dry eye

A Helpful Media

Drug ad disclaimers and the Internet can result in better patient care.

KELLY NICHOLS, O.D., M.P.H., Ph.D.

Nowadays, it’s not enough to explain why we prescribe certain medications and how they work in order to achieve patient satisfaction with our care and compliance to our prescribed treatment. Drug commercial disclaimers and patient Internet searches now require us to be prepared to explain side effects and contraindications and to right patient misinterpretations of these disclaimers and Internet searches.

I arrived at this epiphany during a recent exam.

The pink eye patient

A patient who had moderate to severe dry eye disease recently presented. When I began discussing my treatment plan for her, including cyclosporine ophthalmic emulsion 0.05% (Restasis, Allergan, Inc.), she answered:

“Restasis? Goodness. I was thinking that would be what you would prescribe, but do you know that it shouldn’t be used in patients who have had pink eye?”

“What?” I replied. “Where did you hear that?”

“The commercial,” she said.

I immediately educated the patient regarding the correct contraindications for the drug. Satisfied, she happily departed with her prescription in hand.

Seeking clarification

Some time after I’d successfully managed her expectations in fully educating her about the cyclosporine, I went in to my office to watch the Restasis commercial online, carefully.

The commercial says: “Restasis should not be used by patients with active eye infections and has not been studied in patients with a history of herpes viral infections of the eye. The most common side effect is a temporary burning sensation.”

None of this statement is even remotely close to my patient’s interpretation.

The wheels began turning, and I believe I figured out how the patient came to the conclusion that Restasis is contraindicated in anyone who has had pink eye:

(1) She wonders what herpes viral infection of the eye is and looks it up online. Her search reveals “viral infection of the eye.”

(2) My patient conducts an Internet search for “viral infection of the eye,” and her search reveals “pink eye.”

(3) She wonders why this has not been studied. Perhaps she cannot find this answer and concludes that patients with a history of pink eye just should not take the medication.

Regardless, my patient brought this perception with her to her dry eye exam — a perception that very likely could have resulted in non-compliance to my prescribed treatment and the worsening of her condition.

Benefit/risk ratio

In effect, requiring education on the side effects and contraindications of the ocular medications we prescribe, so we can provide this education to patients and, therefore, achieve patient satisfaction with our care and their compliance to our prescribed treatment, is not a bad thing. It forces us to understand the two critical components of a therapeutic agent: safety and efficacy. And, relating safety to efficacy, in terms of benefit/risk ratio is critical to excellent patient care. In other words, it isn’t that we just need to understand how well a drug works or the risks of taking the drug — what matters is the pull of risk and benefit for the individual patient, and this is an important distinction. OM

DR. NICHOLS IS A FOUNDATION FOR EDUCATION AND RESEARCH IN VISION (FERV) PROFESSOR AT THE UNIVERSITY OF HOUSTON COLLEGE OF OPTOMETRY. SHE LECTURES AND WRITES EXTENSIVELY ON OCULAR SURFACE DISEASE AND HAS INDUSTRY AND NIH FUNDING TO STUDY DRY EYE. SHE IS ON THE GOVERNING BOARDS OF THE TEAR FILM AND OCULAR SURFACE SOCIETY AND THE OCULAR SURFACE SOCIETY OF OPTOMETRY AND IS A PAID CONSULTANT TO ALCON, ALLERGAN, INSPIRE AND PFIZER. DR. NICHOLS CAN BE CONTACTED AT KNICHOLS@OPTOMETRY.UH.EDU. TO COMMENT ON THIS ARTICLE, E-MAIL OPTOMETRICMANAGEMENT@GMAILCOM.