By William Elliott, MD, FACP, and James Chan, PharmD, PhD
Dr. Elliott is Assistant Clinical Professor of Medicine, University of California, San Francisco.
Dr. Chan is Associate Clinical Professor, School of Pharmacy, University of California, San Francisco.
The FDA has approved the first drug-eluting contact lens for correcting ametropia as well as treating ocular allergic itch caused by allergic conjunctivitis. The lens contains and releases ketotifen, a H1 histamine receptor antagonist with mast cell stabilizing properties. It is distributed as Acuvue Theravision with Ketotifen.
INDICATIONS
Ketotifen-eluting contact lens (Ketotifen CL) can be prescribed to correct refractive ametropia (myopia and hyperopia) for phakic or aphakic patients who wear suitable lens and experience ocular itch caused by allergic conjunctivitis. Eligible patients also do not have red eye(s) or more than 1.00 D of astigmatism.1
DOSAGE
One lens is inserted per eye. The pharmacologic benefit lasts about 12 hours, but the lens may be worn longer for vision correction.1 Ketotifen CL is available as a daily disposable contact lens, with 0.019 mg of ketotifen per lens. Lubricating or rewetting solution should not be used with ketotifen CL.
POTENTIAL ADVANTAGES
Ketotifen provides vision correction and treatment for allergic symptoms, potentially improving convenience and compliance and obviating the need for and the challenge of consistent multiple instillations of antiallergic eye drops.
POTENTIAL DISADVANTAGES
Ketotifen CL is not used to treat red eye(s), and the lens should be removed if eyes become red or irritated.1 The most frequently observed adverse reactions are eye irritation, eye pain, instillation site irritation, dry eye, photophobia, and mydriasis.1
COMMENTS
The effectiveness of ketotifen CL in preventing ocular itching was evaluated in two double-masked, randomized, placebo-controlled studies of 244 subjects with allergic conjunctivitis.1,2 Subjects presented with a positive history of ocular allergy to cat hair dander, grass, ragweed, or trees. The allergen eliciting the greatest response on skin tests was used for the conjunctival challenge. Subjects were randomized into three groups. Group 1 received test lens in one eye and control in the contralateral eye (both selected randomly). Group 2 received the test lens bilaterally. Group 3 received control lenses bilaterally. Allergen challenges were conducted in two separate visits, each at 15 minutes after lens insertion and 12 hours later. Ocular itch was assessed on 5-point scale (0 to 4), assessed at three, five, and seven minutes after allergen challenge. Ketotifen CL was more effective than a regular lens (Acuvue) to ocular allergen challenge. Ocular itching was alleviated within three minutes and sustained up to 12 hours. Visual acuity assessments were similar for ketotifen CL and control contact lenses.2
CLINICAL IMPLICATIONS
Ocular allergy is a common condition, with a prevalence of up to 40% of the population.3 Allergic conjunctivitis is the most common type of ocular allergy (characterized by ocular itching), particularly affecting contact lens users. Ketotifen CL provides a more convenient and consistent delivery of medication for treating ocular allergy in contact lens users. The launch date and cost were unavailable at the time of this review.
REFERENCES
- Johnson & Johnson Vision Care, Inc. Acuvue Theravision with Ketotifen contact lens prescribing information. January 2021.
- Pall B, Gomes P, Yi F, Torkildsen G. Management of ocular allergy itch with an antihistamine-releasing contact lens. Cornea 2019;38:713-717.
- Rosario N, Bielory L. Epidemiology of allergic conjunctivitis. Curr Opin Allergy Clin Immunol 2011;11:471-476.
Ketotifen-eluting contact lens can be prescribed to correct refractive ametropia (myopia and hyperopia) for phakic or aphakic patients who wear suitable lens and experience ocular itch caused by allergic conjunctivitis.
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