Dry eye should remain in the hands of eyecare providers

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Currently, I am transitioning into a new OD group where I am helping to launch The Dry Eye Center of PA. Naturally, when I left the previous practice, I was unable to take my patients with me.

Some of my loyal dry eye patients have sought me out in my new location, and I’ve heard from them how they found it challenging to refill chronic medications, such as Restasis (cyclosporine, Allergan), before they got in to see me. Interestingly, some of them sought care with their primary care doctors to get a refill. I’ve come to learn that surprisingly, this is a common practice.

For years, allergists, internists, and pediatricians have prescribed ocular allergy drops. It is not uncommon to see a patient using a prescription allergy medication not prescribed by his eyecare provider.

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Promoting to other professions

Several weeks ago, I learned of a more recent, somewhat concerning trend. Since the Allergan and Actavis merger, sales reps are now promoting Restasis to primary care doctors, internist and allergists. Pharmaceutical reps calling on internists, PCPs, and allergists are now carrying and promoting Restasis-promoting to professions that don’t even own a slit lamp.

This sparked a phone call to Allergan to find out if this was in fact true. And it is. According to Allergan, sales reps visiting such doctors is a pilot program, with visits only to doctors currently prescribing Restatis. Reps will not be visiting doctors not prescribing Restatis.  

My initial response to this news was like a kick in the gut as the new director of a dry eye specialty within a medically oriented optometric practice. This could be a huge step back in our role for public awareness of dry eye disease, a disease that requires very specific testing and examination to develop an effective treatment plan. Do all patients with dry eye complaints respond to and need Restasis? I wish it were that cut and dried.

Next: Is revenue behind the decision?

Is revenue behind the decision?

The truth is, primary care doctors, internists, and allergist are already prescribing and refilling Restasis for our patients. This is still absurd to me. I would not think to refill a patient’s blood pressure medication or antibiotic just because she was in for an exam. Instead, I would recommend calling the prescribing doctor.
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Why? These doctors are already prescribing the drug or are refilling it for patients. The Allergan representative I spoke with said the company is simply helping to educate doctors already prescribing Restasis to have a better understanding of dry eye disease and to refer to an eyecare provider for follow up.

That may be true, but I suspect that increased revenue has to have played into Allergan’s decision. Restasis brings in more that a half a billion dollars in sales,¹ and dry eye affects an estimated 5 million Americans.²   

Direct-to-consumer marketing works! Patients may not know what dry eye really is, but thanks to direct-to-consumer marketing through TV and print ads, the majority of patients have heard of Restasis.

Next: What does it mean for the dry eye specialty practice?

What does it mean for the dry eye specialty practice?

What does this mean to a dry eye specialist? Dry eye is a disease of the eye and a complex one to properly diagnose. There are a battery of tests that aid in diagnosis and clinical findings that allow for proper diagnosis of either aqueous deficient or evaporative dry eye.  Treatments are in no way a one-size-fits-all approach. By promoting Restasis to non-eyecare providers, we are downplaying an important message that this is complex, multi-factorial disease.

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One could argue that ocular allergy is easier to diagnose based on symptoms alone-without a slit lamp exam. Hallmark symptoms are itching and watering which worsen when the patient rubs her eyes and often has a seasonal presentation with co-existing systemic symptoms of nasal congestion and sneezing.

Patients who would benefit from a medication to control their dry eye symptoms need a thorough exam by an eyecare provider, ideally one who specializes in dry eye to determine the best treatment. Let’s not forget that dry eye symptoms are often the presenting symptoms for systemic diseases, such as Sjögren’s syndrome. Also, the education that goes into dry eye patients is overwhelming, and it is hard to imagine an internist discussing the details it deserves.

The analogies are countless. Would you ask your family doctor for a root canal? Would you ask your podiatrist about a lingering cough?

This is a wake-up call that I hope you will answer by taking back care for your patients and communicating with your network of referring doctors.

Dry eye should stay a disease treated by eyecare providers.

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References

1. FiercePharma. Restasis, Allergan. http://www.fiercepharma.com/special-reports/restasis-allergan-top-10-drug-patent-losses-2014. Accessed 11/04/15.

2. National Eye Institute. Facts about dry eye. https://nei.nih.gov/health/dryeye/dryeye. Accessed 11/04/15.