A Light at the End of the Tunnel: Compounding Ophthalmic Medications for Emergencies
Ophthalmologists and other medical professionals often encounter routine visits from patients that turn into treatment emergencies. Many diseases of the eye, if not treated immediately, can have disastrous consequences. Compounding is essential to treatment of these kinds of ophthalmic emergencies, as a recent joint letter from the American Academy of Ophthalmology, the American Association for Pediatric Ophthalmology and Strabismus, the American Glaucoma Society, the American Society of Retina Specialists, and the Cornea Society emphasizes.
The Urgency of Ophthalmological Compounding
Many ophthalmic patients are coping with severe infections that require immediate treatment. Their infections cannot be helped by antibiotic ophthalmic medications which lack the concentration or strength to treat the severity of their infection, and their ophthalmologist doesn’t want to risk their vision by delaying treatment. Instead, a compounded preparation of a fortified antibiotic ophthalmic solution is a better option.
At times, a drug may be discontinued although patients still need it; when this happens compounding may be the only answer for ophthalmic patients fighting to save their vision. Discontinued drugs are often perfectly safe, but removed from the market for economic reasons. Compounding is also crucial when the market is faced by manufacturing shortages of crucial ophthalmic medications that need to be used immediately and on a continuing basis to ensure they are effective. Finally, at times commercially available drugs are not available in useful doses for standard ophthalmic clinical purposes. When this is the case, doses may be fractionated and used as needed; the drug bevacizumab, also known as Avastin, is a prime example of this.
The plain fact is the outpatient use of compounded ophthalmic medications has become essential to a large number of ophthalmology practices. This is because ophthalmologists must often cope with potentially life-altering situations and case-by-case emergencies right in their offices. Without the right medication tools ready for use during these emergencies, patients risk vision loss and blindness, and practitioners risk serious damage to their practices. Most ophthalmologists aren’t in large hospital or clinical settings, so good advice and relationships with pharmaceutical providers is even more important. There is a serious need for high-quality ophthalmic compounding resources for these reasons.
Ophthalmic Medications for Emergent Needs
Many of ophthalmology’s recent advances concern new ophthalmic medications. Sterile ophthalmic medications are at the heart of ophthalmic treatment, and compounding is central to providing the breadth and depth of medication regimens that ophthalmologists today require. This is principally because, according to the top recognized ophthalmological professional organizations in the U.S., it is essential to have particular ophthalmic preparations on hand in outpatient settings to avoid delays in treatment and resulting adverse consequences.
Up to 11 million Americans have some form of macular degeneration, either AMD or wet macular degeneration. AMD is one of the leading sources of vision loss among those over 50. The speed of progression varies from person to person; in some people it may be very slow, but in others the vision may be lost rapidly in one or both eyes. Patients with macular degeneration require immediate intervention to slow vision loss and prevent blindness. Patients with active macular degeneration typically receive monthly intravitreal injections of VEGF-inhibitor medications such as bevacizumab/Avastin, ranibizumab, or aflibercept. The standard response among ophthalmologists is in-office treatment upon detection of the disease. This achieves maximal results by avoiding all delay — any of which may be significant — and improving the outcome.
Endophthalmitis is severe inflammation caused by bacterial infection, fungi, or in rare cases protozoa or viruses, inside the eye. Symptoms include pain, redness, swelling, and vision loss, so immediate treatment with intravitreal antibiotics is essential to avoiding permanent blindness, and in some cases loss of the entire eye itself. Common treatment choices include amikacin, ceftazidime, ciprofloxacin, and vancomycin.
“Glaucoma” actually refers to a group of diseases that lead to loss of vision and blindness as a result of damage to the optic nerve. Medication regimens, which lower the pressure of the eye significantly, can slow glaucoma in some people, but not others. Early detection and immediate treatment are essential to living with any type of glaucoma and guarding against major vision loss. Without immediate intervention glaucoma patients lose their peripheral vision, with straight-ahead vision eventually decreasing until blindness results.
Therefore, glaucoma is a treatment emergency that demands aggressive action. Intravitreal vascular endothelial growth factor (VEGF) inhibitors such as bevacizumab/Avastin, ranibizumab, or aflibercept are the most common ophthalmic medications for glaucoma. Mitomycin C is used in the treatment of glaucoma-related surgical filtration procedures that have failed and at the time of surgery to prevent blindness, scarring, and fibrosis.
Symptomatic VMA is a disease of the interface between the vitreous humor — the jelly inside the eyeball — and the retina. VMA can lead to decreased visual acuity, metamorphopsia (a kind of distorted vision with partial vision loss), and overall vision loss. It is typically treated with injectable antiplasmin inhibitors that dissolve protein buildups in the eye, such as ocriplasmin.
Ophthalmologists will always need reliable, skilled compounding providers in order to maintain the right standard of care. Patients with serious ophthalmological issues are struggling to keep their sight, and their ophthalmologists are fighting right beside them. Skilled compounding professionals provide them with the tools they need to win these important battles.
Compounding ophthalmic medications is a high demand area that requires intensive knowledge and quality. Pharmaceutica North America would like to be your resource for high-quality compounding products for all of your compounding needs. For more about pharmaceutical compounding and purchasing bulk APIs, please contact Pharmaceutica North America, your trusted compounding resource.