Off the Cuff: New Beginnings

This study quantified costs of eye care providers' Medicare Part D prescribing patterns for ophthalmic medications and to estimate the potential savings of generic or therapeutic drug substitutions and price negotiation. The Medicare Part D 2013 prescriber public use file and summary file were used to calculate medication costs by physician specialty and drug. Savings from generic or therapeutic drug substitutions were estimated for brand drugs. The potential savings from price negotiation was estimated using drug prices negotiated by the United States Veterans Administration (USVA). Main outcome measures included the total cost of brand and generic medications prescribed by eye care providers.

Eye care providers accounted for $2.4 billion in total Medicare Part D prescription drug costs and generated the highest percentage of brand name medication claims compared with all other providers. Brand medications accounted for a significantly higher proportion of monthly supplies by volume, and therefore, also by total cost for eye care providers compared with all other providers (38% vs. 23% by volume, p<0.001; 79% vs. 56% by total cost, p<0.001). The total cost attributable to eye care providers is driven by glaucoma medications, accounting for $1.2 billion (54% of total cost; 72% of total volume). The second costliest category, dry eye medications, was attributable mostly to a single medication, cyclosporine ophthalmic emulsion (Restasis, Allergan), which has no generic alternative, accounting for $371 million (17% of total cost; 4% of total volume). If generic medications were substituted for brand medications when available, $148 million would be saved (7% savings); if generic and therapeutic substitutions were made, $882 million would be saved (42% savings). If Medicare negotiated the prices for ophthalmic medications at USVA rates, $1.09 billion would be saved (53% savings).

Researchers concluded that eye care providers prescribed more brand medications by volume than any other provider group. They suggested that efforts to reduce prescription expenditures by eye care providers should focus on increasing the use of generic medications, primarily through therapeutic substitutions and that policy changes enabling Medicare to negotiate prescription drug prices could decrease costs to Medicare.

This study compared the outcomes and complications of topical difluprednate 0.05% and loteprednol gel 0.5% after routine cataract surgery. Subjects received either difluprednate emulsion 0.05% (n=30 eyes) or loteprednol gel 0.5% (n=30 eyes) after routine cataract surgery. Topical steroid drops were initiated three days before cataract surgery and continued for two weeks postoperatively. Anterior chamber (AC) cell grade, corneal edema, corneal pachymetry, visual acuity, ocular surface quality (Oxford scale) and intraocular pressure (IOP) were evaluated at one day, one week and one month postoperatively.

Patients treated with difluprednate or loteprednol had statistically similar resolution of their AC cell grade and corneal edema at one day, one week and one month postoperatively (p>0.05 at each study visit). Difluprednate-treated and loteprednol-treated eyes achieved a mean best-corrected visual acuity of at least 20/25 by one week postoperatively (0.055 and 0.061 logarithm of the minimum angle of resolution, respectively). The nasal ocular surface quality at one week had improved in loteprednol-treated eyes compared with difluprednate-treated eyes (1.0 vs. 1.9 Oxford score, respectively), but similar at all other visits. There was no statistical difference between IOP levels between both treatment groups. In the difluprednate-treated group, one patient developed rebound inflammation, and two patients developed cystoid macular edema at their one-month postoperative visit.

The anti-inflammatory effect, visual recovery and IOP of patients using topical difluprednate or loteprednol gel after cataract surgery were equivalent. Investigators found that there may be an additional short-term benefit of loteprednol gel in protecting the ocular surface after cataract surgery.

Eighty left eyes of 80 subjects with TDS (study group) and 70 left eyes of 70 subjects with myopia and astigmatism (control group) were included in this study to investigate the shifting of the line of sight (LoS) and the refractive, topographic, and aberrometric parameters that may be associated with the shifting of the LoS in eyes with tilted disk syndrome (TDS). Line-of-sight coordinates on the horizontal (x) and vertical (y) axes, and refractive, topographic and aberrometric parameters were evaluated. All parameters were compared between groups, and correlations were analyzed for the study group.

In the study group, the LoS significantly shifted to the superotemporal direction compared with the control group. The shift on the y-axis was correlated with mean cylindrical refractive error, total root mean square (RMS), higher-order aberration RMS, vertical coma and vertical trefoil values.

Results demonstrated a superotemporal shifting of the LoS in eyes with TDS. Researchers wrote that this shift must be accounted for to prevent decentralization and provide satisfactory outcomes, as eyes with TDS have an important place among candidates for refractive and multifocal intraocular lens implantation surgeries.