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allergy symptoms. At the end of the study, they were asked which agent provided better relief of their ocular allergy symptoms and which one they would like me to write a prescription for," Dr. McCabe said. Bepreve "got the jumpstart on the relief of their ocular itching," Dr. McCabe said. "By almost a 2-to-1 margin, 19 patients compared to 11 rated Bepreve as giving them better all-day relief of ocular itching. Overall patients felt that Bepreve rather than Pataday offered better relief of morn- ing ocular allergy symptoms, however the greatest difference was seen in the first week. Our patients also reported that Bepreve provided better relief of evening ocular allergy symptoms. They rated Bepreve as more effec- tively improving their ocular allergy symptoms in the evening when com- pared to Pataday." Dr. McCabe concluded, "Despite all we hear about dosing and compli- ance, patients chose the greater effi- cacy of Bepreve over the once-a-day convenience of Pataday for improved relief of their multi-symptom associ- ated allergic conjunctivitis." Dr. Blaiss provided his thoughts on ocular allergies from the perspective of an allergist. Most patients come to Dr. Blaiss complaining of nasal problems associated with their eyes. "Basically every patient with ocular allergy symptoms has nasal problems," he said. 4 July 2012 Improving the treatment of ocular allergies Dr. Blaiss continued by giving an overview of what he looks at in rhinoconjunctivitis. He tries to deter- mine if the allergies are seasonal or perennial, which makes the patient's past history important, especially family history. "If mom, dad, or a sibling has aller- gies, the chance of that person having allergies is two- to three-fold," he said. Environmental history is also key, he said. Questions to ask patients include are they exposed to pets or dust mites? Are mold spores in the air that can cause long-term rhinoconjunctivitis? To manage patients with ocular allergies, Dr. Blaiss goes over avoid- ance procedures. For example, if a patient is allergic to pollen, Dr. Blaiss suggests the patient stay in during the early morning and evening hours, when pollen counts are at their high- est. Lubricating eye drops have also been shown to help flush out the eye and remove allergens, he said. "What we do a lot of are system- atic therapies and a great deal of oral second-generation antihistamines," Dr. Blaiss said. "The problem is even the second-generation non-sedating antihistamines are not efficacious as far as ocular allergies." In fact, many of the over-the- counter drugs can lead to drying of the eyes. Dr. Blaiss places almost every rhinoconjunctivitis patient he sees on an intranasal agent, an antihistamine and/or corticosteroid. "Some of these do have a label as far as decreasing ocular symptoms as- sociated with allergic rhinitis," he said, but they are usually not as efficacious as topical ocular agents, especially in patients with moderate to severe allergic conjunctivitis. Contact information Blaiss: michael.blaiss@gmail.com Holland: Eholland@holprovision.com Lane: sslane@AssociatedEyeCare.com Lindstrom: Brenda Boff, assistant to Dr. Lindstrom, blboff@mneye.com McCabe: DrMcCabe@McCabeVisionCenter.com "[Lastacaft] doesn't seem to have quite the same level of potency, it causes some discomfort, and it causes redness," Dr. Lindstrom said. Although Bepreve and Pataday are the two most popular topical medications prescribed in the U.S., no head-to-head clinical studies have been published directly comparing the two. Because of this, Dr. McCabe took it upon himself to lead an investigator- initiated, single-center, single-masked switch patient preference study. The purpose was to compare patient perceived relief of ocular itch and ocular allergy symptoms when treat- ing allergic conjunctivitis with Bepreve and Pataday. Thirty patients participated in the study, which was conducted during fall allergy season. Patients took either Bepreve twice daily or Pataday once daily for 2 weeks, followed by a week- long washout period using artificial tears twice a day. After the washout period ended, patients switched to the remaining branded drop for 2 weeks. "During the time they took these drops, they filled out a daily diary at noon and 8 p.m. where they rated how well that medication relieved various Figure 7 This supplement was produced by EyeWorld and supported by an educational grant from ISTA Pharmaceuticals. Copyright 2012 ASCRS Ophthalmic Corporation. All rights reserved. The views expressed here do not necessarily reflect those of the editor, editorial board, or the publisher and in no way imply endorsement by EyeWorld or ASCRS. ISTA supplement_EW July 2012-DL2_Layout 1 6/3/14 2:43 PM Page 1

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