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March 2003
IN THIS ISSUE

New ESCRS trial in bid to cut endophthalmitis rate to 0.01%
Lasik corrects refractive errors after PK in selected patients
Africa-Luz mobilises to provide eye care in regions riven by poverty
Multifocal IOL
choice hinges on patterns of daily routine
Anti-histamine drug mitigates risk of developing DLK after Lasik, says study
Untreated eyelid inflammatory disorders pose risk for postoperative complications
Thermotopography shows ‘enormous promise’
for diagnosis and treatment of eye diseases
Lasik offers ‘very effective treatment’ for
refractive errors after PK, says US specialist
Good results with PRK and Lasek rival Lasik for top spot in refractive excimer laser surgery
Orbital lymphomas respond well to local, systemic therapies, says study
Laser technologies still beam but economy and consumer demand will determine future of refractive surgery
Legally blind cardiologist finds new beat in low vision rehabilitation
‘Pivotal’ anti-TGF antibody therapy reduces
filtering bleb wound formation, says report
Neuroprotective agents stem optic nerve damage
by ‘offering a solution’ to open-angle glaucoma
Echothiophate iodide shortage leaves US specialists struggling to find alternative for acute cases
Postoperative complications of PK will have serious consequences unless tackled 'aggressively’
Private refractive clinics claim young specialists as public waiting lists grow in Canadian eye surgery
German doctors’ helpers oil the cogs of the private ophthalmic practice
Study of 900 ICLs reveals good safety and long-term refractive results, says Spanish specialist
New toric IOL corrects high corneal astigmatism after cataract surgery, Austrian study reveals
IVF children run increased risk of developing
retinoblastoma, claim Dutch researchers
Suture-free DLEK preserves corneal surface topography and ensures faster wound healing
The day I said goodbye to cataracts and hello to the world without glasses
Retina specialists and trauma ophthalmologists
prepare to trade notes at joint Hungarian conference
Night blindness casts bogeyman into the shadows
Erbium laser phaco requires longer time but less energy for moderately hard cataracts
FEATURES
From The Editor
Reflections on Refractive Surgery
In Your Good Books
Bio-ophthalmology
In The Driving Seat
Prime Site
The Collector's Eye
Regulatory Matters



Echothiophate iodide shortage leaves US specialists struggling to find alternative for acute cases

Barbara Boughton
in Fort Lauderdale, Florida

A TEMPORARY shortage in the US of echothiophate iodide which is used to treat advanced glaucoma has left ophthalmologists scrambling to find alternative solutions patients who need the drug.
“It’s a great drug, though a limited use drug. But for months we haven’t been able to get it for our patients,” said Wayne Bizer DO, an ophthalmologist based in Fort Lauderdale, Florida, US.

Wyeth Pharmaceuticals stopped manufacturing echothiophate iodide (phospholine iodide) in the US and is now gearing up a plant in the UK to produce it. Pharmacists like Jerry Feldman of Jerry’s Drugs in Sunrise, Florida began stockpiling the drug six months ago when the shortage began.
“I purchased as much as Wyeth would sell me — about a dozen bottles — but I’ve run out since then,” Mr Feldman said.

Echothiophate iodide, which can cause cataracts, is a drug used in advanced glaucoma as a last resort — often in patients who have already had cataracts removed. It’s also used for esotropia in children when surgery will not correct the problem.
A few months ago, when treating a woman with advanced glaucoma, Dr Bizer was forced to perform surgery because the drug was not available for use.

“The surgery was successful. But I would have liked to have avoided it when using an eye drop would take care of the situation,” he said. Wyeth made the “strategic” decision to pull the plug on echothiophate iodide after the company examined its “overall pharmaceutical portfolio”.

But after contacting the American Academy of Ophthalmology (AAO), the makers of the glaucoma drug rescinded their decision and, according to AAO public relations representative Michelle Stephens, the AAO and Wyeth were in talks for about a year about manufacturing it.

But by then, it was already too late. The plant where echothiophate iodide had been manufactured in upstate New York had already shifted to manufacturing another product. “So we had to find another facility where we had the capacity to make the drug,” Wyeth spokesperson Douglas Petkus said.

They eventually located a facility in Gosport, England. But while that facility awaits FDA approval, the drug is unavailable except through an IND process.
To get the drug, an ophthalmologist must complete appropriate forms including a Statement of Investigator form. The drug is only being sold directly to ophthalmologists; it is not available through pharmacies.

Mr Petkus said the company has informed ophthalmologists about the availability of the drug through the IND process. The AAO received a statement from the company in early January and it is now posted on the AAO website www.aao.org.
“I didn’t see the statement until recently, while the shortage has been going on for about a year,” Dr Bizer said.

Mr Petkus estimates that the facility in Gosport will have FDA approval within the next 30 to 60 days from the time of writing. Then, the company will begin marketing the drug in the US again.

“It will be available to ophthalmologists without going through the IND process,” he said.
There is no shortage of the drug in Europe. To obtain an information pack with directions on how to get echothiophate iodide through an IND process, US ophthalmologists can call 1 800 666 7248 between 8 a.m. and 8 p.m. EST.

Wayne Bizer DO
Florida Medical Centre, Fort Lauderdale, Florida, US
Email: wfbizer@mediaone.net


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