YAFI Online Programming // Disease State Management and Drug Therapy

An Octet of Ocular Conditions

Current "Eye" diology

Educational Objectives

After participating in this activity, pharmacists will be able to:

  • DISCUSS common ocular condition’s pathophysiology and causes
  • IDENTIFY recent changes in available medications to treat ocular conditions
  • DISTINGUISH each FDA-approved product by the condition that it treats
  • DISCUSS barriers to care, adherence, and administration of eye drop waste
  • MAXIMIZE the pharmacist’s role in identifying OTC products, referring patients for prescription strength medication, and counseling patients about both

After participating in this activity pharmacy technicians will be able to:

  • LIST basic facts about ocular conditions
  • IDENTIFY reputable sources for patients who have ocular conditions to find information
  • DIFFERENTIATE between over-the-counter and prescription drugs for ocular conditions
  • IDENTIFY patients who need referral to the pharmacist for recommendations or referral

Session Offered

Release Date: September 24, 2018

Expiration Date: September 24, 2021

Course Fee

Free

Session Codes

18YC78-BXT66-Pharmacist

18YC78-XPV46-Pharmacy Technician

Accreditation Hours

2.0 hours of CE

Abstract

Ocular problems—many of which cause severe vision loss or blindness—are on the rise in the US. Common eye diseases include glaucoma, agerelated macular degeneration, dry eye, conjunctivitis and blepharitis. Pharmacy staff may be the first providers a patient approaches to consult about an eye condition since many treatment options are available over-the-counter. Armed with knowledge of ophthalmic conditions and treatments, pharmacists can determine if patients are candidates for self-treatment, evaluate the appropriateness of pharmacotherapy, screen for medication-induced eye disorders, and promote proper medication adherence. Patients often use ophthalmic products; patient education should be a top priority for pharmacy staff.

Accreditation Statements

The University of Connecticut School of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Pharmacists and pharmacy technicians are eligible to participate in this application-based activity and will receive up to 0.2 CEU (2 contact hours) for completing the activity, passing the quiz with a grade of 70% or better, and completing an online evaluation. Statements of credit are available via the CPE Monitor on- line system and your participation will be recorded with CPE Monitor within 72 hours of submission

ACPE UAN:
0009-0000-18-078-H01-P
0009-0000-18-078-H01-T

Grant funding: Alcon Laboratories, Inc

Cost: Free

Initial Release Date: September 24, 2018

Expiration Date: September 24, 2021

To obtain CPE credit, visit the UConn Online CE Center

Use your NABP E-profile ID and the session code 18YC78-BXT66 for pharmacists or 18YC78-XPV46 for pharmacy technicians to access the online quiz and evaluation.

First- time users must pre-register in the Online CE Center. Test results will be displayed immediately and your participation will be recorded with CPE Mon- itor within 72 hours of completing the requirements.

For questions concerning the online CPE activities, email joanne.nault@uconn.edu

Faculty

Stefanie C. Nigro, PharmD, BCACP, BC-ADM, CDE, Assistant Professor, MCPHS University

Elizabeth Haftel, PharmD, CDE, Assistant Professor, MCPHS University, Boston, MA.

Faculty Disclosure

Drs. Nigro and Haftel have no actual or potential conflicts of interest associated with this article.

Disclosure of Discussions of Off-label and Investigational Drug Use

This activity may contain discussion of off label/unapproved use of drugs. The content and views presented in this educational program are those of the faculty and do not necessarily represent those of the University of Connecticut School of Pharmacy. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Content

Introduction

Ocular problems—many of which may cause severe vision loss or blindness—are on the rise in the US. A change in vision is common. Sensitivity to light and the need to wear glasses to see near or far are expected parts of aging. However, the development of certain age-related eye diseases including cataracts, diabetic retinopathy, glaucoma, and macular degeneration can significantly impair vision, further reducing quality of life and independence. Currently, 1.3 million people in the US are blind and more than $139 billion in healthcare costs are related to ocular problems.1 As the population continues to age, these numbers are expected to worsen. Pharmacy staff may be the first providers a patient approaches to consult about his or her eye condition. Yet, many pharmacists and other healthcare providers
express lack of confidence caring for patients with ocular conditions. With improved ophthalmic knowledge, pharmacists can help patients navigate overcrowded over-the-counter (OTC) aisles, understand proper use of eye care products, and improve overall satisfaction with their care.

References

Full List of References

1. National Institutes of Health, National Eye Institute. (March 2014). Eye disease statistics. Available at: https://nei.nih.gov/sites/default/files/neipdfs/NEI_Eye_Disease_Statistics_Factsheet_2014_V10.pdf
2. Elton M. Ocular conditions from A to Z (ii). Pharm J. 2007;278:255-258.
3. Fiscella RG, Jensen MK. Ophthalmic disorders. In: Krinsky DL, Ferreri SP, Hemstreet B, et al.,eds. Handbook of Nonprescription drugs. 19th ed. Washington, DC: American Pharmacists Association; 2018.
4. Mcgwin G, Xie A, Owsley C. Rate of eye injury in the United States. Arch Ophthalmol. 2005;123(7):970-6.
5. Wilson SA, Last A. Management of corneal abrasions. Am Fam Physician. 2004;70(1):123-8
6. Mcgwin G, Hall TA, Xie A, Owsley C. Trends in eye injury in the United States, 1992-2001. Invest Ophthalmol Vis Sci. 2006;47(2):521-7.
7. Pagan-Duran B. Recognizing and Treating Eye Injuries. American Academy of Ophthalmology. https://www.aao.org/eyehealth/tips-prevention/injuries. Published March 1, 2016. Accessed August 15, 2018.
8. Chakravarthy U, Evans J, Rosenfeld PJ. Age related macular degeneration. BMJ. 2010;340:c981.
9. American Academy of Ophthalmology Retina/Vitreous Panel. Preferred Practice Pattern Guidelines. Age-Related Macular Degeneration. San Francisco, CA: American Academy of Ophthalmology; 2015.
10. Congdon N, O’Colmain B, Klaver CC, et al. Causes and prevalence of visual impairment among adults in the United States. Arch Opthalmol 2004;122:477-85.
11. Jager RD, Mieler WF, Miller JW. Age-related macular degeneration. N Engl J Med. 2008;358(24):2606-17.
12. Lim LS, Mitchell P, Seddon JM, Holz FG, Wong TY. Age-related macular degeneration. Lancet. 2012;379(9827):1728-38.
13. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS report no. 8. Arch Ophthalmol. 2001;119(10):1417-36.
14. AREDS2 Research Group. “Lutein/Zeaxanthin and Omega-3 Fatty Acids for Age-Related Macular Degeneration. The Age-Related Eye Disease Study 2 (AREDS2) Controlled Randomized Clinical Trial.” JAMA, published online May 5, 2013.
15. Goralczyk R. Beta-carotene and lung cancer in smokers: review of hypotheses and status of research. Nutr Cancer. 2009;61(6):767-74.
16. Mousa SA, Mousa SS. Current status of vascular endothelial growth factor inhibition in age-related macular degeneration. BioDrugs. 2010;24(3):183-94.
17. Falavarjani KG, Nguyen QD. Adverse events and complications associated with intravitreal injection of anti-VEGF agents: a review of literature. Eye (Lond). 2013;27(7):787-94.
18. Lemp MA, Nichols KK. Blepharitis in the United States 2009: a survey-based perspective on prevalence and treatment. Ocul Surf. 2009;7(2 Suppl):S1-S14.
19. American Optometric Association. Blepharitis. Accessed August 15, 2018. Available at: https://www.aoa.org/patients-andpublic/eye-and-vision-problems/glossary-of-eye-and-visionconditions/blepharitis
20. American Academy of Ophthalmology AAO Cornea/External Disease PPP Panel. Preferred Practice Pattern

21. Guideline Blepharitis. San Francisco, CA: American Academy of Ophthalmology; 2013.Chen SC, Sheu SJ. Recent advances in managing and understanding uveitis. F1000Res. 2017;6:280.
22. National Eye Institute (NEI). Facts about uveitis. Accessed August 15, 2018. Available at: https://nei.nih.gov/health/uveitis/uveitis
23. Gutteridge IF, Hall AJ. Acute anterior uveitis in primary care. Clin Exp Optom. 2007 Mar;90(2):70-82.
24. Wittenberg S. 10 Clinical pearls for treating uveitis. American Academy of Ophthalmology, 2008. Accessed August 15, 2018. Available from: https://www.aao.org/youngophthalmologists/yo-info/article/10-clinical-pearls-treatinguveitis
25. Olson RJ, Braga-Mele R, Chen SH, Miller KM, Pineda R, Tweeten JP, Musch DC. Cataract in the Adult Eye Preferred Practice
Pattern. Ophthalmology. 2017 Feb 124(2) P1-P119.
doi:10.1016/j.ophtha.2016.09.027
26. Chang DF, Braga-mele R, Mamalis N, et al. Prophylaxis of postoperative endophthalmitis after cataract surgery: results of the 2007 ASCRS member survey. J Cataract Refract Surg. 2007;33(10):1801-5.
27. Azari AA, Barney NP. Conjunctivitis: a systematic review of diagnosis and treatment. JAMA. 2013;310(16):1721-9.
28. Cronau H, Kankanala RR, Mauger T. Diagnosis and management of red eye in primary care. Am Fam Physician. 2010 Jan 15;81(2):137-144.
29. Shekhawat NS, Shtein RM, Blachley TS, Stein JD. Antibiotic Prescription Fills for Acute Conjunctivitis among Enrollees in a Large United States Managed Care Network. Ophthalmology. 2017;124(8):1099-1107.
30. National Eye Institute (NEI). Facts about dry eye. Updated July 2017. Accessed August, 8, 2018. Available at:
https://nei.nih.gov/health/dryeye/dryeye
31. Restasis(cyclosporine) [package insert]. Irvine, CA: Allergan; 2012.
32. Lacrisert (hydroxypropyl cellulose) [package insert]. Bridgewater, NJ. Bausch and Lomb; 2016.
33. Dry eye assessment and management research study group (DREAM). n-3 Fatty Acid Supplementation for the Treatment of Dry Eye Disease. N Engl J Med. 2018;
34. Prum BE, Rosenberg LF, Gedde SJ, Mansberger SL, et al. Primary Open-Angle Glaucoma Preferred Practice Pattern
Guidelines. Ophthalmology, 2016;123(1). doi:10.1016/j.ophtha.2015.10.053
35. Maier PC, Funk J, Schwarzer G, Antes G, Falck-ytter YT. Treatment of ocular hypertension and open angle glaucoma: meta-analysis of randomised controlled trials. BMJ. 2005;331(7509):134.
36. Krupin T, Liebmann JM, Greenfield DS, Ritch R, Gardiner S. A randomized trial of brimonidine versus timolol in preserving visual function: results from the Low-Pressure Glaucoma Treatment Study. Am J Ophthalmol. 2011;151(4):671-81.
37. Jonas JB, Aung T, Bourne RR, Bron AM, Ritch R, Panda-Jonas S. Glaucoma. The Lancet. 2017;390(10108):2183-2193. doi: 10.1016/S0140-6736(17)31469-1.
38. Kang HK, Luff AJ. Management of retinal detachment: a guide for non-ophthalmologists. BMJ. 2008;336(7655):1235-40.
39. Li J, Tripathi RC, Tripathi BJ. Drug-induced ocular disorders. Drug Saf. 2008;31(2):127-41.
40. Jobling AI, Augusteyn RC. What causes steroid cataracts? A review of steroid-induced posterior subcapsular cataracts. Clin Exp Optom. 2002;85(2):61-75.
41. American Academy of Ophthalmology. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy. San Francisco, CA: American Academy of Ophthalmology; 2016.

42. American Optometric Association. Optometric clinical practice recommendations for monitoring ocular toxicity of selected medications. Accessed August 8, 2018. Available at: https://www.aoa.org/Documents/optometrists/QI/optometricclinical-practice-recommendations-for-monitoring-ocular-toxicityof-selected-medications.pdf
43. American Academy of Ophthalmology. Managing Intraoperative Floppy Iris Syndrome. San Francisco, CA: American Academy of Ophthalmology; 2009.
44. Patel A, Cholkar K, Agrahari V, Mitra AK. Ocular drug delivery systems: An overview. World J Pharmacol. 2013;2(2):47-64.
45. TrueTear website. https://www.truetear.com/
46. Sun CQ, Ou Y. New Developments in the Treatment of Glaucoma. Curr Ophthalmol Rep, 2018; 6(2): 73-76.doi: 10.1007/s40135-018-0166-3
47. Sun Pharma Announces U.S. FDA Approval of CEQUATM to Treat Dry Eye Disease [news release]. Mumbai, India and Princeton, NJ: Sun Pharmaceutical Industries; August 16, 2018. https://cequapro.com/pdf/cequa-news-release.pdf.
48. Jones D. Enhanced eyelashes: prescription and over-the-counter options. Aesthetic Plast Surg. 2011;35(1):116-21.
49. Newman-casey PA, Robin AL, Blachley T, et al. The Most Common Barriers to Glaucoma Medication Adherence: A Cross-Sectional Survey. Ophthalmology. 2015;122(7):1308-16.
50. Schwartz GF, Hollander DA, Williams JM. Evaluation of eye drop administration technique in patients with glaucoma or ocular hypertension. Curr Med Res Opin. 2013;29(11):1515-22.
51. Olthoff CM, Hoevenaars JG, Van den borne BW, Webers CA, Schouten JS. Prevalence and determinants of nonadherence to topical hypotensive treatment in Dutch glaucoma patients. Graefes Arch Clin Exp Ophthalmol. 2009;247(2):235-43
52. Boskovic J, Leppee M, Culig J, Eric M. Patient self-reported adherence for the most common chronic medication therapy. Scand J, Public Health. 2013;41(4):333–335.
53. Mira, J. A Spanish Pillbox App for Elderly Patients Taking Multiple Medications: Randomized Controlled Trial. J Med Internet Res. 2014;16(4).
54. Jimmy B, Jose J. Patient medication adherence: measures in daily practice. Oman Med J. 2011;26(3):155-9.
55. Sasaki H, Yamamura K, Nishida K, Nakamura J, Ichikawa M. Delivery of drugs to the eye by topical application. Progress in Retinal and Eye Research, 1996;15(2): 583-620. doi:10.1016/1350-9462(96)00014-6.
56. Pharmacist's Letter Technician Tutorial. Calculating Days' Supply. Pharmacist's Letter 2011;27(6):270630.