Dropless finds warm reception at VAs

Physical and psychological conditions make Imprimis Pharmaceutical’s Dropless ideal for some veterans.

By Robert Stoneback, associate editor

Two veterans’ health centers have found Imprimis Pharmaceutical’s Dropless to be an ideal formulation for some of their patients.

Most veterans tend to be older men, some of whom have physical disabilities or impairing psychological conditions such as PTSD or dementia, says Seth Pantanelli, MD, who serves as the chief of ophthalmology at the Lebanon, Pa., VA Health Center. Because of these factors, a disproportionately large percentage of the VA patients are not compliant or rely on a caregiver. That’s where Dropless can help.

Dropless, available in both Tri-Moxi and Tri-Moxi-Vanc formulations, is a transzonular injection of antibiotics and steroids delivered during cataract surgery, bypassing the need for post-operative eye drops.

“Overall, our patients are very happy with it,” says Dr. Pantanelli. Dr. Pantanelli first used Dropless on patients at the Penn State Hershey Eye Center, where he is an assistant professor of ophthalmology. He estimates that about 20 veterans have been treated with Dropless since he first used it at the VA this spring.

The Dropless treatment costs about $20, compared to approximately $140 for a full complement of eye drops, according to Dr. Pantanelli. This is a great costs savings for the government, which foots the bill for surgeries at the VA, he adds.

EFFICACY & SAVINGS

Nathan Hesemann, MD, is clinical instructor at the University of Missouri School of Medicine, and chief of eye services at the Truman VA in Columbia, Mo. He ordered 40 doses of Dropless as a “test run” for his VA when it was released in the spring. As of this fall, he’s used the treatment on 50 veterans, going above his initial order.

“Dropless has worked very well,” he says. Of his veterans who have selected Dropless formulation for one eye, all have gone on to use it for their second eye.

Like Dr. Pantanelli, he also finds it helpful for avoiding compliance issues; even with written instructions and phone calls, about 15% of his veterans would still use drops improperly.

While Dr. Hesemann’s biggest concern with his patients is efficacy, it’s hard for him to ignore the money the Department of Veterans’ Affairs could save with Dropless.

CONSULT FIRST

A known shortcoming of Dropless is the risk of breakthrough inflammation, which occurs when the triamcinolone injection wears off too early, says Dr. Pantanelli. According to observations he’s made at his own practice, that only occurs in about 8% of cases, numbers which are backed up by recent studies, he says.

He emphasizes that this should not be a warning against the drug, as it works great the vast majority of the time.

His “most important pearl” for this is to give upfront counseling to potential Dropless patients, and let them know if they experience irritation or light sensitivity, they should be seen and prescribed topical eye drops; these will resolve the symptoms within a day or two.

DROPLESS’ FUTURE

Mark Baum, CEO of Imprimis, is pleased that the veterans are seeing such positive results, and he hopes more VAs will use Dropless.

According to Imprimis, Dropless has been used in more than 1 million eyes in the United States. OM

Ophthalmic responses to when nature misbehaves

Charitable donations, and deeds, to support those in need after Irma and Harvey.

By Robert Stoneback, associate editor

Considering the damage this year’s hurricane season has already wrought, the AAO and Pan-American Association of Ophthalmology are asking its respective members to donate to a hurricane relief fund.

According to the AAO, the fund began in response to the damage incurred by Harvey, Irma and Katia, and aims to assist those in affected areas needing health services.

All donations received will be sent to the nonprofit Americares, a disaster relief and global health organization. (For more information, including donation links, you can see the AAO’s full press release at tinyurl.com/y9zs8j6n .)

THE VIEW FROM MIAMI

At Bascom Palmer, plans were in play to keep the main hospital in Miami open and staffed. By the afternoon of Sept. 9, hours before Irma came calling, 300 people — faculty, residents, fellows, emergency management, security and maintenance, and their families and pets — found hospital floor space to call their own until Irma left town.

A few days after she left, Bascom’s emergency van, equipped with glaucoma medications and other therapies, along with sun and eyeglassses, headed for the Keys to help those in need. (To read more, go to https://tinyurl.com/ybxqw7fk )

THE VIEW FROM OCALA

Peter J. Polack, MD, of Ocala Eye Practice, had a personal experience with Hurricane Irma. Hurricanes aren’t new to Dr. Polack, or the town of Ocala; in 2004, it was hit by two hurricanes almost back to back. This led his practice to create a readiness plan to prepare for future storms. Also, many staff members installed generators to help run “bare essentials,” like refrigerators and lights in their own homes. Lessons learned.

On Sept. 9, the day before Irma made landfall in Florida, Dr. Polack said he started to feel winds from the hurricane’s outer bands whipping through the town.

“The storm hit us the night of the 10th late into the evening. My wife and I were awakened by the sound of a large tree falling in our backyard,” he said. The French drain in their swimming pool failed, so they “spent most of the wee hours of the early morning from 3:00 to 5:00 pushing water from the back porch into the pool. Since the power had gone out by this time, I had to resort to using a hose to siphon water out of the pool as it had started to overflow. This while we were being pelted by 70+ mph wind and rain.”

THE MORNING AFTER

With power out in most of the town after Irma, Dr. Polack’s clinic stayed closed a good part of the week. Nothing was damaged. Flooding stranded some of Dr. Polack’s staff at their homes for a few days, but thankfully no one was seriously hurt. The damage was not nearly as severe as what was experienced further south in Florida, said Dr. Polack.

We haven’t forgotten Harvey. Bernard Milstein, MD, of League City, Texas, provided free optical and contact lens services, including refraction, at his three practices. His story can be read on the AAO’s site at tinyurl.com/ybn4q825 . OM

Alcon realigns services to raise the bar for customers

Technical service, clinical application and portfolio teams now organized together

By Robert Stoneback, associate editor

Last year, Alcon realigned its service teams to better serve its customers, by folding its technical service, clinical application and commercial portfolio teams into one unit.

This year, Alcon surveyed its customers for their thoughts about the effort. In short, their customers thought it was a fine idea.

In May, Alcon asked 428 of its U.S. customers who had recently had a service visit to compare its Alcon experience with that of other medical device companies’. According to Alcon, its field service team received an overall ranking of 4.9 out of 5 in the categories “time it took to complete repair” and “professionalism of technician.” They also ranked a 4.7 in “ease of requesting service” and “time to arrive at location.”

Internal collaboration

“Having these functions reside under one organization enables Alcon to further strengthen the internal collaboration of teams,” and obtain feedback directly from our customer-facing organizations, says Seba Leoni, Alcon vice president and global head of its surgical suite. “This allows the portfolio teams to take the voice of Alcon’s customers directly to R&D and other key functions, ensuring the company is always in tune with customers’ needs.”

Alcon’s goal, says Mr. Leoni, is to give its customers the same level of confidence in its services and products, regardless of where they are – Manhattan skyscraper, a clinic in rural China, or anywhere in between. The company also wants to ensure that customers get the most out a platform’s life cycle.

Alcon has over 1,000 associates worldwide in clinical application or technical services roles to aid customers. In the U.S., says Mr. Leoni, a specialist from a regional team can be onsite usually within 24 hours of a request for assistance. OM