FOCUS ON …
Akten Topical Anesthetic Delivers Added Comfort and Convenience
LESLIE GOLDBERG, ASSOCIATE EDITOR
The clinical effects of intravitreal anti-VEGF have been a blessing for AMD patients. Unfortunately, the same can't be said for the injection procedure itself. For therapy to succeed, patients must be active partners — willing to endure with aplomb a regimen of monthly injections. And their physicians must make every effort to minimize discomfort while still keeping a busy practice running smoothly.
So it may come as a surprise to find that the Preferences and Trends study presented at last year's ASRS meeting revealed that the two most common methods of anesthesia for intravitreal injection were the somewhat inconvenient methods of either topical anesthetic with a soaked cotton-tip or pledget (36.11% of respondents) or subconjunctival lidocaine (23.74%). A topical anesthetic drop was preferred by 20.71%, and a topical viscous anesthetic by 17.68%.
Perhaps the unique advantages of a new option for topical anesthesia can offer retinal specialists improved patient comfort and better practice efficiency.
The new topical ocular anesthetic Akten (Akorn, Inc. of Lake Forest, IL) offers advantages in concentration, administration, time to clinical effect, duration of efficacy, and more. Akten is the first FDA-approved ophthalmic gel anesthetic with a 3.5% dose of lidocaine hydrochloride. It can be used in dozens of surgical and diagnostic procedures where a topical anesthetic would be appropriate.
The recommended dose is 2 drops applied to the ocular surface in the area of the planned procedure. In a multicenter, randomized of 209 patients,1 mean time to onset of action was approximately 60 seconds and 92% of subjects achieved anesthesia within 5 minutes. Approximately 84% of subjects treated with the 3.5% dose of Akten experienced anesthesia for at least 5 minutes, 55% of subjects experienced anesthesia for 10 minutes or longer and 27% experienced anesthesia for 15 minutes or longer.
Akten's formulation as a viscous gel extends the duration of effect, according to the manufacturer. It may be reapplied to maintain anesthetic effect. The drug has no known contraindications.
The most common adverse reactions are conjunctival hyperemia, corneal epithelial changes, headache, and burning upon instillation.
Retinal specialist Alice T. Lyon, MD, of Northwestern University in Chicago has been using Akten for 6 months. "The effect is much better tolerated than what we were using previously," says Dr. Lyon. "Our patients have better relief of pain." She uses Akten solely for intravitreal injections and says that while patients still feel the injection, it no longer hurts.
"We try not to place the drops on the cornea, but on the conjunctiva. We are seeing less irritation to both the conjunctiva and the cornea. We use a drop of lidocaine and betadine in the cul-de-sac and then drop the Akten in," says Dr. Lyon.
She adds that because they are putting the drop in after the lidocaine and betadine and having patients hold their eye closed rather than open, there is less exposure and surface irritation. She say that the gel helps facilitate the anesthesia.
Leo Santamarina, MD, of Keystone Eye Associates, in Philadelphia, has been using Atken since January. He uses it almost exclusively for intravitreal injections but will sometimes use it to place a contact lens when doing laser surgery in a patient who has had discomfort with only proparacaine drops.
Dr. Santamarina says patients who have had 2% lidocaine jelly in the past seem to have slightly less discomfort with the new product. "Akten is easier to use since it is less viscous than the jelly and it spreads along the surface of the eye better. It also seems to have a faster onset than the jelly," he adds. RP
For more information, visit the Akorn Web site at www.akorn.com.