Therapeutics

The Use of NSAIDs in Ophthalmology

Staff can play an important role in patient compliance.

Bill Kekevian, Senior Associate Editor

In ophthalmology, non-steroidal anti-inflammatory drugs (NSAIDs) are used following intraocular surgery, often cataract surgery, to reduce pain and inflammation. While the doctor is the one who prescribes it, staff can play an important role for patients using NSAIDs by helping them obtain, understand the use of and monitor compliance with this class of drugs. Jai G. Parekh, MD, MBA, of Brar-Parekh Eye Associates in Woodland Park, N.J., and Clinical Associate Professor of Ophthalmology at the New York Eye & Ear Infirmary, is a surgeon specializing in anterior segment and cataract surgery. He says without staff support, he couldn’t successfully get the message about medication use to his patients. Dr. Parekh, or “Dr. J” as he is known by his patients, has a history of experience with NSAIDs, especially, the bromfenac molecule, the active ingredient in the recently FDA approved Prolensa (Bausch + Lomb).

This article will review what the ophthalmic professional can do to assist the doctor and some issues of concern about this class of medications.

How staff can help

“Most of the interaction between the patient and the office occurs at the level of the staff,” says Dr. J. “With the push in modern day eye care to see more patients, physicians need other people to help get the job done.” A big part of assisting the physician get the message across is making sure the patient understands the instructions given to them about medications. In order to do that, there are a couple hints you might consider.

First off, learn from your team. “We never have brand new staff telling patients what to do,” Dr. J says. “We usually have them do a little shadowing with myself or one of my partners just so they know what our style is.”

Second, echo what the doctor has already told the patient, especially if the patient seems confused or overwhelmed. “If the patient and family hear it two or three times, by the time they leave my office, they’ll get the message,” Dr. J says.

Third, know about the drug the doctor prescribed because its use could reveal whether the patient is compliant. “The staff knows how to take certain medications and the dosing regimen. They know, for example, allergy products are taken once or twice a day, prostaglandins at night, modern NSAIDs once a day, and brand-artificial tears four times a day.” When patients are confused about dosage or have other questions about medications, like where to pick up prescriptions, information about insurance coverage or if there are any coupons available for their prescription, they’re going to contact the practice’s staff.

NSAID Use

“These medications have come a long way since over the last couple of decades,” Dr. J says, referring to an era when ophthalmic NSAIDs weren’t quite as powerful. “On label, they’re used to treat postoperative pain and inflammation.” He says NSAIDs, for the most part, are used in concert with corticosteroids.

He offers one final way a practice can ensure good compliance. “These days, because of pressure to use generic products from the managed-care plans and pharmacies, we tend to tell patients to bring their drops with them every visit, whether the drops are for glaucoma, allergy, or postoperative reasons. That way, we know exactly and precisely what they’re getting and that helps locate the problem if we’re not achieving the outcomes we expect in modern eye care.”

Bromfenac ophthalmic solution

Brand names: Bromday (0.09%), Prolensa (0.07%).

Label indications: Nonsteroidal anti-inflammatory agent; inhibits COX-1 and COX-2.

Dosage: One drop per day into affected eye(s) beginning one day prior to surgery, continued day of surgery and through the first 14 days.

Contraindications: none.

Diclofenac sodium ophthalmic solution

Brand names: Voltaren Ophthalmic (0.1%).

Label Indications: Corneal and cataract surgery. Prevention & treatment of post-op (cataract extraction) ocular inflammation. Pain & photophobia due to corneal refractive surgery.

Dosage: One drop in affected eye(s) four times a day for two weeks, beginning 24 hours post-cataract surgery; one to two drops in affected eye(s) within one hour preoperatively and 15 minutes postoperatively, continue one to two drops four times a day for three days after corneal refractive surgery.

Contraindications: Hypersensitivity to ASA or NSAIDs.

Flurbiprofen sodium ophthalmic solution

Brand names: Ocufen (0.03%).

Label indications: To be used before certain types of eye surgery (such as cataract removal).

Dosage: Apply the drops before surgery to the affected eye(s) every 30 minutes starting two hours before surgery (for a total of four drops). Intended for short-term use only.

Contraindications: Hypersensitivity to ASA or NSAIDs. Active epithelial herpes simplex keratitis.

Ketorolac tromethamine ophthalmic solution

Brand names: Acular (0.5%), Acular LS (0.4%), Acuvail (0.45%).

Label indications: Ocular itching associated with allergic conjunctivitis, ocular pain and inflammation, burning and stinging.

Dosage: For 0.5%: One drop applied to the affected eye four times a day for two weeks following surgery. For 0.4%: One drop four times a day on the operated eye for up to four days. For 0.45%: One drop applied to the affected eye twice daily beginning one day prior to cataract surgery and continued through the first two weeks of the postoperative period.

Contraindications: Hypersensitivity to ASA or NSAIDs.

Nepafenac ophthalmic suspension

Brand names: Nevanac (0.1%), Ilevro (0.3%).

Label indications: For pain and inflammation associated with cataract surgery.

Dosage: For 0.1%: 1 drops three times a day to affected eye(s) beginning One day before cataract surgery, on the day of surgery and through two weeks postoperatively. For 0.3%: One drop once daily beginning one day before cataract surgery, on day of surgery, and continue through the first two weeks postoperatively; an additional drop should be administered 30-120 minutes before surgery.

Contraindications: Hypersensitivity to NSAIDs or any ingredients. OP