Therapy provides option to alleviate blepharoptosis

Here, the author answers questions about a new therapy, based on firsthand experience with it.

What is Upneeq, and how does it work?

Upneeq, from RVL Pharmaceuticals, Inc., is a therapy indicated for adults who have acquired blepharoptosis (or droopy lids). The drop contains oxymetazoline hydrochloride ophthalmic solution 0.1%, which is a direct-acting alpha adrenergic receptor agonist.

Mueller’s muscle contains these target receptors; and so, contraction of this muscle occurs raising the eyelid.

Please take us through the patient experience with the product. For example, is it dispensed at your practice, if not, how does the patient receive it?

We utilize a patient questionnaire, which contains the question, “Would you like your eyes to be more open?” If the patient selects “yes,” and they have no health issues, such as those mentioned below, my technician takes a picture of the patient with our iPad and then doses the worst eye. The technician finishes pre-testing and by the time I enter the exam room — between 5 minutes to 15 minutes later — the drop has had time to take effect.

The technician then takes another photo, and I review the results with the patient. We have found this to be the most effective use of time to identify qualified patients, achieve results and get patients (as well as staff) excited about the product. When the patient has a result they love, we dose the other eye and write a prescription for the medication.

I write a prescription for 90 vials (the drug preservative free, and one vial will treat both eyes) with three refills, so the patient has a one-year supply if the medication is utilized every day, which, ultimately, is up to the patient.

Incidentally, RVL Pharmaceuticals is the pharmacy that exclusively fills Upneeq. This is convenient for my practice, as there are no call backs or prior authorizations. This is advantageous for my patients, as Upneeq is delivered directly to their homes. RVL Pharmacy does not accept payments from insurance providers, which helps bypass insurance restrictions.

What results can an O.D. expect?

The results can be quite dramatic. In the related studies, the average lift was 1 mm, but it can be as much as 3.5 mm.

What benefits does it provide to your practice?

New technology is part of our practice culture, and our patients reap the benefit. This, in turn, keeps our patients in our practice and generates referrals. So many people have ptosis and are not ready for surgery or may not be good surgical candidates. Such patients appreciate this non-invasive option and are grateful that we brought up their need and provided a solution.

For whom is it contra-indicated?

There are no contra-indications, but it’s important to note that alpha-adrenergic agonists, as a class, may impact blood pressure. Thus, I would advise Upneeq patients who have cardiovascular disease, orthostatic hypotension and/or uncontrolled hypertension or hypotension to seek care if their condition worsens post drop. Also, I would prescribe Upneeq with caution in patients who have cerebral or coronary insufficiency or Sjögren’s syndrome because of the possibility of vascular insufficiency. I would advise these patients to seek care if signs and symptoms of potentiation of vascular insufficiency, such as swelling or difficulty breathing, develop. Further, Upneeq may increase the risk of primary angle-closure glaucoma in patients who have untreated narrow-angle glaucoma. I would advise these patients to seek immediate care if acute narrow-angle glaucoma signs and symptoms develop. OM

DR. MCGEE is owner of Precision Vision of Edmond, in Edmond, Oklah. She is the vice-president of Intrepid Eye Society and past president of the Oklahoma Association of Optometric Physicians. She serves as a consultant for Allergan, EyeEco, EyeVance, Cynosure, Compulink, Lumenis, Optovue, Sun Pharma, Osmotica, Tarsus and Takeda.