Cure CL Intolerance

Elestat soothes itching, improves comfort and boosts lens-wear time in allergy sufferers.
Walter S. Ramsey, O.D., F.A.A.O., Charleston, W. Va.

A little more than half (54%) of contact lens wearers suffer from ocular allergies, making them particularly susceptible to contact-lens intolerance.¹ Allergens can become trapped under the lens, prolonging their contact with the ocular surface. In addition, contact-lens wear may actually alter the eye’s immunologic status, according to a study published in Cornea.² By wearing contact lenses, patients double their level of eotaxin, an inflammatory chemokine that can cause eosinophilia and ocular tissue damage and increase the severity of papillae in patients who have giant papillary conjunctivitis.

Peak-allergy season

During peak-allergy season, which differs depending on the portion of the United States where you live, 73% of contact-lens wearers cope with their allergies by using rewetting drops or taking their lenses out a little earlier than usual.³ Meanwhile, some 42% simply switch from their contact lenses to back-up spectacles during allergy season to achieve relief, according to an Asthma and Allergy Foundation of America survey.

To identify patients at high risk for allergy-related contact-lens intolerance, take a patient history, which includes questions regarding allergic symptoms. Check for signs of allergy during the exam, and look for tarsal follicles or Crescent sign, which is the presence of conjunctivi-tides of allergic origin on the lower lids. Look for the latter during the pre-fitting portion of the contact-lens evaluation. Also, when contact-lens patients present with intolerance to their lenses due to allergies, choose a treatment option that will reduce their discomfort so they may continue to enjoy the vision provided by their contact lenses. One such treatment option: Elestat (epinastine HCL ophthalmic solution 0.05%, Inspire Pharmaceuticals).

The effects of Elestat

In an effort to help patients with allergy-related contact-lens intolerance wear their lenses longer and more comfortably, researchers from New York organized a multicenter, randomized, open-label study to evaluate the effects of the topical allergy medication Elestat on contact-lens comfort in patients with contact lens intolerance during allergy season.⁴ (Inspire Pharmaceuticals sponsored this study.)

Elestat Details ACTIVE INGREDIENTS: EPINASTINE HCL 0.05% (0.5MG/ML), EQUIVALENT TO EPINASTINE 0.044% (0.44MG/ML) PRESERVATIVE: BENZALKONIUM CHLORIDE 0.01% INACTIVE INGREDIENTS: EDETATE DISODIUM; PURIFIED WATER; SODIUM CHLORIDE; SODIUM PHOSPHATE, MONOBASIC; AND SODIUM HYDROXIDE AND/OR HYDROCHLORIC ACID (TO ADJUST THE PH). PH: 7 OSMOLARITY: A RANGE OF 250 TO 310 MOSM/KG.

The study was conducted at 12 centers throughout the U.S. All subjects were age 18 or older with current allergy-season symptoms of contact-lens intolerance related to allergic con-junctivitis. All reported wearing daily-wear lenses consistently for at least one month.

During a five- to seven-day enrollment period, all patients were instructed to use rewetting drops as needed with a minimum of b.i.d. dosing. In the following five- to seven-day treatment period, the researchers randomized the patients to use either rewetting drops pro re nata (PRN) (b.i.d. minimum), or Elestat b.i.d. with rewetting drops PRN.

Results for the two groups varied significantly in several areas: ⁴

Inspire Pharmaceutical’s design for the Elestat study.

• Duration of comfortable wear. The average comfortable daily-wear time over the treatment period was 9.21 hours with Elestat, compared with 7.34 hours for patients using rewetting drops alone. Patients using Elestat gained 1.33 hours of comfortable wear time with treatment, while those using rewetting drops alone gained 0.43 hours.

• Subjective itching. Patients rated their itching on a scale of 0-to-4 at baseline and again at the end of the treatment period. Subjective itching scores for eyes treated with Elestat improved approximately 33% vs. an approximate 4% improvement in eyes treated with wetting drops alone.

• Overall comfort. Patients also used a 0-to-4 scale to rate their overall ocular comfort. The average im-provement from baseline was 0.48 points with Elestat treatment, compared with a 0.07-point rise in patient-re-ported comfort with the rewetting drop use.

• Use of rewetting drop. Patients in both groups were allowed to self-medicate with rewetting drops as needed.

During the treatment period, Elestat patients used the re-wetting drops an average of 2.79 times per day. In comparison, patients who followed a rewetting-drop alone schedule used the drops an additional 3.35 times per day on average.

Other studies of Elestat have yielded similar results. For instance, one study revealed that these drops reduced itching up to 81% within three minutes, and researchers have shown that symptom control of allergic conjunctivitis lasts eight to 12 hours.^5,6,7,8

With a pH similar to natural tears, a high degree of tolerability, and low potential for ocular surface drying, some practitioners, including myself, advise patients who have allergies to use Elestat before allergy season to avoid symptoms.⁹

1. Asthma and Allergy Foundation of America. Eye on Allergies Survey. July 2006.

2. Moschos MM, Eperon S, Guex-Crosier Y. Increased eotaxin in tears of patients wearing contact lenses. Cornea. 2004 Nov;23(8):771–5.

3. Asthma and Allergy Foundation of America. Eye on Allergies Survey. July 2006.

4. Data on file. Inspire Pharma.

5. Abelson MB, Gomes PJ, Vogelson CT, et al. Clinical efficacy of olopatadine hydrochloride ophthalmic solution 0.2% compared with placebo in patients with allergic conjunctivitis or rhinoconjunctivitis: A randomized, double-masked environmental study. Clin Ther. 2004 Aug;26(8):1237–48.

6. Ibid.

7. Elestat prescribing information, Allergan.

8. Friedlaender M, et al. Objective evaluation of antiallergic therapy. Poster presented at the Annual American Society of Cataract and Refractive Surgery (ASCRS) Symposium; May 1–5, 2004; San Diego.

9. Data on file. Inspire Pharmaceuticals.