SOCIAL

  THE WAY I SEE IT

GOING OFF LABEL

TO HELP PATIENTS, CONSIDER THE OFF-LABEL USE OF DRUGS

MARC BLOOMENSTEIN, O.D., F.A.A.O.

IN ATHENS, GA., I actually met one of the two people who read my column. (I will admit, I thought most of my readers have pica, six cats and pray to a god to save my demented soul; yet, this young O.D. wasn’t eating dirt or covered in cat hair.) She asked that I write about off-label uses. Sadly, the moment felt almost like when that great English band Spinal Tap was touring America, only to hear a radio DJ say, “File them under the ‘whatever-happened-to. . .?’ file.” I have a whole lecture dedicated to this topic. But, I felt obligated to honor the request.

CYCLOSPORINE 0.05%

Anytime that you verbalize, “you need to lubricate that” this could be used. From an off-label point of view, this drug treats both signs and symptoms of dry eye. Also, consider it for inflammation; where there is inflammation there is keratoconjunctivitis sicca (H16.223). I’m talking pingueculum, pterygium, corneal dystrophies, marginal infiltrates and meibomian gland dysfunction. In “My Big Fat Greek Wedding” terms, this medication is the “Windex” of the eye.

BRIMONIDINE TARTRATE 0.15%

A few drops into a small sample of tears blanches the eyes as white as a new pair of compression socks. This off-label use may be the best drop an O.D. has in his or her arsenal. Simply add 2 drops of brimonidine tartrate 0.15% for every 1ml of tear solution, and this is Visine’s kryptonite. Another great use is stabilizing the hippus in night-driving glare patients. A drop at dusk can help to reduce glare for hours.

AZITHROMYCIN 1%

Yes, this is still available and aside from the obvious off-label use in MGD, it is great for recurrent corneal erosion, abrasions and in conjunction with an amniotic membrane. This solution provides the high concentration of this aminoglycoside to the necessary tissue.

TONIC WATER

Drinking tonic water, which contains quinine (a muscle relaxant) is a good way to help patients cease myokymia. This self-limiting condition is as annoying as hiccups, and this treatment will help to reduce the time of that aggravating muscle twitch.

GANCICLOVIR 0.15%

This medication is indicated for herpetic viruses, however, in terms of viral conjunctivitis, adenovirus and enterovirus don’t stand much of a chance.

NSAIDS

For all your make-believe diagnoses, such as phlegmanuclitis or miccoito dystrophy, you can’t go wrong with this treatment option. It’s liquid aspirin. Side effects include dizziness, rashes and stomach problems.

MISCELLANEOUS

Don’t forget about our old favorites: epinephrine for an episcleritis diagnosis, betadine for viral conjunctivitis and all the medications that have dysgeusia as a great topical appetite suppressant. We can make differences in our patient’s lives — one eye at a time.

THINK OUTSIDE THE BOX

To go off label is what makes us doctors and enables us to find the best uses of modern products with which to help our patients. I’d have no qualms telling a patient to run 10 miles to build up a good sweat if I thought that would benefit his or her eye sight. Unless, of course, the only thing that this does is tear his or her meniscus, and motivate the patient to seek another eye doctor. OM

DR. BLOOMENSTEIN practices at Schwartz Laser Eye Center in Scottsdale, Ariz. He is a founding member of the Optometric Council on Refractive Technology. He is a speaker and advisory board member for: Allergan, Bausch + Lomb, Shire, Akron, TearLab, OcuSoft, Lunovus and AMO. Email him at mbloomenstein@gmail.com, or visit tinyrl.com/OptometricManagement.