Spotlight ON TECHNOLOGY & TECHNIQUE

Gain Additional Staying Power With This Topical Anesthetic

By Leslie Goldberg, Associate Editor

In the course of a typical day, an ophthalmologist may be called upon to perform any number of invasive procedures, ranging from simple diagnostic tests such as scleral depression to in-office treatments like ALT to full-blown cataract surgery. With so many instances in which patients come into contact with diagnostic or surgical instruments, the need to maintain patient comfort and safety are paramount. Indeed, no matter how eloquent your explanation of the procedure or how empathetic your chairside manner may be, the one thing patients are likely to remember most is how much — or how little — pain you inflicted.

Comfortably Numb

And so it is that ophthalmologists welcome any advance that can minimize patient discomfort and hasten recovery. The new topical ocular anesthetic Akten — from Akorn, Inc. of Lake Forest, Ill. — offers unique advantages in concentration, administration, time to clinical effect, duration of efficacy and more. For starters, Akten is the first FDA-approved ophthalmic gel anesthetic with a 3.5% dose of lidocaine hydrochloride. It can be used in dozens of surgical and diagnostic procedures where a topical anesthetic would be appropriate.

The recommended dose is two drops applied to the ocular surface in the area of the planned procedure. In a multicenter, randomized double-blind study involving 209 patients,¹ the mean time to onset of action was approximately 60 seconds and 92% of subjects achieved anesthesia within 5 minutes. Approximately 84% of subjects treated with the 3.5% dose of Akten experienced anesthesia for at least 5 minutes, approximately 55% of subjects experienced anesthesia for 10 minutes or longer and 27% experienced anesthesia for 15 minutes or longer.

Akten's formulation as a viscous gel extends the duration of effect, according to the manufacturer. It may be reapplied to maintain anesthetic effect. The drug has no known contraindications.

The most common adverse reactions are conjunctival hyperemia, corneal epithelial changes, headache and burning upon instillation.

Physician Feedback

Los Angeles retinal specialist Roger Novack, M.D., Ph.D., has been using Akten since its launch in October 2008, primarily when injecting eyes with anti-VEGF drugs. Dr. Novack says that he used to use lidocaine with Q-tips in the majority of these cases, but finds that he can now use Akten, or a combination of the two. "At end of the procedure, patients' eyes usually feel irritated, but not with the Akten," he says. "It tends to be a longer-lasting anesthetic. It is a good product to use both before and after an injection."

Rama D. Jager, M.D., of Oak Forest, Ill., has used Akten for the last several months, also for intravitreal injections in the clinic. "My patients seem to like it," he says. "They have a lot less postoperative pain. I have used it in surgery — but I think it works best with injections." With the previous topical anesthetic he used for injections, Dr. Jager had to dip a swab into the anesthetic, apply it to the inferotemporal fornix and let it sit there. "With Akten, a viscous gel, you just have to squirt a little bit on to the ocular surface and let it sit. We are able to minimize corneal toxicity with Akten, and I like that it's preservative free." OM

Neither Dr. Novack nor Dr. Jager has a financial interest in Akorn.

For more information, visit the Akorn Web site at www.akorn.com.

Reference

1. Busbee BG, Alam A, Reichel E. Lidocaine hydrochloride gel for ocular anesthesia: results of a prospective, randomized study. Ophthalmic Surg Lasers Imaging 2008 Sep-Oct; 39(5):386-90.