Correspondence: Damon S Dierker, Eye Surgeons of Indiana, 9202 N Meridian St, #100, Indianapolis, IN, 46260, USA, Email
| | - Scott G Hauswirth
- Department of Ophthalmology, Sue-Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO, USA
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Saenz B, Ferguson TJ, Abraham N, Mueller BH, Parkhurst GD. Evaluation of Same-Day versus Next-Day Implantation of Intracanalicular Dexamethasone for the Control of Postoperative Inflammation and Pain Following Cataract Surgery. Clin Ophthalmol 2021; 15:4615-4620. [PMID: 34916773 PMCID: PMC8669496 DOI: 10.2147/opth.s334297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 11/12/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the safety and efficacy of a sustained-release intracanalicular dexamethasone insert for postoperative inflammation and pain implanted in a clinical setting preoperatively or on postoperative day 1. Methods Single-site, retrospective, contralateral eye study of patients undergoing cataract surgery. Included were subjects with a dexamethasone intracanalicular insert implanted in the clinic immediately prior to surgery in one eye (same-day) and on postoperative day 1 (POD1) in the contralateral eye. The primary outcome measure was the resolution of anterior chamber inflammation at 1 week postoperative. Secondary outcome measures included proportion of eyes requiring additional therapy for pain and inflammation through 1 month as well as the number of eyes with IOP spikes above baseline. Safety measures included adverse events through 1 month postoperative. Results Sixty-two eyes of 31 subjects were included in the case series. At 1 week postoperative, 52% of the eyes (n = 16) achieved complete resolution of inflammation in the same-day group and 58% (n = 18) met this endpoint at 1 week in the POD1 group. One subject in the same-day group required additional therapy for rebound inflammation and no eyes required additional therapy in the POD1 group. There were no reports of pain at 1 week or 1 month in either group. There were no implant-related adverse events in either group. Conclusion The favorable results of this study indicate that the sustained-release dexamethasone insert can be safely implanted in the clinic either preoperatively on the day of surgery or on postoperative day 1 for the control of pain and inflammation following cataract surgery.
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